{"id":6300,"date":"2025-06-12T06:00:47","date_gmt":"2025-06-12T06:00:47","guid":{"rendered":"https:\/\/medical-article.com\/?p=6300"},"modified":"2025-06-12T06:00:47","modified_gmt":"2025-06-12T06:00:47","slug":"can-ehrs-expand-to-become-health-systems-platform-of-platforms-udhps","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=6300","title":{"rendered":"Can EHRs Expand to Become Health Systems\u2019 \u201cPlatform of Platforms\u201d (UDHPs)?"},"content":{"rendered":"
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By VINCE KURAITIS & NEIL JENNINGS\n<\/div>\n<\/div>\n
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In a\u00a0previous post<\/a> in this series, we discussed healthcare\u2019s migration toward Unified Digital Health Platforms (UDHPs) \u2014 a \u201cplatform of platforms.\u201d Think of a UDHP as healthcare\u2019s version of a Swiss Army knife: flexible, multi-functional, and (ideally) much better integrated than the drawer full of barely-used apps most health systems currently rely on. We included a list of 20+ companies jockeying for UDHP dominance, including two familiar EHR (electronic health record) giants \u2014 Epic and Oracle. This raises the obvious question for today\u2019s post:<\/p>\n

Can EHRs level up into becoming UDHPs \u2014 becoming healthcare\u2019s platform of platforms? Or are they trying to wear a superhero cape while tripping over their own cables?<\/p>\n

We see good arguments pro and con, and like most things in healthcare \u201cit\u2019s complicated.\u201d Some say EHRs are uniquely positioned to make the leap. Others believe the idea is like trying to teach your fax machine to run population health analytics.<\/p>\n

Thus, we\u2019ll lay out the arguments for differing points of view, and you can decide for yourself.<\/p>\n<\/div>\n

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This entry is part 4 of 4 in the series\u00a0Platforming Healthcare \u2014 The Long View<\/a><\/div>\n

by\u00a0Vince Kuraitis<\/a>\u00a0and\u00a0Neil P. Jennings<\/a>\u00a0of Untangle Health<\/p>\n

Here\u2019s an outline of today\u2019s blog post:<\/p>\n

A Brief Recap: What are UDHPs?
\nThesis: EHRs Can Expand to Become UDHPs<\/p>\n

EHRs Currently Own the Customer Relationship
\nMany Customers Have an \u201cEHR-First\u201d Preference for New Applications
\nEpic and Oracle Health are Making Strong Movements Toward Becoming UDHPs<\/p>\n

Antithesis: EHRs Can NOT Become Effective EHRs<\/p>\n

EHRs Carry a Lot of Baggage
\nCustomers are Skeptical
\nEHR Analytics Are NOT Optimized To Achieve Critical Health System Objectives
\nEHR Switching Costs are Diminishing
\nCloud Native Platforms Accelerate Innovation and Performance
\nIt\u2019s Not in EHR DNA to Become A Broad-Based Platform<\/p>\n

Synthesis and Conclusion<\/p>\n

This is a long post\u2026over 4,000 words\u2026so we\u2019ve clearly got a lot to say on the matter. Hope you brought snacks!<\/p>\n

A Brief Recap: What are UDHPs? (Unified Digital Health Platforms)<\/h3>\n

In our\u00a0previous extensive post<\/a>\u00a0on UDHPs, we described them as a new category of enterprise software. A December 2022 Gartner Market Guide report characterized the long-term potential:<\/p>\n

The [U]DHP shift will emerge as the most cost-effective and technically efficient way to scale new digital capabilities within and across health ecosystems and will, over time, replace the dominant era of the monolithic electronic health record (EHR).<\/p>\n

The DHP Reference Architecture is illustrated in a\u00a0blog post by Better<\/a>. Note that UDHPs are visually depicted as \u201csitting on top\u201d of EHRs and other siloed sources of health data:<\/p>\n\n

We noted that almost any type of large healthcare organization \u2014 health systems, health plans, pharma companies, medical device companies, etc. \u2014 had a need for UDHPs. However, today\u2019s focus is more narrow \u2014 we limit the discussion to UDHPs in hospitals and health systems, primarily in the U.S. We use the term \u201chealth system\u201d to encompass hospitals and regional health delivery systems.<\/p>\n

In this post, we focus on the two largest EHR vendors in the U.S. \u2014 Epic and Oracle Health; they have a\u00a0combined market share<\/a>\u00a0of 65% of hospitals and 77% of hospital beds.<\/p>\n

In the remaining sections, we will lay out arguments on both sides of the issue of whether EHRs can (or cannot) expand to become UDHPs. The graphic below is our crack at a visual summary. The balloons represent the thesis \u2013 that EHRs\u00a0can expand<\/em>\u00a0to become UDHPs; the anchors represent the antithesis \u2013 that EHRs\u00a0can not expand<\/em>\u00a0to become UDHPs.<\/p>\n\n

<\/h3>\n

Thesis: EHRs Can Expand To Becoming UDHPs<\/h3>\n

Let\u2019s look at the case for EHRs expanding to become effective UDHPs.<\/p>\n

<\/span><\/p>\n

1) EHRs Currently Own the Customer Relationship<\/h4>\n

Fueled by federal HITECH incentives and mandates, health systems have made significant investments in their existing EHRs:<\/p>\n

As of 2021, 96% of non-federal acute care hospitals in the U.S.\u00a0had adopted<\/a>\u00a0a certified EHR.
\nThey made huge capital commitments to purchase and install their EHR, often hundreds of millions of dollars.
\nMany existing clinical workflows are built on EHRs.
\nA majority of a patient\u2019s clinical data in a health system resides inside their EHR.<\/p>\n

According to SoftwareReviews,\u00a0Epic<\/a>\u00a0and (Oracle)\u00a0Cerner Millennium<\/a>\u00a0EHRs receive good to high ratings from health system customers.<\/p>\n

Thus, any new vendor attempting to sell new healthcare enterprise software (i.e., a UDHP) will face a high hurdle: \u201cWe already have an EHR\u2026why should we consider you?\u201d<\/p>\n

2) Many Customers Have an \u201cEHR-First\u201d Preference for New Applications<\/h4>\n

Health systems have been trying to stay afloat in a veritable tsunami of\u00a0point solutions<\/a>. This creates a range of challenges, including:<\/p>\n

Complexity and integration challenges
\nRegulatory and compliance risks
\nFragmentation of care
\nUser adoption and training
\nCost and ROI concerns<\/p>\n

As shown in the graphic below, a 2024\u00a0Bain & Company\/KLAS<\/a>\u00a0survey of health systems found that 81% increasingly plan to look to existing vendors before considering offerings from new vendors.<\/p>\n

More specifically, the survey found that 79% plan to look to their EHR vendor first for new solutions before looking to others.<\/p>\n\n

University Hospitals<\/a>\u00a0is an example of a health system with an EHR-First strategy. According to Robert Eardley, CIO, this guiding principle ensures the health system prioritizes tools and innovations available within its Epic electronic health record platform whenever feasible.<\/p>\n

3) Epic and Oracle Are Making Strong Movements Toward Becoming UDHPs<\/h4>\n

Perhaps the best argument that EHRs are capable of becoming Unified Digital Health Platforms is that Epic and Oracle Health are already making bold moves. Let\u2019s take a look at them individually.<\/p>\n

Epic\u2019s EHR Expansion Plans<\/h3>\n

Epic is more than a basic EHR \u2014 it offers existing customers a broad base of capabilities.<\/strong>\u00a0Interop guru Brendan Keeler has written extensively about Epic. In his article \u201cAn Epic Saga: The Origin Story<\/a>\u201d he describes how Epic grew to its current size. The Appendix provides an extensive list of \u201cEpic Modules.\u201d<\/p>\n

In an insightful 2024\u00a0analysis of Epic\u2019s dominant market position<\/a>, Seth Joseph included a list of\u00a0Products You Can Replace with Epic<\/a>. The list included over 150 capabilities \u201cto help you identify areas where you could use your Epic software to either replace or avoid purchasing niche applications\u2026\u201d<\/p>\n

Epic also is expanding new offerings to new customer categories. In the article \u201cEpic Beyond the Provider Empire<\/a>\u201c, Brendan Keeler provides a detailed list:<\/p>\n

Health Grid \u2014 software sold to<\/em><\/p>\n

Labs
\nMedical device companies
\nPayers
\nTelehealth companies
\nClinical trials<\/p>\n

Health Grid Adjacent offerings<\/em><\/p>\n

Cosmos \u2014 \u201ca massive clinical dataset created by pooling information from Epic health systems\u201d
\nPayer Gateway \u2014 a \u201clighter-weight service for payers that enables them to receive clinical data from Epic healthcare organizations\u201d
\nChart Gateway \u2014 \u201cEpic\u2019s service that streamlines how life insurance companies get medical records from Epic healthcare organizations\u201d
\nEpicCare Link \u2014 \u201ca web-based portal product that lets Epic healthcare organizations offer non-Epic providers a way to interact with them.\u201d<\/p>\n

Other stuff<\/em><\/p>\n

Supply Shop \u2014 services offerings
\nRevcyclers \u2014 \u201cThird parties working with Epic and provide billing services to help improve revenue cycle outcomes\u201d
\nCornerstone Partners \u2014 deep relationships with Microsoft and InterSystems<\/p>\n

But wait\u2026there\u2019s more. At HIMSS 2025, Epic announced<\/a>\u00a0additional AI capabilities in the works and that it is developing a healthcare-specific enterprise resource planning (ERP) system. While we view an ERP as a big stretch, it\u2019s also a potential game-changer for Epic.<\/p>\n

Using a\u00a0framework created by David Yuan of Tidemark<\/a>, Brendan Keeler\u00a0capsulized<\/a>\u00a0Epic\u2019s broader platform strategy:<\/p>\n

With additions like the\u00a0ERP<\/em>, Epic is clearly evolving beyond a traditional EHR system, but is it enough to meet the UDHP needs of modern health systems?<\/p>\n

Oracle Health Goes Beyond Being a Traditional EHR<\/h3>\n

In October 2024, Oracle\u00a0announced<\/a>\u00a0a new EHR. As described by the company,\u00a0Oracle Health<\/a>\u00a0has many characteristics that make it look more like a UDHP than a traditional EHR. It aims to go significantly beyond the capabilities of a traditional EHR:<\/p>\n

Embedded Artificial Intelligence (AI)<\/strong>: Unlike EHRs where AI is often a bolt-on, Oracle\u2019s new system is designed with AI as a core component, integrated across the entire clinical workflow. This includes a Clinical AI Agent, AI-driven insights at the point of care, AI-powered summaries, and personalized care plans.
\nEnhanced User Experience<\/strong>: Recognizing the clinician burden associated with traditional EHRs, the new system emphasizes an intuitive and user-friendly design with features like voice-driven navigation and search, multimodal search, and a customizable interface.
\nOracle Health Data Intelligence<\/strong>\u00a0is an AI and analytics solution embedded within the EHR, enabling integration of disparate data sources, real-time insights, and population health management tools.
\nNext-Generation Oracle Cloud Infrastructure<\/strong>\u00a0offers advantages of enhanced security, scalability, and performance, and better data exchange.
\nPatient Engagement Tools<\/strong>: The new EHR includes a reimagined patient portal focused on empowering patients to access and control their medical history, facilitating communication with providers, and enabling self-service capabilities for patients to manage appointments, pay bills, and access health information.
\nFocus on Value-Based Care<\/strong>: The system is designed to support value-based care models by streamlining information exchange between payers and providers, improving care coordination, and providing insights into cost and resource allocation.<\/p>\n

Oracle Health aims to move beyond being a system of record to becoming a system of action \u2014 an intelligent, integrated platform that actively assists clinicians, engages patients, and drives better outcomes in a more efficient and secure manner. Oracle\u2019s\u00a0most recent announcement<\/a>\u00a0of a platform partnership with Cleveland Clinic and G42 is consistent with the migration toward becoming a UDHP.<\/p>\n

Oracle Health is still in its early stages of a roll-out, with an early adopter program launched in 2025. Therefore, extensive, widely published surveys and large-scale customer feedback about this new platform aren\u2019t yet available.<\/p>\n

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Antithesis: EHRs Can NOT Become Effective UDHPs<\/h3>\n

Now let\u2019s examine arguments suggesting that EHRs aren\u2019t capable of becoming health systems\u2019 \u201cplatform of platforms\u201d \u2014 a UDHP.<\/p>\n

1) EHRs Carry a Lot of Baggage<\/h3>\n

Today\u2019s EHRs are criticized on a number of fronts:\u00a0errors and safety issues<\/a>,\u00a0cost<\/a>,\u00a0lack of competition<\/a>,\u00a0lack of interoperability<\/a>, and\u00a0lack of usability for clinicians<\/a>.<\/strong>\u00a0\u00a0COVID-19 highlighted many of the weaknesses in EHRs\u00a0as being<\/a>\u00a0\u201clarge, slow monoliths that don\u2019t quickly adapt to new, emergent demands on their design and workflow.\u201d<\/p>\n

But what about the high satisfaction scores previously cited? EHRs are more likely to consider health system administrators as their \u201ccustomers.\u201d As noted above,\u00a0clinician<\/em>\u00a0\u201cuser\u201d satisfaction is generally low.<\/p>\n

Vendors also have allowed customers to customize EHR implementations. Local customization leads to substantial differences in how the system operates from one site to another. The often-used colloquial phrase is that there are \u201c50 dialects of Epic.\u201d While some degree of EHR customization is necessary and can increase clinician buy-in, over-customization can result in difficulty interoperating, as data definitions and workflows can differ greatly. With each EHR instance potentially unique, extending EHRs to become UDHPs carries forward organization-specific configurations which may result in substantial longitudinal maintenance (for either the health system or the partners connected to the EHR).<\/p>\n

Finally, Epic\u2019s unique size and dominant market position could attract antitrust challenges from government regulators. Even today, as\u00a0Seth Joseph documents<\/a>, Epic is already attracting lawsuits from multiple \u201csmaller, adjacent vendors.\u201d As Epic adds ERP and Cerner and Epic continue adding adjacent features and capabilities, they are expanding their positions, potentially garnering additional regulatory oversight.<\/p>\n

2) Customers are Skeptical<\/h3>\n

Even while many health systems might have an \u201cEHR-First\u201d integration preference, many are also skeptical of their EHR vendor\u2019s promises and their ability to integrate new apps. Sage Growth Partners report entitled\u00a0The New Healthcare C-Suite Agenda: 2024-25<\/a>\u00a0addressed the issue:<\/p>\n

C-Suites are at a technology crossroads: Very few are satisfied with their EMR vendor, the market is flooded with point solutions but integrations are frustrating employees more, and despite the policy relaxations around telehealth during the last three years, telehealth and in-home hospital tools are not well integrated with EMRs.<\/p>\n

When asked \u201cHow well does your current vendor live up to the promises it makes about the EMR, only 26% responded \u201cextremely well\u201d or \u201cvery well.\u201d<\/p>\n

Perhaps most importantly, \u201c\ud835\udc28\ud835\udc27\ud835\udc25\ud835\udc32 \ud835\udfcf\ud835\udfd5% \ud835\udc28\ud835\udc1f \ud835\udfd0\ud835\udfce\ud835\udfd0\ud835\udfd1 \ud835\udc2b\ud835\udc1e\ud835\udc2c\ud835\udc29\ud835\udc28\ud835\udc27\ud835\udc1d\ud835\udc1e\ud835\udc27\ud835\udc2d\ud835\udc2c \u201c\ud835\udc2c\ud835\udc2d\ud835\udc2b\ud835\udc28\ud835\udc27\ud835\udc20\ud835\udc25\ud835\udc32 \ud835\udc1a\ud835\udc20\ud835\udc2b\ud835\udc1e\ud835\udc1e\u201d \ud835\udc2d\ud835\udc21\ud835\udc1a\ud835\udc2d \ud835\udc2d\ud835\udc21\ud835\udc1e \ud835\udc04\ud835\udc0c\ud835\udc11 \ud835\udc30\ud835\udc22\ud835\udc25\ud835\udc25 \ud835\udc26\ud835\udc1e\ud835\udc1e\ud835\udc2d \ud835\udc2d\ud835\udc21\ud835\udc1e \ud835\udc26\ud835\udc1a\ud835\udc23\ud835\udc28\ud835\udc2b\ud835\udc22\ud835\udc2d\ud835\udc32 \ud835\udc28\ud835\udc1f \ud835\udc2d\ud835\udc21\ud835\udc1e\ud835\udc22\ud835\udc2b \ud835\udc28\ud835\udc2b\ud835\udc20\ud835\udc1a\ud835\udc27\ud835\udc22\ud835\udc33\ud835\udc1a\ud835\udc2d\ud835\udc22\ud835\udc28\ud835\udc27\u2019\ud835\udc2c \ud835\udc27\ud835\udc1e\ud835\udc1e\ud835\udc1d\ud835\udc2c \ud835\udc26\ud835\udc28\ud835\udc2f\ud835\udc22\ud835\udc27\ud835\udc20 \ud835\udc1f\ud835\udc28\ud835\udc2b\ud835\udc30\ud835\udc1a\ud835\udc2b\ud835\udc1d, down from 25% in 2022.\u201d<\/p>\n

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3) EHR Analytics Are NOT Optimized To Achieve Critical Health System Objectives<\/h3>\n

Any individual EHR can NOT be viewed as the \u201csource of truth\u201d for a patient\u2019s clinical history:<\/p>\n

Multiple EHR Vendors<\/strong>. Both in the U.S.\u00a0and<\/em>\u00a0abroad, larger health systems often are Frankenstein\u2019s monsters stitched together from various acquisitions. Thus, they frequently sport a patchwork of competing EHRs. A HIMSS Analytics\u00a0study<\/a>\u00a0found that the average health system has 18 different EHR vendors across inpatient and outpatient settings.<\/p>\n

Multiple Point Solutions and Sources of Data<\/strong>. Patient data in health systems is spread across multiple systems, not just EHRs.<\/p>\n

Patient and Data \u201cLeakage.\u201d<\/strong>\u00a0Today\u2019s patients are more motivated by convenience than loyalty to one health system; patient leakage\u00a0across<\/em>\u00a0care providers is significant. A study in\u00a0International Journal of Medical Informatics<\/a>\u00a0found that \u201conly 4.5 % of expenditure-weighted individual Medicare beneficiaries had their MU medical records associated with a single vendor, while 19.8 % of expenditure-weighted beneficiaries had their MU medical records stored in 8 or more vendors.\u201d<\/p>\n

Patient Health and Care Data is Increasingly Outside of EHRs<\/strong>. A\u00a0McKinsey study<\/a>\u00a0examined how a lifetime of patient health and care data is likely to be created (see the graphic below).<\/p>\n\n

By adding the numbers in the right column, you\u2019ll see that a person generates an estimated total of 1,106.4 terabytes of health data over the course of a lifetime. However, only 0.4 terabytes \u2014 or 0.04% \u2014 is clinical data, i.e., likely to reside in today\u2019s EHRs.<\/p>\n

The implication: EHRs are likely to contain only a fraction of a patient\u2019s health and care data.<\/strong>\u00a0Optimal end-to-end analytical systems for patient data \u2014 ones designed for both prevention and care \u2013 will need to pull data from across a diverse range of sources. These capabilities don\u2019t exist in today\u2019s EHRs.<\/p>\n

We\u2019ve noted that the roots of EHRs are as systems of record to document processes for fee-for-service billing, but it goes deeper than that.<\/p>\n

Driven by early incentives like Meaningful Use, EHR design heavily prioritized billing for individual services and administrative tasks. Consequently, their architecture emphasized documenting the\u00a0volume<\/em>\u00a0of care delivered for reimbursement, rather than the\u00a0value<\/em>\u00a0of patient outcomes and efficiency.<\/p>\n

The limited interoperability inherent in many early EHR systems fostered data silos. This fragmentation made it difficult to achieve the comprehensive, holistic patient view essential for effective value-based care (VBC) and value-based payments (VBP), care coordination, population health management, total cost of care measurement and management, and other capabilities needed for cutting-edge health systems.<\/p>\n

In turn, traditional EHRs typically lacked access to longitudinal claims data and the sophisticated analytics necessary to robustly measure costs and patient outcomes. They also frequently lacked standardized mechanisms for capturing patient-reported outcomes (PROs) and didn\u2019t streamline clinical workflows to specifically support value-focused care delivery. As a result, these systems weren\u2019t inherently designed to optimize for the principles and diverse payment models of VBC.<\/p>\n

While EHR technology has advanced, these foundational limitations continue to present significant hurdles for health systems navigating the complex transition towards VBC and population health. Addressing these inherent design constraints is crucial for realizing the full potential of digital health in a future-proofed, value-driven healthcare landscape.<\/p>\n

4) EHR Switching Costs are Diminishing<\/h3>\n

In the past, switching EHRs was akin to moving houses during a blizzard\u2026with three toddlers and a herd of goats. High switching costs created a defensive moat to protect EHRs from competitors, either other EHRs or a new category of UDHPs.<\/p>\n

However, government policy, legislation, and regulation over the past two decades have promoted interoperability and appropriate exchange of patient data. The HITECH Act, the 21st Century Cures Act, the promotion of HL7 FHIR APIs, and the creation of TEFCA exemplify this trend.<\/p>\n

As patient data becomes more fluid and readily shareable across different systems, switching costs are diminished. This is even more pronounced outside the U.S., where standards like\u00a0openEHR<\/a>\u00a0\u2013 a standardized clinical data model which separates data from applications \u2013 are gaining traction, demonstrating the potential of data standardization to ease system transitions. The\u00a0EU Data Act<\/a>\u00a0mandates the ability to switch data providers seamlessly.<\/p>\n

Furthermore,\u00a0the evolution towards a UDHP doesn\u2019t necessarily require a complete and immediate EHR replacement.<\/strong>\u00a0As we discussed in a\u00a0previous blog post<\/a>, UDHPs can be architected to integrate with and leverage existing data repositories, including EHRs. This incremental approach to UDHP adoption can significantly reduce the perceived and actual costs of transitioning to a more unified digital health ecosystem.<\/p>\n

5) Cloud Native Platforms Accelerate Innovation and Performance<\/h3>\n

The roots of EHRs are as systems of record to document fee-for-service billing processes, replacing on-site processes with (typically) on-prem software. UDHPs, on the other hand, are typically cloud native software, allowing broad scalability, availability, and acting as hubs for innovation. With CHIME\u2019s 2024 survey suggesting \u201c24% of CIOs highlighted applicational rationalization and optimization a top priority,\u201d this begs the question: where should this application rationalization and optimization take place?<\/p>\n

Cloud native software is a strong contender, offering many of the CIO-sought benefits and the ability to scale in a cost-transparent way. Neil\u2019s recent piece \u201cHead in the Cloud: Today\u2019s Healthcare Executive<\/a>\u201d covers the shift to cloud-first infrastructure as a result of more than just market needs, but also a change in leadership. As the Epic-selecting CIOs of the 2010s are retiring, a new technologist profile is emerging and leaning cloud-first.<\/p>\n

To be clear, we are not referring to simply lifting-and-shifting an EHR from on-prem to the cloud. While changing hosting providers and locations can add incremental benefits to performance, cost of ownership, and scalability, the full benefits of cloud-first platforms are not achieved by migrating legacy software.<\/p>\n

To get the full benefits of a cloud-first approach, there will need to be a re-architecture of systems.<\/strong>\u00a0This is a large task, but we have many of the pieces today, with scalable databases, Master-Data-Management products, EMPI products, and headless EHRs (ONC Certified EHRs of record that permit customers to reskin the patient and provider-facing experiences). Some leading organizations are already creating cloud-hosted centralized data platforms that create a single source of truth, brokering data across their technical ecosystem. Below, we\u2019ll cover some leading benefits of this more encompassing cloud-first approach.<\/p>\n

\u00a0<\/p>\n\n

Where EHR vendors have historically moved slowly, cloud service providers are rapidly adding shared services and tooling. With their consumption-based pricing models, they are directly incentivized to enable and encourage onboarding new users, use cases, applications, and databases. Not everyone will need or want to build from scratch in the cloud, and as highlighted in the previous post, cloud-hosted ERP platforms are also rising to the occasion to meet UDHP needs.<\/p>\n

Beyond the list of benefits above,\u00a0it is the approach of these new service providers that encourages us to question whether EHRs can remain UDHPs in the long term<\/strong>. The cloud service providers (or hyperscalers) and ERPs are willing to integrate with anyone, host and provision anything anywhere, and provide centralized, distributed accessible, \u2013 and also open \u2013 systems. AWS and Azure, for example, would happily host your Epic instance, connect to your athenaHealth tablespace, and your point solutions. Please, continue adding more!<\/p>\n

And, they have the most advanced, scalable databases and data platforms to accommodate that data. This makes the next generation of point solutions, CDS features, or AI-derived agents even easier to create as cloud-first, as the data are already there, centralized, and accessible.<\/p>\n

EHR customers are also flocking to cloud vendors already, seeing benefits in hosting costs, scalability, testing, and other areas. From KLAS\u2019 Epic in the Public Cloud 2024 report: \u201cThe majority [of survey respondents] utilize a cloud provider for Epic disaster recovery, and this often serves as the initial step in the Epic cloud migration journey.\u201d IDC takes it a step further in their 2024-2025 Health Data Platforms for Providers Vendor Assessment, introducing multi-cloud implementations as a possible route, stating that \u201cNearly half (49.2%) of U.S. healthcare providers will prioritize IT modernization initiatives extending into 2025. This emphasizes the need for platforms that scale effectively and integrate seamlessly with existing and emerging systems in the healthcare ecosystem. Multicloud adaptability will be essential to achieving this.\u201c<\/p>\n

This suggests one answer to the question of where application rationalization and optimization should occur: in the cloud<\/strong>. The cloud vendors are willing and able to accommodate any EHR and are aligning incentives to accelerate cloud adoption. If these cloud platforms can manage healthcare\u2019s data complexity, what\u2019s stopping them from being the UDHPs accelerating innovation in healthcare?<\/p>\n

6) It\u2019s Not in EHR DNA to Become a Broad-Based Platform<\/h3>\n

EHRs are set in their ways \u2013 kinda like your uncle who still uses a flip phone. Unlike many of today\u2019s most successful tech companies, EHRs are not \u201cplatform native.\u201d We list some potential ways this could inhibit an EHR\u2019s expansion toward becoming a UDHP:<\/p>\n

\u201cSoftware Thinking\u201d vs. \u201cPlatform Thinking.\u201d<\/strong>\u00a0To truly understand the transformative potential of Unified Digital Health Platforms, it\u2019s crucial to distinguish between traditional \u201csoftware thinking\u201d and more expansive \u201cplatform thinking.\u201d By their very definition, UDHPs aren\u2019t simply new software; they represent a fundamental shift towards a platform business model, complete with a\u00a0new set of rules<\/a>\u00a0requiring a different mindset for success.<\/p>\n

Seth Joseph<\/a>\u00a0astutely observed that EHRs still think of themselves as software companies, whereas the bigger opportunity is to migrate from being \u201ca software vendor in the marketplace to the marketplace itself.\u201d This transition necessitates a fundamental change in how these systems are conceived, built, and operated.<\/p>\n

Expansion Through In-House Development vs. Expansion Through M&A.\u00a0<\/strong>Historically, Epic has largely favored expansion through in-house development rather than embracing the platform strategy of growth through acquisitions and fostering an external ecosystem. Judy Faulkner, the influential founder of Epic, has famously stated Epic will never be sold and has also historically maintained a stance against acquiring other companies.<\/p>\n

This inward focus contrasts sharply with the approach of established platform giants who have made hundreds of acquisitions:<\/p>\n

Alphabet<\/a>\u00a0(Google) \u2014 200+<\/p>\n

Amazon<\/a>\u00a0\u2014 125+<\/p>\n

Meta<\/a>\u00a0\u2014 100+<\/p>\n

Microsoft<\/a>\u00a0\u2014 275+<\/p>\n

To scale effectively and exponentially, it\u2019s necessary to take an ecosystem-first approach.<\/p>\n

Foot-Dragging On Interoperability vs. Interoperability by Default.\u00a0<\/strong>The early historical approach of many EHR vendors has been characterized as\u00a0foot-dragging on interoperability<\/a>, a stark contrast to the \u201cinteroperability by default\u201d ethos of successful platform businesses.<\/p>\n

Building One Company vs. Building an Ecosystem of Partners.\u00a0<\/strong>Finally, until the past decade the traditional EHR model was operated under the assumption that external developers weren\u2019t truly necessary, a viewpoint diametrically opposed to the platform business model where developers are central.<\/p>\n

In 2017, Epic opened its app store to a slow start. Epic was viewed as unresponsive by many app developers. We also remember developers claiming that Epic was not respecting their intellectual property rights, i.e., \u201cYour IP is now our IP.\u201d<\/p>\n

Epic has since developed much more vibrant developer programs. In yet\u00a0another blog post<\/a>, Brendan Keeler describes and rates developers\u2019 options in working with Epic. He concludes by advising devs to \u201ctemper your expectations.\u201d<\/p>\n

Synthesis and Conclusion:<\/h2>\n

OK, we\u2019ll admit that the Thesis\/Antithesis thing was a\u00a0little<\/em>\u00a0dramatic. Let\u2019s revisit the wording:<\/p>\n

Thesis: EHRs Can Expand To Becoming UDHPs
\nAntithesis: EHRs Can\u2019t Become Effective UDHPs<\/p>\n

We\u2019ll also concede that the wording is a bit misleading \u2014 it implies black\/white scenarios under which EHRs either will or will not become UDHPs. The reality, as always, is messier than a binary choice. It\u2019s not \u2018EHRs will\u00a0totally<\/em>\u00a0become UDHPs\u2019 or \u2018EHRs are doomed to the dustbin of history.\u2019 It\u2019s more like\u2026shades of gray, with a healthy dose of \u2018we\u2019ll see.\u2019\u201d<\/p>\n

The UDHP market is very early \u2014 the\u00a0Gartner report<\/a>\u00a0that we cited in our\u00a0previous blog post<\/a>\u00a0on UDHPs estimated that the market is only 5% penetrated and that UDHP adoption will take 5 to 10 years.<\/p>\n

As we\u2019ve noted, UDHPs can be adopted incrementally and over time. UDHPs can accommodate EHRs as components, and UDHPs and EHRs are not mutually exclusive: we don\u2019t see EHRs as going away any time soon.<\/p>\n

We expect that different organizations will make different decisions, depending on a number of factors such as:<\/p>\n

Size and resources. Larger health systems likely will see greater needs for a UDHP; smaller systems more likely will look to their EHR for integrations.
\nOrganizational complexity and geographic footprint. Multi-state footprints, a mix of care settings across the acuity spectrum, and wide ranges of specialties all add complexity, required connections, and more opportunity with a UDHP approach.
\nCurrent EHR vendor. Some EHR vendors might succeed at developing UDHP capabilities, others might not. TBD.
\nPricing of UDHPs vs. EHRs. TBD.
\nEvolution of UDHP capabilities and market acceptance. TBD.
\nUDHP vendor and market evolution. In our previous post, we highlighted over 20 UDHP vendor \u201ccandidates\u201d, and later suggested that this number would shrink drastically.<\/p>\n

In our next post in this series, we\u2019ll segment the healthcare provider market to evaluate for whom (which hospitals and health systems) the EHR could serve as the UDHP and when it makes sense to choose a cloud-first solution.<\/p>\n

Vince Kuraitis<\/em><\/a> JD\/MBA is an independent consultant with over 35 years\u2019 experience across 150+ healthcare & tech companies. <\/em>\u00a0\u00a0Neil Jennings<\/a> is Vice President, Consulting at Untangle Health<\/a>. Vince publishes The Healthcare Platform Blog<\/a>, where this post first appeared. The authors want to<\/em>\u00a0thank several colleagues for their review and commentary on an earlier draft of this post:\u00a0<\/em>Michael Byczkowski<\/em><\/a>, Global Head of Healthcare at SAP;\u00a0<\/em>Brendan Keeler<\/em><\/a>, Interoperability Practice Lead at HTD Health;\u00a0<\/em>Sandra Raup<\/em><\/a>, President at Datuit; and\u00a0<\/em>Chris Notaro<\/em><\/a>, CEO of Untangle Health<\/em>.<\/p>\n<\/div>\n<\/div>\n

<\/p>\n

<\/p>\n

<\/p>","protected":false},"excerpt":{"rendered":"

By VINCE KURAITIS & NEIL JENNINGS In a\u00a0previous post in this series, we discussed healthcare\u2019s migration toward Unified Digital Health Platforms (UDHPs) \u2014 a \u201cplatform of platforms.\u201d Think of a UDHP as healthcare\u2019s version of a Swiss Army knife: flexible, multi-functional, and (ideally) much better integrated than the drawer full of barely-used apps most health…<\/p>\n","protected":false},"author":0,"featured_media":6301,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-6300","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-other"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/6300"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=6300"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/6300\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/6301"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=6300"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=6300"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=6300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}