Which Platform of Platforms (UDHP) is Right for your Health System? A Market Analysis – The Health Care Blog

By NEIL JENNINGS & VINCE KURAITIS

This entry is an element 5 of 5 within the sequence Platforming Healthcare — The Long View

In previous posts on this sequence, we have now coated the definitions of Unified Digital Well being platforms and whether or not “EHRs can turn out to be UDHPs.” On this follow-on publish, we’ll speak via the necessities for achievement for a UDHP and which forms of healthcare organizations are greatest fitted to which forms of UDHPs. This publish will construct on findings from the earlier posts.

The Market Wants UDHPs: Key Takeaways from Earlier Posts

Key Takeaway 1: The healthcare business wants UDHPs to create a centralized, frequent structure for healthcare organizations

Key Takeaway 2: The healthcare organizations leveraging UDHPs will obtain a myriad of advantages, from aggressive benefits to medical, monetary, and operational good points

Key Takeaway 3: UDHPs aren’t all-or-nothing or mutually unique from EHRs. As we explored in our final publish, EHRs might increase into UDHPs. These EHRs as UDHPs (or the relative platform of platforms) stands out as the optimum selection for some market segments. EHRs may be accommodated into cloud-first UHDPs.

Key Takeaway 4 / Guiding Criterion: This publish will concentrate on US regional and native well being techniques and outpatient teams of all sizes.

The Method: Market -> Segments -> Choices -> Match

• For this publish, we’ll begin from the top-down market perspective, analyzing the general market panorama.
• As soon as we have now described the panorama, we’ll name out the important thing segments (group varieties, sizes, and profiles) that we are going to be evaluating.
• At this level, we’ll approximate IT budgets and IT workforce sizes by group sort to find out capabilities of constructing versus relying on companions and distributors.
• Then, we’ll evaluate the constraints for implementation and possession, outlining the drivers of UDHP match.
• Subsequent, we’ll break down the alternative ways UDHPs will be developed and maintained.
  • Leveraging an EHR as UDHP
  • License from UDHP vendor
  • “Dwelling grown” cloud-first resolution
• Lastly, we’ll crosswalk the segments and the optimum possibility for every phase, based mostly on their particular wants and estimated IT and budgetary sources.

The Healthcare Market & Main Well being System Segments

Beginning with a compelling graphic from the Kaiser Household Basis, we see a 2023 breakdown of the full US healthcare medical expenditure, totaling ~$4.9 trillion.

Whereas the full healthcare spend that occurred in hospitals is an astounding ~$ 1.5 trillion, accounting for 31% of whole healthcare spend, this leaves a lot of care outdoors the 4 partitions of hospitals. This quantity of care occurring outdoors of hospitals aligns with efforts to push sufferers into much less acute care settings, emphasizing preventative, proactive drugs as an alternative of acute, reactive drugs. As the necessity for UDHPs applies to greater than inpatient hospitals, we may even evaluate the opposite segments highlighted within the pie chart, together with: outpatient clinics and follow teams, and “different well being” containing providers delivered at different contexts like PACs and SNFs, and Ambulatory surgical facilities.

Desk 1 under illustrates the important thing segments as we outline them, together with the tough depend of whole entities, their relative breakdown by measurement, estimates of annual income, and subsequent estimates of IT finances. We’re estimating typical IT budgets as being between 2-5%, based mostly on DefinitiveHealthcare and WittKieffer sources; we perceive that a couple of organizations are increased or decrease than this vary. The target, with out spending an excessive amount of time on the science mission, is to tough out IT budgets by phase to align organizational sources and wishes with the best-fitting UDHP.

Desk 1

United States Healthcare Segments: IT Finances Evaluation

1 (AHA – 1957 (unaffiliated) + 227 (small techniques)), 2 (Statista), 3 (Futuremarketinsights), 4 (Businesswire), 5 (NIH), 6 (Chartis), 7 (DefinitiveHC), 8 (DefinitiveHC),9 (GrandviewResearch, income per MD) , 10 (AMGA), 11 (Grandviewresearch), 12 (Definitive Healthcare), 13 (Witt Kieffer), 14 (Precedence Research), 15 (Ibisworld as of 2023), 16 – these corporations doubtless skew increased as they’re distant first, relying on digital care platforms.

We’re additionally together with two succinct charts from the Witt Kieffer piece, as a result of they inform a transparent story concerning the large variance in IT spent throughout the healthcare continuum.

Supply: WittKieffer

Supply: WittKieffer

Defining Match: Segments (and their wants) Are Not Created Equal

Desk 1 above highlights the wide selection of healthcare segments that make up the multi-trillion greenback US healthcare market. As these organizations vary from a couple of physicians to lots of of hospitals spanning huge geographic areas, it shouldn’t shock anybody that the organizational wants will differ tremendously.

Whereas the UDHP market remains to be in improvement, listed below are a few of our concerns on what is going to outline profitable architectures and implementations. We summarize the determinants of organizational match into two buckets: Capabilities & Wants

Organizational Capabilities

As proven in Desk 1 above, IT budgets are finite, together with IT and technical groups’ time. Discovering the precise resolution for the precise group ensures that wasted money and time are averted. The UDHP ought to “match” your group’s capabilities.

Finances & Employees

Finances is an apparent place to begin, with the 2-5% of annual revenues offering clear constraints. A small follow with a couple of hundred thousand {dollars} in annual IT finances shouldn’t be contemplating a multi-million greenback Epic set up, in fact.

Immediately correlated with finances is the scale of your IT workforce. There are staffing ratio discussions, with business normal really useful ratios of IT employees to non-IT employees from 1:50 as much as 1:150 or so. Whereas considerably apparent for the smaller organizations (in case you have 5 clinicians and three assist employees, you doubtless have a singular IT one that may be an workplace supervisor), it is a consideration for the medium to giant organizations. In case your whole workforce measurement is restricted, including new applied sciences to handle in-house will be daunting. Employees and workforce measurement come into play not only for longitudinal upkeep, but additionally for implementation.

Budgets can be utilized to find out which UDHP choices are possible, however staffing will affect how the UDHP can be carried out and maintained.

Present IT Footprint

The group’s present technical footprint can also be an vital issue when figuring out the optimum UDHP implementation method. As that is immediately associated to the IT technique, we may even body this part as some high-level guiding questions:

• What are the core techniques of workflow and of file?
• Which of the next does the IT footprint embody?
  • Software program as a Service
  • Platforms as a service
  • Infrastructure as a service
• Does the group construct and keep functions, portals, and techniques from scratch?
• Are present IT techniques hosted regionally? Hybrid? On public clouds?
• Does the group have a improvement workforce? A DevOps workforce?

Organizational Wants

The complement to capabilities is the group’s present wants. Overbuilding or overinvesting will not be the objective; the objective is discovering the precise match. To outline organizational wants, we’ll break them down into drivers of complexity, the necessity to keep aggressive, and IT technique.

Drivers of Organizational Complexity

Whereas delivering healthcare in at present’s digital-first world is complicated for all suppliers and practitioners, organizations function at totally different ranges of complexity based mostly on their scale, scope, enterprise mannequin, and footprint.

Beginning with scale, bigger organizations sometimes have extra sophisticated wants. Because the variety of beds enters the hundreds, the variety of suppliers exceeds 2,000, and also you begin getting into tens of millions of annual visits, each the number of interactions and the quantity of interactions improve. Along with the variety of individuals (sufferers, suppliers), the variety of bodily places is one other main driver of complexity, the place a single, standalone small hospital could also be less complicated than a multi-state, multi-specialty doctor group.

The scope of the group’s care providers is one other main issue. Are there solely outpatient/ambulatory practices? Are they solely major drugs? Or, are there specialty teams? Is there a mixture of acuity settings? Does the group have pressing care, emergency drugs, dwelling well being, hospital outpatient specialties? Does the group have its personal labs, imaging facilities, and surgical procedure facilities? As you proceed so as to add extra forms of care that may be delivered, the IT infrastructure is challenged in new and thrilling methods.

Supplier organizations’ enterprise fashions additionally play a key function in organizational complexity, with the shift in the direction of value-based care and risk-bearing fashions. As supplier organizations shift in the direction of risk-bearing fashions, it’s usually an incremental shift with risk-based and fee-for-service fashions operating in parallel. Along with the (comparatively) less complicated configuration of including one other insurance coverage plan, the info and care supply coordination of risk-based plans are an order of magnitude extra sophisticated than conventional fee-for-service care fashions. This shift has expanded past enterprise well being techniques and enormous hospitals and is cascading via giant ambulatory practices, which have distributed footprints and traditionally smaller IT budgets.

Geographic footprint is a significant driver of organizational complexity and IT (amongst different) wants. Is the group a singular location or unfold out inside a metropolis? Is it distributed throughout a number of states, international locations (Canadian presence), or different geos (tribal nations, US territories, and so forth.)? As organizations increase to multi-state footprints, for instance, there are differing rules for licensure (the scope of NPs for instance), e-prescribing, and different localizations like regional language wants: this all have to be accommodated in EHRs and different techniques. That is all on high of the necessity for referral networks, reference labs, pharmacies, and native well being info exchanges. As well as, there are regional privateness, knowledge sharing, and different necessities that apply to cross-state or multi-region companies. When geographies span a number of forms of borders, it will get much more sophisticated.

Geography is extra than simply technicalities associated to knowledge sharing, licensure, and care supply: we can’t overlook the individuals and their cultural and regional variations. The US is an extremely numerous nation the place there are 430 languages spoken throughout the states and territories. Addressing cultural, language, and regional variations is a complexity that many giant well being techniques and nationwide healthcare suppliers face, and there are a myriad of research exhibiting that sufferers are extra engaged, have higher outcomes, and are extra glad with care delivered of their most well-liked language. Anybody who has labored on an internationalization or localization effort for a product will perceive the complexity, however the implications of languages, regional variations and norms, are far reaching and can’t be underestimated. They increase past multi-language assist, impacting content material (care summaries, letters, affected person directions), and even workplace schedules.

Group Must Stay Aggressive / Differentiated

Past simply managing their very own complexities, healthcare organizations are sometimes run as companies (there are some not-for-profit organizations, together with a nationwide chief that we spotlight later). With the shift to decrease acuity care contexts, personal fairness rollups, regulatory adjustments, and the fixed want for extra patient-centric care – the market and opponents are altering shortly!

Organizations have quickly altering wants to be able to keep aggressive and differentiated within the digital-first healthcare ecosystem. Each organizational wants and affected person/supplier expectations are driving initiatives for lasting differentiation.

Beginning with organizational wants, some organizations are constructing aggressive data moats, leveraging differentiated knowledge entry and repositories, to stay aggressive. Whether or not accessed as a part of a digital community or trade or owned wholly internally, this method depends on IT infrastructure to securely retailer, course of, safe, and dealer knowledge to related techniques.

When it comes to expectations, whereas sufferers at present have extra management of their very own healthcare information, it’s nonetheless not sufficient. Main organizations understand that sufferers don’t need to work together with separate care contexts, specialties, and amenities individually. As an alternative, they’re prioritizing unified affected person experiences (a element of UDHPs) to simplify affected person interactions throughout their technical and operational ecosystem. This transition to affected person consumerism is offering one other level the place organizations compete: affected person engagement and loyalty.

IT Technique

As organizations get bigger in measurement, they’ve extra outlined IT methods, with enterprise organizations sustaining multi-year roadmaps. These roadmaps define the prescribed method to attain organizational priorities and outline the tasks and budgets for upcoming years.

Whereas this level is foundationally vital, it additionally varies tremendously, relying on the idiosyncratic wants of every group. Nonetheless, there are some frequent themes and choices we will sometimes discern when reviewing a roadmap. We’ll body them as questions under:

• Is the group attempting to increase or shrink the scope of its IT perform?
• Is there a robust desire for constructing vs. shopping for vs. partnering?
• What key unmet wants have but to be addressed and are prioritized?
• What’s working at present (and notably excluded from roadmaps)?
• The place does organizational management have their sights targeted to extend effectivity, competitiveness, differentiation, and care high quality by way of IT efforts?

Defining UDHP Choices for Completely different Healthcare Segments

Whereas healthcare at-large wants UDHPs, the particular wants differ by group measurement and complexity. Associated, not all implementations of UDHPs will have to be the identical, and we see three major paths for organizations to implement and architect their UDHPs.

Mapping UDHP Choices to Market Segments

Possibility 1: Leveraging an EHR as a UDHP

There are a number of drivers that push healthcare organizations towards their EHR because the default UDHP. These techniques already accommodate the complexity, sensitivity, and technical necessities for working in a regulated business. A few of the main tailwinds, as coated in our earlier publish (“Can EHRs be Health System’s “Platform of Platforms” (UDHPS)) are as follows:

• EHRs Presently Personal the Buyer Relationship
• Many Prospects Have an “EHR-First” Desire for New Functions
• Epic and Oracle Well being are Making Sturdy Actions Towards Changing into UDHPs

Because of finances constraints, the EHR stands out as the solely sensible UDHP possibility for a lot of organizations. Smaller practices and medical teams could have a single IT particular person, chargeable for EHRs, {hardware}, software program, printers, fax machines, and the whole lot else. If IT budgets are beginning round $100,000 per yr, and EHRs could take as much as half of that, there isn’t budgetary or employees room for different techniques. Elation calls out that the anticipated license price of an EHR per clinician is round $1,200 per yr; Folio3 shares an identical quantity. That is earlier than upkeep, assist, coaching, and different bills associated to the EHR, and earlier than different IT-related bills not associated to the EHR. When the EHR makes up a considerable portion of the finances, it is smart to look there first.

Along with these factors talked about within the earlier publish, when EHRs are tailor-made to smaller organizations, distributors perceive that their prospects want a associate that fills in gaps. athenaHealth’s athenaOne bundle providing, for instance, contains add-ons that complement the core EHR throughout the group: from affected person engagement and communication, to pre-visit and sched/reg assist, to RCM and declare submission assist. Positioned as an “all-in-one follow resolution,” they’re framing the providing as greater than an EHR and provide many UDHP advantages.

Transferring upmarket to bigger doctor teams and small hospitals or well being techniques, IT budgets get bigger as income grows and care contexts get extra sophisticated. As we start to see multi-state footprints, giant multi-specialty teams, and acute care settings, organizations could outgrow the ambulatory-focused EHRs like athenaHealth, ECW, and others. That is the place Epic and Cerner step in and are completely satisfied to satisfy these organizations’ wants.

Epic’s Connect (previously often known as Group Join), for instance, is a particular providing that permits giant well being techniques to sublicense their Epic occasion, provisioning entry to regional hospitals or well being techniques. Whereas this feature permits smaller healthcare organizations to leverage the advantages of Epic, the fee will be an order of magnitude increased than outpatient, license-based EHRs.

In 2024, OhioHealth Van Vert Hospital invested $12MM to transition to Epic by way of CareConnect. Leveraging the identical budgetary assumptions as above, if the EHR is ~50% of finances, and finances is ~2-5% of income, this implies that the hospital has >$480MM in annual income ($12M * 2 / .05). Implementing Epic as a standalone well being system or hospital group is dear, and a 2024 publish from Becker’s notes that prices could begin within the tens of tens of millions, however can attain a billion {dollars} or extra for bigger well being techniques.

Because the IT budgets get bigger, technical groups improve in measurement and capabilities, and it naturally follows that extra superior choices are explored or required.

Possibility 2: License from UDHP Vendor

As denoted above, not all organizations have ample IT budgets and employees to architect, construct, and handle their very own system. However, for big well being techniques with greater than a billion {dollars} in annual income (estimated at ~175 or so in the US), these choices begin to turn out to be possible if not essential. These giant hospitals and well being techniques could start trying past their EHR to satisfy their UDHP and platform-of-platforms wants. Why?

As highlighted within the earlier post:

• EHRs Carry a Lot of Baggage
• Prospects are Skeptical
• EHR Analytics Are NOT Optimized To Obtain Essential Well being System Aims
• EHR Switching Prices are Diminishing
• Cloud Native Platforms Speed up Innovation and Efficiency
• It’s Not in EHR DNA to Turn out to be A Broad-Based mostly Platform

The final publish additionally shared a HIMSS research that confirmed that the common hospital had 16 EHRs in 2016. Whereas this quantity has doubtless consolidated down up to now decade, multi-EHR and multi-system-of-workflow architectures are very a lot a actuality at present. Specializing in the complexity angle on this piece, we’ll spotlight 4 extra, complementary factors as to why an outside-the-EHR UDHP will be the best resolution for bigger hospitals and enterprise well being techniques.

There are 4 major causes that we are going to spotlight the necessity for a UDHP to exist past the core EHR:

1. No singular EHR can accommodate the whole lot that well being techniques have to do
2. Some level options are nonetheless higher than their EHR-native competitor
3. Some organizations leverage a number of core EHRs (there are organizations that use each Cerner and Epic throughout their hospitals)
   1. Whether or not as a result of M&As, IT or clinician desire, or different causes, some well being techniques nonetheless use a combined EHR footprint.
   2. This presents in several methods, however is usually one of many following:
      1. One system for inpatient, one for outpatient
      2. One system for clinicals, one for RCM
      3. Or, distinct techniques at distinct places (usually as a result of M&A)
4. M&As and rollups are nonetheless operating rampant
   1. Mergers and acquisitions mix greater than market footprints and medical capabilities; additionally they convey IT groups and infrastructure. That is the place we start to see the actual glimpses of Frankstein’s monster.
   2. Some stats from Kaufman Hall:
      1. 72 whole transactions in 2024, with 27 not together with a divestiture. Whereas this quantity could not appear that top in a vacuum, the full image of the final decade+ shines mild onto the actual quantity of those transactions. From 2014 to 2024, there have been 933 whole M&A transactions. That’s a whole lot of technical complexity to scrub up.

When it comes to licensing an outside-the-EHR platform, the primary post within the UDHP sequence features a complete checklist of potential distributors, constructing from Gartner’s authentic list. Now we have additionally highlighted in earlier posts that the license method will not be an all-or-nothing method, and sometimes includes a hybrid mannequin, constructing on high of 1 or a number of EHRs. Every group’s particular wants are totally different, and so they could use their licensed platform from a UDHP associate to various levels.

Possibility 3: “Dwelling-grown” cloud-first resolution

The ultimate possibility that we’ll cowl on this publish is for the main well being techniques, and sure restricted to the highest 15-20 techniques as a result of complexity, expense, and staffing necessities. Progressing past the cloud and platform vendor partnerships talked about above, these techniques are constructing enterprise knowledge platforms and UDHPs immediately inside cloud environments, leveraging cloud providers from AWS, GCP, Azure, InterSystems, or others.

Beginning with a mini case research. We plan to additional expound upon Ascension’s work in a future publish.

The State of affairs: Ascension checks the entire bins for a big, complicated group.

Ascension’s Scale: 16 States, 94 wholly owned or consolidated hospitals, 27 extra hospitals via partnerships. 99,000 associates, 23,000 suppliers.

Ascension’s Scope: Inpatient, outpatient, and the whole lot in between.

Ascension’s Employees: ~3,000 working in IT (per LinkedIn)

Ascension’s IT Footprint: Heterogenous, 18 EHRs, 40+ affected person portals

Want for differentiation / competitiveness: Excessive, each regionally and throughout the 16 states

The Downside:

• Sufferers aren’t conscious of “care contexts,” they count on a unified expertise.
• Ascension’s numerous set of EHRs and myriad of different techniques weren’t tightly built-in
• No singular EHR nor operational system was an entire supply of reality
• There have been knowledge variations throughout techniques that compound and exacerbate expertise inconsistencies throughout shopper digital touchpoints

The Resolution:

• Ascension created an “Enterprise Knowledge Service Layer (EDSL),” mapping knowledge from a number of EHRs right into a unified, centralized FHIR schema to facilitate frictionless shopper entry to normalized and harmonized knowledge
  • This depends on deep partnerships with EHR distributors and different companions.
  • FHIR, not totally adopted by all vendor companions, was made extra accessible utilizing REST APIs and a GraphQL orchestration layer to supply knowledge on demand to digital functions
• A unified affected person expertise, “AscensionOne” was developed on high of the EDSL to supply a singular place for sufferers to ebook visits, get care, handle their well being information, and pay for care.

The Outcomes So Far:

After one yr, over 400,000 members are utilizing the unified affected person expertise, constructed on high of the Enterprise Knowledge Service Layer. The appliance is averaging 4.8 stars within the app retailer.

Ideas from a pacesetter on EDSL efforts:

MJ Barrois, Senior Director of Product Administration:

“Our mission to higher serve our communities was a key driving issue behind our funding in constructing our inside platform. EDSL represents our dedication to assist form a future the place extremely interoperable and moveable knowledge is quickly accessible to all of our sufferers. To supply care to these most weak and in want, we try to be good stewards of their knowledge and we work carefully with our EHR companions to make healthcare knowledge securely accessible, simply discoverable, and comprehensible to the sufferers we serve.”

Summarizing the house grown possibility:

Whereas this feature will not be the optimum selection for all organizations, Ascension is paving a path that can be simpler for others to comply with. As we revisit the maturity curve proven above, the technical capabilities and necessities will get simpler yr after yr. AI is accelerating knowledge mapping and infrastructure optimization. We count on that the “homegrown” resolution can be extra attainable for the highest 50 or so well being techniques within the subsequent few years. If there may be ever any doubt about what the cloud techniques can do, we’d recommend testing this cloud comparison cheat sheet from ByteByteGo. You possibly can shortly see that the cloud platforms can deal with just about something you’ll be able to throw at them in case you have the precise workforce and budgets in place.

Trying forward

Right this moment, AI and our better-than-ever {hardware} proceed lowering boundaries to entry, and the necessity for UDHPs will rise as organizations improve their IT footprints. Selecting a platform to construct round is the vital determination organizations ought to make at present. This platform determination can be an integral element of organizations’ AI methods, which is a necessary lever for brief time period competitors and long-term differentiation. There’s a whole lot of noise round AI implementation greatest practices at present, however the consensus (per AIDoc) seems to be {that a} centralized, ruled platform method is greatest, which depends on unified digital well being platforms and knowledge.

As we glance a couple of years out, a extremely potential state of affairs is that by 2030, cloud-first implementations like Ascension’s can be commonplace not simply among the many high 7 well being techniques, however the high 50. Internet hosting EHRs (like Epic and Cerner) on public clouds, pioneered by Geisinger, has been de-risked. As soon as within the cloud, it’s solely a matter of time earlier than the opposite cloud-first capabilities are evaluated and deemed a step ahead from legacy, healthcare-specific platforms and providers.

For the subsequent cohort down in measurement in the identical interval, it’s extremely doubtless that EHR-complementing UDHPs can be licensed by the subsequent high 150 well being techniques and hospitals. These already cloud-first techniques will play properly with cloud-hosted EHR techniques and supply entry to cloud advantages not attainable as a result of employees and budgetary limitations of those smaller organizations.

What’s the ultimate frontier? Ideally, by 2030, we may even start seeing uptake in openEHR and open-syntax, cloud-first platforms in the US. Epic isn’t going anyplace, but.

Vince Kuraitis JD/MBA is an impartial marketing consultant with over 35 years’ expertise throughout 150+ healthcare & tech corporations. Neil Jennings is a options engineer on the well being care workforce at Akamai Applied sciences. Vince publishes The Healthcare Platform Blog, the place this publish first appeared. The authors thank a number of colleagues for his or her evaluate and commentary on an earlier draft of this publish: M.J. Barrois, Senior Director of Product Administration at Ascension; Jim Sabogal, Healthcare Vertical Lead at CDW; and Taylor Gartley, Director at Fold Well being.