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Bevey Miner, Consensus Cloud Solutions 1:38 AM (8 hours ago)

Consensus is taking fax data, received by rural clinics, post acute, substance abuse clinics, home health et al, and helping them put it into their systems of records–which are in general not FHIR-enabled. They allow those facilities & services to receive referrals from acute care hospitals. By 2027 many of these standards are going to need to be FHIR enabled. Bevey Miner, EVP at Consensus, is a health care veteran who is working on both a policy and technology level to improve access to care, and thinks a lot about what unstructured data means in a world where we are trying to use data for AI and more. Super interesting chat about the murky backwaters of health care data and services. As Bevey says, “Not everyone is going to be Epic to Epic to Epic”–Matthew Holt

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Feeling the Pressure 6 Apr 8:55 PM (yesterday, 8:55 pm)

By MIKE MAGEE

After Trump crashed the markets, citizens worldwide are “feeling the pressure.” But in the spirit of calming us down, let’s consider a story of human cooperation and success from our past.

It has been estimated that a medical student learns approximately 15,000 new words during the four years of training. One of those words is sphygmomanometer. the fancy term for a blood pressure monitor. The word is derived from the  Greek σφυγμός sphygmos “pulse”, plus the scientific term manometer (from French manomètre).

While medical students are quick to memorize and learn to use the words and tools that are part of their trade, few fully appreciate the centuries-long efforts to advance incremental insights, discoveries, and engineering feats that go into these discoveries.

Most students are familiar with the name William Harvey. Without modern tools, he deduced from inference rather than direct observation that blood was pumped by a four chamber heart through a “double circulation system” directed first to the lungs and back via a “closed system” and then out again to the brain and bodily organs. In 1628, he published all of the above in an epic volume, De Motu Cordis. 

Far fewer know much about Stephen Hales, who in 1733, at the age of 56, is credited with discovering the concept of “blood pressure.” A century later, the German physiologist, Johannes Müller,  boldly proclaimed that Hales “discovery of the blood pressure was more important than the (Harvey) discovery of blood.” 

Modern day cardiologists seem to agree.

Back in 2014, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure reported that “With every 20 mm Hg increase in systolic or 10 mm Hg increase in diastolic blood pressure, there is a doubling risk of mortality from both ischemic heart disease and stroke.” 

But comparisons are toxic. No need to diminish Harvey who correctly estimated human blood volume (10 pints or 5 liters), the number of heart contractions, the amount of blood ejected with each beat, and the fact that blood was continuously recirculated – and did this all 400 years ago. But how to measure the function, and connect those measurements to an amazingly significant clinical condition like hypertension, is a remarkable tale that spanned two centuries and required international scientific cooperation. 

Harvey was born in 1578 and died in 1657, twenty years before the birth of his fellow Englishman, Stephen Hales. Hales was a clergyman whose obsessive and intrusive fascination with probing the natural sciences drew sarcasm and criticism from the likes of classical scholar and sometimes friend, Thomas Twinning. He penned a memorable insult laced poem in Hales’ honor titled “The Boat of Hales.” 

“Green Teddington’s serene retreat
For Philosophic studies meet,
Where the good Pastor Stephen Hales
Weighed moisture in a pair of scales,
To lingering death put Mares and Dogs,
And stripped the Skins from living Frogs,
Nature, he loved, her Works intent
To search or sometimes to torment.”

The torment line may be well justified in light of Hales own 1733 account of his historic first ever mention of the measurement of arterial blood pressure, illustrated below, and self-described here:

“’In December I caused a mare to be tied down alive on her back; she was fourteen hands high, and about fourteen years of age; had a fistula of her withers, was neither very lean nor yet lusty; having laid open the left crural artery about three inches from her belly, I inserted into it a brass pipe whose bore was one sixth of an inch in diameter … I fixed a glass tube of nearly the same diameter which was nine feet in length: then untying the ligature of the artery, the blood rose in the tube 8 feet 3 inches perpendicular above the level of the left ventricle of the heart; … when it was at its full height it would rise and fall at and after each pulse 2, 3, or 4 inches.” 

Having established the existence of “blood pressure,” the world would wait nearly another century to gain access to a reliable tool for measurement. That advance came from the hands of French physician-physicist, Jean Léonard Marie Poiseuille. He was born in 1799, amidst the flames of the French Revolution. In 1828, as a doctoral candidate, his dissertation on the use of a mercury manometer, attached to an anticoagulant laced cannula, in lab animal vessels as small as 2 mm in diameter, yielded measurable, and reproducible arterial pressure readings, earning him a gold medal from the Royal Academy of Medicine. 

Carl Ludwig, a 31-year old professor of physiology, next decided Poseuille needed a permanent and transportable record. His solution in 1847 was to attach a float with a writing pen to the open mercury column. As the mercury rose, the pen scratched out a reading on a revolving smoked drum. 

But direct arterial puncture was impractical and invasive. By 1855, scientists had surmised that applying external counter pressure to an artery could obliterate the pulse below the obstruction, and that measuring the pressure generated by an obstructing external rubber ball would essentially reveal the blood pressure generated by a contracting heart – the systolic pressure. 

In 1881, an Austrian physician named Karl Samuel Ritter von Basch created an elaborate portable machine that included a manometer capable of measuring the internal water pressure inside an inflatable rubber ball applied at the wrist to the radial artery. The pressure necessary to eliminate the pulse below was roughly the peak pressure of the column of blood when the heart contracted. Eight years later, the French physician, Pierre Carle Édouard Potain, replaced the water with air for compression. 

By 1896, blood flow was appreciated as a series of waves that peaked when the heart contracted, and fell as the heart relaxed. The wrist compressing rubber rubber cup was replaced by an air filled cuff wrapped around the upper arm which constricted the larger brachial artery. A Russian surgeon, N.C. Korotkoff,  in 1905, suggested that doctors listen to the waves rather than feel for the pulse. The sounds he described became known as Korotkoff sounds.

As described in a 1941 translation of the Russian paper, Korotkoff wrote, “On the basis of this observation, the speaker came to the conclusion that a perfectly constricted artery under normal conditions, does not emit any sounds…The sleeve is put on the middle third of the arm; the pressure in this sleeve rises rapidly until the circulation below this sleeve stops completely. At first there are no sounds whatsoever. As the mercury in the manometer drops to a certain height, there appears the first short or faint tones, the appearance of which indicates that part of the pulse wave of the blood stream has passed under the sleeve…Finally all sounds disappear. The time of disappearance of the sounds indicated the free passage or flow of the blood stream… Consequently, the reading of the manometer at this time corresponds to the minimum (diastolic) blood pressure.” 

It is easy to forget, in an age of semiconductors, photocells and strain gauges, that progress in understanding the human circulatory system took centuries to acquire, and international cooperation. When Covid hit, homes that could acquired Home Blood Pressure Monitors and Pulse Oximeters that attached to an index finger and delivered oxygen saturation of blood and pulse with no delay. For a little more, you can access a Portable ECG monitor  in the comfort of your own home.

Mike Magee MD is a Medical Historian and regular contributor with THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

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The World’s Psychoactive Drug of Choice 3 Apr 10:21 PM (4 days ago)

By MIKE MAGEE

Question: What is the world’s most widely used psychoactive drug?

Answer: Caffeine

In the U.S., caffeine is consumed mainly in the form of coffee, tea, and cola. But coffee dominates. Worldwide, humans consume over 10 million tons of coffee beans a year. Roughly 16% (1.62 million tons) is devoured by Americans. The daily intake of caffeine varies depending on type of beverage and brand as the chart below indicates. 

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On average, each American consumes approximately 164 mg of caffeine each day. That’s roughly 1 small cup of Dunkin or (3.5) 12-ounce Diet Cokes (Trump consumes at least 12 cans of Diet Coke a day). 

Across the globe, daily consumption of caffeine is close to universal. Eight in 10 humans consume a caffeinated beverage daily. That makes this chemical substance the “most commonly consumed psychoactive substance globally.” Its popularity is related to its ability to deliver three useful physiological enhancements – wakefulness, motor performance, and cognition.

Image

Chemically, caffeine is a close cousin of adenosine which is present in brain neurons. Adenosine builds up in synaptic connections between brain neurons. When it binds to special receptors, it activates neurons that promote sleepfulness. Ingested caffeine is water and lipid soluble, and therefore is able to traverse the blood-brain barrier. Once inside, its chemical structure mimics that of adenosine, and it occupies adenosine receptors because it shares the same approximate shape and size. When these receptors are occupied by caffeine, adenosine molecules are unable to activate the receptors. The net effect is wakefulness.

Caffeine passes thru small intestine cell walls and is absorbed within 45 minutes of ingestion. From there, it is distributed to all bodily cells reaching highest concentrations within 1-2 hours. The average time required to remove 1/2 of a caffeine dose (the half-life) is 3 to 7 hours. Thereafter it is broken down in the liver. 

Over 30 plants species naturally produce caffeine. The most common source of caffeine are the seeds or beans of two coffee plants ( Coffee arabica and Coffee canephora), the leaves of tea plants, the seeds of the cocoa plant (Theobroma cacao) used in chocolate production, and kola nuts (used to produce Cola beverages). 

For chocolate lovers, caffeine levels depend on the product. A 4 ounce bar of dark chocolate has approximately 80 mg of caffeine. Night time ingesters may do better with milk chocolate which contains 24 mg in 4 ounces. 

Pure solid caffeine is bitter, odorless, and melts at 235 degrees C. The 60’s generation were familiar with various tablet forms  like No-Doz (Bristol-Myers Squibb) and Vivarin (SmithKline Beecham). Each tablet contained 100 mg of caffeine. The U.S. market is estimated at $60 million annually. The three top consumer markets are college students (for “all-nighters”), truck drivers and body builders. 

None of this is especially breaking news. The restorative powers of boiling tea leaves was first documented in 3000 BC. The Cocoa bean was harvested by Mayans in 600 BC. Coffee use is more recent, with first accounts in the Middle East in the 15th century. Three centuries later, French chemists isolated the active ingredients, with the term Caféine first appearing in the French scientific literature in 1822. 

Back in 1911, Trump may have run into a problem ingesting 10 Cokes a day. Public officials viewed the product (and its stimulants) with suspicion. In fact, their seizure of 20 kegs of Coca-Cola syrup in Chattanooga, TN, led to the landmark case, United States v. Forty Barrels and Twenty Kegs of Coca-Cola. The company prevailed only to have the U.S. Congress pass a law the following year requiring that the company include the phrase “habit-forming” on their label. 

These days, caffeine consumption varies with age and sex –  “2 mg/kg/day in children, 2.4 mg/kg/day in women, and 2.0 mg/kg/day in men.” As for caffeine powder tablets, they remain unregulated. Reading between the lines, experts are preaching caution a bit more often, as in this government summary in 2017: 

“When taken together, the literature reviewed here suggests that ingested caffeine is relatively safe at doses typically found in commercially available foods and beverages. There are some trends in caffeine consumption, such as alcohol-mixed energy drinks, that may increase risk of harm. There are also some populations, such as pregnant women, children, and individuals with mental illness, who may also be considered vulnerable for harmful effects of caffeine. Excess caffeine consumption is increasingly being recognized by health-care professionals and by regulatory agencies as potentially harmful.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

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Platform Shift: From EHRs to UDHPs (Unified Digital Health Platforms) – – Section 2 1 Apr 10:51 PM (6 days ago)

By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK

This entry is Section 2 of part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown above.

Today’s post is section 2 and will continue to describe and discuss a potential successor to the EHR era — Unified Digital Health Platforms (UDHPs). Here’s an overview:

Mayo Clinic Platform: Healthcare platforms and AI

The Mayo Clinic Platform (MCP)was launched several years ago with the goal of building the future Mayo Clinic business model that could move beyond the bricks-and-mortar approach to traditional healthcare and open up new avenues for products and services. The adoption of a platform business model was considered essential to serving patients beyond the traditional Mayo Clinic geography as well as a way to incentivize innovation in AI and decentralized care in the home. 

A large longitudinal database with both structured and unstructured data provides a foundation for the MCP, particularly in respect to catalyzing innovation in clinical applications of AI. The database called Mayo Clinic Platform Discover has over 7.3 million de-identified patient records that can be used for training AI models as well as in research and discovery for early-stage startups in particular who wish to join the MCP ecosystem. The dataset is referred to as “Data behind glass” for the privacy and security standards that are needed to create the bedrock for a collaborative ecosystem.

Source: Mayo Clinic Platform Playbook

MCP is a three-sided market that has solution developers, data providers, and clinicians composing the three sides. MCP acts as the orchestrator of the ecosystem and additional partners such as Mercy have joined as data contributors in the MCP component called Mayo Clinic Platform Connect. These are the primary components of the platform. 

The Mayo Clinic Platform Playbook identifies six key success factors:

MCP vets startups and more mature technology vendors through a process that can begin with providing access to the longitudinal database for developing and training models (early-stage startups) to scaling solutions across MCP and affiliated hospitals with Mayo Clinic. The robust governance structure and integration with MCP makes scaling into other systems much more feasible.

AI governance is a core component of the MCP and why they were one of the original sponsors of the Coalition for Health AI (CHAI) to bring together leading industry players to create the standards for responsible AI across validation, explainability, and transparency.  Ensuring that AI tools have been rigorously validated is necessary for clinician adoption of AI as well as maintaining the trust of patients. These standards act as a kind of “rules of the road” for technology solution providers on the MCP.

MCP utilizes ServiceNow’s Application Portfolio Management (APM) solution that enables users to create a comprehensive inventory of all applications used by a company. Many health systems struggle to deal with the accumulation of applications over time and this creates security issues, redundancies, and risks to hospitals. The APM solution facilitates integration of application portfolios with clearer lines for ownership, responsibility for maintenance and decommissioning, and administrative roles. 

For MCP this type of solution offers a myriad of advantages when orchestrating an ecosystem of technology vendors and applications that are integrated with Mayo Clinic’s digital infrastructure (EHRs, pathology and radiology applications, etc.) and beyond when the MCP partners with both technology vendors on their platform and external hospitals and systems.

The challenge of maintaining trust in a UDHP is considerable. In the MCP case, one can find technology solutions that can have a platform business model that engages with multiple other technology vendors. This creates a “platform of platforms” scenario with considerable complexity and can carry with it cybersecurity risks if collaborators of these external platforms have security vulnerabilities or challenges with interoperability. Therefore a rigorous vetting process with standards for not only validation of AI models but inclusive of integration into the MCP network.

Business and Strategic Implications of UDHPs

UDHPs will reshape many competitive dynamics of healthcare.

A Platform Shift – Disrupting EHRs?

In the short- to medium-term, UDHPs will be complementary to EHRs. EHRs are deeply entrenched in today’s healthcare delivery systems.

But as noted earlier, the roots of today’s EHRs are as systems of record to document claims submissions. To be fair, Epic, Oracle, and other EHRs are attempting to move beyond their historic narrow scope. 

But, the long-term prize is to become the system of action that automates interoperability, data sharing, and workflows within and across healthcare organizations. The BOI Strategy Playbook depicts the fundamental platform shift:

Health interoperability guru Brendan Keeler has noted that it probably won’t be another EHR that displaces Epic:

Disruptive software change for B2B SaaS takes decades across all industries for enterprise size clients. Meaningful disruption is not a pure play competitor but the end result of an entire platform change (Windows was disrupted by mobile, not by another PC OS or antitrust). What disrupts an incumbent EHR won’t be another EHR.

Oracle’s new, next generation EHR should be characterized more as a UDHP than as a traditional EHR. Writing in Cloud Wars, Bob Evans makes a case for Oracle’s strategy:

… the bromide about how “what got you here won’t get you there” will provide a stark example of why niche providers that dominated the on-prem world will be overmatched and pushed to the periphery in the modern world of cloud and AI. Larry Ellison has committed the full resources of his entire company to ensuring that Oracle Health can address not only EHRs and adjacent segments but also the entire $16-trillion healthcare industry….Oracle has been dealing with everything from software integration to massive global deployments to complex governance issues for the world’s largest and most-complex organizations for more than 30 years.

EHRs likely won’t go away, but they’re at risk of becoming commoditized as the value-creation and value-capture opportunity shifts toward UDHPs.

UDHPs Enable New Ecosystems & Strategic Partnerships

While private health systems are likely early customers, UDHPs can be adopted by or extended to many other sectors or subsectors of healthcare. Let’s consider some examples:

Consulting firm Zühlke described how UDHPs can be deployed by life sciences companies.

Because life sciences companies… are not tech companies, they will usually want to consider licensing a digital health technology platform in the form of a platform as a service (PaaS). This enables them to sidestep some of the complexity of building their own platform and focus on their core business.

Salesforce described how its UDHP offering is suitable for Med Tech companies. 

Many MedTech companies rely on multiple technology systems that weren’t designed with customer engagement or the ability to work with each other in mind. It’s essential to integrate this into a unified experience. A single platform that is easy to manage, can grow with your business, and can integrate with existing data and homegrown systems can power your organization more effectively.

Government organizations are candidates for UDHP adoption. An Australian public hospital system deployed ServiceNow’s UDHP.

Better’s UDHP is the underlying technology supporting the OneLondon shared care planning solution across the city of London. The  “end-of-life Universal Care Plan (UCP) – is supporting a population of approximately 10m people, across 5 Integrated Care Systems, over 40 NHS trusts, and 1,400 general practices.” 

A report for the Norwegian Directorate of e-health illustrates how a UDHP could go beyond EHRs to enable a broader digital care delivery system:

Finally, we see the potential for the creation and adoption of UDHPs that cater to particularly large and/or complex subsectors of healthcare delivery. Medical imaging is one example where a UDHP might be deployed by an imaging center, a large radiology group, or even within a health system.  According to NetApp, “medical imaging comprises 90% of medical data [storage] worldwide.“ Of the over 1,000 FDA-authorized AI medical device algorithms, approximately 75% relate to medical imaging. 

AI Will Play a Major Role in UDHP Adoption

While we foresee that AI will play a key role in UDHP adoption and implementation, the specifics are unclear and up for grabs. We anticipate that over time AI will be embedded in every layer of healthcare IT and will be applied to a wide range of administrative and clinical workflows – both within and across organizations. 

An example – in the past, there have been huge battles over user interfaces:

Another user interface battle is shaping up for clinician mindshare. AI will play a major role.

As noted in TechCrunch, “the interface is where the profit is.” We can anticipate the battle…but anticipating the winner(s) is much harder.

UDHPs Enable Platform Business Models

Incumbent healthcare organizations can extend UDHP technological infrastructure to reconceptualize themselves as having platform business models. SAP makes the case that “the future hospital is a platform.” 

Mayo Clinic has been a poster child for innovative thinking with its Mayo Clinic platform. Dr. Gianrico Farrugia, President and CEO at Mayo Clinic, described Mayo’s transition from a traditional pipeline business model to an innovative platform model:

Our current healthcare model functions as a pipeline, which is linear, highly transactional, and inflexible. The failings of this model were clear during the pandemic, where collaboration was limited and stress to individual nodes led to points of failure. This, in turn, hampered and in some cases paralyzed the entire system. 

A platform model of health care and ecosystem is fundamentally different. A platform is built around secure, collective resources such as a powerful analytic engine and an open ecosystem of trusted collaborators and is highly dynamic, self-learning, inherently accessible, and scalable. This approach brings together providers, medical device companies, health tech startups, patients, and payers, among others, to design integrated end-to-end solutions that are supported by longitudinal clinical data and AI algorithms. A platform is purposefully collaborative and fuels innovation and access instead of limiting it.

UDHPs Advance the Movement Toward Cloud (CIO POV)

Across industries, the IT landscape is experiencing a significant shift towards cloud computing. Organizations are increasingly adopting multi-cloud and hybrid cloud strategies to optimize operations, enhance flexibility, and reduce vendor lock-in. This trend is driven by the need for scalability, cost-efficiency, and access to advanced services like AI and analytics. 

UDHPs align strongly with the cloud computing trend by leveraging its scalability, flexibility, and accessibility. Cloud infrastructure enables UDHPs to integrate disparate systems, facilitate data sharing, and support innovative applications.

Long-Term Potential for Winner(s)-Take-All?

Currently there are 20+ UDHPs. This market has many long-term characteristics of a highly concentrated, winner(s)-take-all marketplace. By “highly concentrated”, we mean a monopoly (one dominant firm), a duopoly (two dominant firms), or an oligopoly (a small group of dominant firms — typically three to five):

We foresee the UDHP market as becoming a battle for applications and developers. Developers prefer to work on as few platforms as possible, ideally one or two.

UDHPs thus will have strong indirect network effects. Buyers will prefer UDHPs that offer a wide range of applications created by developers; developers will converge on platforms that have the greatest number of buyers.

The smartphone operating system (OS) market provides an analogy. In 2006, there were 12 companies offering smartphone OSs; by 2015, the battle was over — Android and Apple iOS owned more than 99% of the market. Today these winners each boast over 2 million apps on their OS platforms.

Implications: As the UDHP market becomes more concentrated,  there will be a few winners and many losers. Buyers should evaluate vendors carefully.

Summing Up

Unified Digital Health Platforms are a new category of enterprise software, one that Gartner predicts “will, over time, replace the dominant era of the monolithic electronic health record (EHR).”

Today, the UDHP market is still very early – about 5% penetrated.

UDHPs offer compelling value propositions –  improving clinical care, overcoming the limitations of EHRs, offering modular architectures, enabling a common infrastructure, and providing competitive advantage.  

UDHPs also promise to shake up the competitive landscape of healthcare by creating a major platform shift. In the short term, they must collaborate with EHRs; in the long term, they can commoditize EHRs. They enable new platform business models and facilitate the development of new ecosystems and partnerships. 

UDHPs will play a major role in the broader “platforming” of healthcare. They’re a trend worth watching.

Vince Kuraitis JD/MBA is an independent consultant with over 35 years’ experience across 150+ healthcare & tech companies. He publishes The Healthcare Platform Blog, where this post first appeared.

Girish Muralidharan was an SVP at GE Healthcare until April 2024 and held a variety of Executive business management roles across Imaging equipment, tech enabled services, digital platforms & solutions over the last 2 decades.

Dr. Jody Ranck is a researcher with over 30 years of experience in global and domestic US health technology and covered AI, data analytics, and SDoH with Chilmark Research.

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Musk Moves US to Socialized Medicine 1 Apr 5:17 AM (7 days ago)

By THCB STAFF

After a few weeks analyzing government spending and putting all of his calculations into Grok, the head of DOGE, Elon Musk, has made another decisive move in the attempt to save the government money. Speaking on the Joe Rogan show, Musk declared that his team had given Big Balls and Little Balls instructions to stop screwing around with the minor stuff like cutting off foreign aid saving the lives of children or getting all worked up about storing paper records in a mine, and to “go after the real money”. It turns out that means putting all US health care into a national health service and eliminating all private, non state-run health care.

He told Rogan, in between injections of what he claimed were vitamin supplements, that “the DOGE team realized that the British government spends about $7,500 per capita on health care, and the US government spends about $8,000”. After observers noticed a few puffs of smoke coming from Musk’s side of the room he went on to say, “that means our government can use the example of the Brits and cut spending by $500 a head and as an added bonus, private employers can stop wasting money on health care premiums”. When asked by Rogan if this new move was influenced by his desire to cut costs at his companies, Musk appeared to be unaware that he ran any companies.

Musk went on to say, “it’s incredible that we’ve been giving all these hospitals and health insurers government money and they’ve been sticking it in their hedge funds. Little Balls told me that he read a post from some blogger claiming that there’s over $500 billion sitting on the balance sheets of big hospitals and non-profit health plans. Now we have nationalized them all, that money can be put to better use.”

Rogan asked him how this would work and Musk said that all doctors, nurses and hospitals now worked for the Federal government and could just deliver care for free. “They’ll be paid British wages, and they’ll be happy–British people are still rich enough to be buying Teslas, no one else is! And if the line is too long, then people can fly to Scotland where they’ve got this socialized health care thing down pat. I understand President Trump has a special going at his hotel on that golf course, if you don’t mind looking at the windmills.”

When asked whether he supported Musk’s move, President Trump told the White House press corps that he wasn’t on the group call but that Don Jr had mentioned that Adderall was free in the UK, so it seemed like a good idea to both of them.

In unrelated news, Tesla also announced a stock buy-back in the amount of $500 billion.

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Platform Shift: From EHRs to UDHPs (Unified Digital Health Platforms)- Section 1 30 Mar 11:21 PM (8 days ago)

By VINCE KURAITIS, GIRISH MURALIDHARAN & JODY RANCK

This entry is part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown below.

30 Year

This entry is part 3 of 3 in the series Platforming Healthcare — The Long View. This essay is the next in the series entitled “Platforming Healthcare — the Long View”. The series presents a 30-Year Framework for Platforming Healthcare. An updated v2.0 of a graphic depicting this 30-Year Framework is shown above.

Today’s post will describe and discuss a potential successor to the EHR era — Unified Digital Health Platforms (UDHPs). Here’s an overview:

Later this week THCB will run the second section which will include analysis of the Mayo Clinic Platform.

Background and Environmental Trends

Healthcare is fragmented. Data is not standardized and has existed in silos. Patients and clinicians have disjointed experiences. Payment structures create conflicting incentives.

Electronic Health Records (EHRs) were once touted as the key solution for transforming healthcare to a modern, digitally-enabled industry. Yet, they continue to frustrate clinicians with poor UI/UX and largely fulfill a primary role as a system of record to document claims submissions. 

Recent technological and business trends have begun transforming healthcare into a more unified and integrated experience: 

Healthcare organizations want integrated solutions, not more point solutions. See the previous blog post in this series — “Beyond Awareness: Understanding the Magnitude of Point Solution Fatigue in Healthcare”.

Gartner’s Key Role in Characterizing the UDHP Movement

The trends and forces listed above open the door and create the need for a new category of enterprise software – Unified Digital Health Platforms (UDHPs). 

A December 2022 Gartner Market Guide report characterized the long-term potential:

The 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).

While Gartner uses the term “Digital Health Platform (DHP), we use the term “Unified Digital Health Platform” because 1) it’s more descriptive of the architecture and its capabilities, and 2) it distinguishes UDHPs from the thousands of other digital health platforms that vary highly in function.

The DHP Reference Architecture is illustrated in a blog post by Better. Note that UDHPs are depicted as “sitting on top” of EHRs and other siloed sources of health data:

Gartner continues to update its market reports on UDHPs. An April 2024 update is entitled: “Innovation Insight: Digital Health Platforms Accelerate Transformation”. As of the date of publishing this blog post, Altera is offering a complimentary copy of Gartner’s 2024 report on UDHPs.  

This blog post is intended to focus more on the business and strategy implications of UDHPs. We strongly recommend reading Gartner’s April 2024 report on UDHPs to gain a more technical perspective.

Gartner also provides an updated (but not exhaustive) list of UDHPs:

We’ll add our own candidates to the list:

The UDHP trend is in very early stages. In its April 2024 report, Gartner estimates that the market is only 5% penetrated and that UDHP adoption will take 5 to 10 years. 

As of today, the capabilities of UDHP offerings are not uniform. In an early market, it isn’t unusual that early offerings from companies will differ. We’ll discuss some possible ramifications in the section below on “Business and Strategic Implications of UDHPs”.

It’s possible that UDHP adoption will move more quickly in countries outside the U.S. In the U.S., Epic and Cerner have a lock on health systems and are attempting to become UDHPs themselves.

In the appendix at the end of the post, we’ve provided a list of resources to explain UDHPs further.

UDHP Value Propositions

UDHPs promise a range of potential value propositions:

Examples of UDHPs

We’ll provide a couple of case studies to illustrate how UDHPs are being developed and deployed:

We invite other UDHP vendors to contribute a substantive guest post describing their offering and how customers deploy it. (Write to Vince vincek@bhtinfo for details.)

Case Study: ServiceNow’s Unified Digital Health Platform in Healthcare Operations

One example of a UDHP in practice is ServiceNow’s digital health platform. This case study examines its architecture, customization capabilities, and real-world applications within healthcare provider settings.

ServiceNow’s UDHP Architecture and Key Components

As shown in the diagram below, ServiceNow’s digital health platform is structured to integrate multiple healthcare workflows while ensuring compliance and security. The platform is built on a multi-layered architecture that includes:

The layered approach enables healthcare organizations to integrate existing IT systems while adopting new digital health solutions.

Custom Workflow Capabilities: Enhancing Operational Efficiency

One of the key advantages of ServiceNow’s UDHP is its capability to support custom workflows tailored to the needs of healthcare providers. Custom workflows allow organizations to automate and optimize processes beyond standard out-of-the-box solutions.

Example: Custom Workflow for Clinician Onboarding

A common challenge in healthcare is the complexity of onboarding new clinicians, especially in large hospital networks. Traditional onboarding processes involve multiple departments, including HR, IT, and credentialing teams, often leading to inefficiencies.

Using ServiceNow’s workflow automation tools, a healthcare organization can create a customized onboarding process that:

By implementing a structured digital workflow, healthcare organizations can accelerate onboarding times, reduce administrative workload, and enhance compliance tracking.

Published Examples of ServiceNow’s UDHP in Healthcare Providers

Several healthcare organizations have deployed ServiceNow’s platform to address operational inefficiencies and improve service delivery. The following examples highlight how UDHP capabilities have been applied in different healthcare settings.

  1. Novant Health: Reducing Administrative Bottlenecks

Novant Health implemented ServiceNow to streamline IT service management and automate healthcare workflows. By leveraging UDHP capabilities, the organization improved system uptime and reduced delays in patient care caused by IT-related issues. Automated workflows ensured that clinicians had immediate access to necessary systems, reducing time spent on administrative requests.

  1. Sentara Healthcare: Digital Workflow Optimization

Sentara Healthcare used ServiceNow’s digital workflows to integrate various operational processes across its network of hospitals and outpatient centers. The platform enabled real-time tracking of equipment maintenance requests, staff allocation, and patient coordination, leading to increased efficiency in care delivery.

  1. Elara Caring: Standardizing Processes Across Multiple Locations

Elara Caring, a home healthcare provider, faced challenges in managing patient referrals, caregiver scheduling, and compliance documentation. By adopting ServiceNow’s UDHP, Elara Caring unified these processes into a single workflow, reducing errors and improving overall patient service coordination.

Conclusion

ServiceNow’s UDHP illustrates the potential of digital platforms in optimizing healthcare workflows, improving operational efficiency, and ensuring compliance. By leveraging structured data, automation, and custom workflows, healthcare organizations can adapt the platform to their unique operational needs.

As more healthcare providers shift towards digital transformation, UDHPs will play a critical role in bridging gaps between traditional healthcare IT systems and emerging digital health innovations.

Vince Kuraitis JD/MBA is an independent consultant with over 35 years’ experience across 150+ healthcare & tech companies. He publishes The Healthcare Platform Blog, where this post first appeared. Girish Muralidharan was an SVP at GE Healthcare until April 2024 and held a variety of Executive business management roles across Imaging equipment, tech enabled services, digital platforms & solutions over the last 2 decades.Dr. Jody Ranck is a researcher with over 30 years of experience in global and domestic US health technology and covered AI, data analytics, and SDoH with Chilmark Research.

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Emory, Balloon Angioplasty, and the Musk Attack on Medical Diplomacy 27 Mar 11:37 PM (11 days ago)

By MIKE MAGEE

 “The recently announced limitation from the NIH on grants is an example that will significantly reduce essential funding for research at Emory.”       

                                              Gregory L. Fenes, President, Emory University 

In 1900, the U.S. life expectancy was 47 years. Between maternal deaths in child birth and infectious disease, it is no wonder that cardiovascular disease (barely understood at the time) was an afterthought. But by 1930, as life expectancy approached 60 years, Americans stood up and took notice. They were dropping dead on softball fields of heart attacks. 

Remarkably, despite scientific advances, nearly 1 million Americans ( 931,578) died of heart disease in 2024. That is 28% of the 3,279,857 deaths last year. 

The main cause of a heart attack, as every high school student knows today, is blockage of one or more of the three main coronary arteries – each 5 to 10 centimeters long and four millimeters wide. But at the turn of the century, experts didn’t have a clue. When James Herrick first suggested blockage of the coronaries as a cause of heart seizures in 1912, the suggestion was met with disbelief. Seven years later, in 1919, the clinical findings for “myocardial infarction” were associated with ECG abnormalities for the first time. 

Scientists for some time had been aware of the anatomy of the human heart, but it wasn’t until 1929 that they actually were able to see it in action. That was when a 24-year old German medical intern in training named Werner Forssmann came up with the idea of threading a ureteral catheter through a vein in the arm into his heart. 

His superiors refused permission for the experiment. But with junior accomplices, including an enamored nurse, and a radiologist in training, he secretly catheterized his own heart and injected dye revealing for the first time a live 4-chamber heart. Two decades would pass before Werner Forssmann’s “reckless action” was rewarded with the 1956 Nobel Prize in Medicine. But another two years would pass before the dynamic Mason Sones, Cleveland Clinic’s director of cardiovascular disease, successfully (if inadvertently) imaged the coronary arteries themselves without inducing a heart attack in his 26-year old patient with rheumatic heart disease. 

But it was the American head of all Allied Forces in World War II, turned President of the United States, Dwight D.Eisenhower, who arguably had the greatest impact on the world focus on this “public enemy #1.” His seven heart attacks, in full public view, have been credited with increasing public awareness of the condition which finally claimed his life in1969. 

Cardiac catheterization soon became a relatively standard affair. Not surprisingly, less than a decade later, on September 16, 1977, an East German physician, Andreas Gruntzig performed the first ballon angioplasty, but not without a bit of drama. 

Dr. Gruntzig had moved to Zurich, Switzerland in pursuit of this new, non-invasive technique for opening blocked arteries. But first, he had to manufacture his own catheters. He tested them out on dogs in 1976, and excitedly shared his positive results in November that year at the 49th Scientific Session of the American Heart Association in Miami Beach. 

He returned to Zurich that year expecting swift approval to perform the procedure on a human candidate. But a year later, the Switzerland Board had still not given him a green light to use his newly improved double lumen catheter. Instead he had been invited by Dr. Richard Myler at the San Francisco Heart Institute to perform the first ever balloon coronary artery angioplasty on an awake patient.

Gruntzig arrived in May, 1977, with equipment in hand. He was able to successfully dilate the arteries of several anesthetized patients who were undergoing open heart coronary bypass surgery. But sadly, after two weeks on hold there, no appropriate candidates had emerged for a minimally invasive balloon angioplasty in a non-anesthetized heart attack patient. 

In the meantime, a 38-year-old insurance salesman, Adolf Bachmann, with severe coronary artery stenosis, angina, and ECG changes had surfaced in Zurich. With verbal assurances that he might proceed, Gruntzig returned again to Zurich. The landmark procedure at Zurich University Hospital went off without a hitch, and the rest is history. 

Within a few years, Gruntzig accepted a professorship at Emory University and relocated with his family. He was welcomed as the Director of Interventional Cardiovascular Medicine.

 “Unlike Switzerland, the United States immediately realized Grüntzig’s capacity and potential to advance cardiovascular medicine. Grüntzig was classified as a “national treasure” by the authorities in 1980; however, he was never granted United States citizenship. Emory University had just received a donation of 105 million USD from the Coca-Cola Foundation (an amount which in 2014 would equal approximately 250 million USD), one of the biggest research grants ever given to an academic institution, which allowed the hospital to expand on treatment of coronary artery disease using balloon angioplasty technology.”

Grunting’s star rose quickly in Atlanta. His combination of showmanship, technical skills, looks and communication skills drew an immediate response. Historians saw him as a personification of the American dream. As they recounted, “The first annual course in Atlanta was held in February 1981. More than 200 cardiologists from around the world came to see the brilliant teacher in action. The course lasted 3 and 1/2 days with one live teaching case per half day and, with each subsequent course, the momentum for angioplasty increased.”

According to Emory records, “In less than 5  years at Emory, Grüntzig performed more than 3,000 PTCA procedures, without losing a single patient.” Remarkably, after 10 symptom free years, Gruntzig’s original patient, Adolf Bachmann, allowed interventional cardiologists from Emory to re-catheterize him on September 16, 1987, the 10-year anniversary of his original procedure. The formal report documented that the artery remained open, and the patient was symptom free.

As this brief history well illustrates, science has historically been a collaborative and shared affair on the world stage. In an age where Trump/Musk simultaneously disassemble America’s scientific discovery capabilities, undermine historic cooperation between nations, and leave international cooperative public health initiatives in shambles, it is useful to remember that institutions like Emory have well understood that science requires international cooperation, and not only has the power to heal individuals, but also promote healthy diplomacy between nations.

Mike Magee MD is a Medical Historian, and a regular contributor to THCB. He is the author of the Kirkus Star reviewed CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

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The Life365 Demo 26 Mar 11:11 PM (12 days ago)

Kent Dicks, CEO, and Kendall Paulsen, Telehealth Solutions lead, at Life 365 showed me their comprehensive set of tools and services for remote patient monitoring, or what I call the “continuous clinic”. Kent did this with MedApps, later acquired by Alere. But at Life 365 he’s building a new approach to getting the tools and platforms easy to use for patients, and also getting that collected data ready for AI systems to monitor patients and enable more immediate care. And Kent & Kendall not only talk about it but they show a deep-water demo with both devices and dashboards of both the monitoring and drug adherence devices. A glimpse into where health care ought to be and hopefully is going!–Matthew Holt

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The Return of American Manufacturing Demands a Chief Health & Benefits Officer (CHBO) to Fix Benefits Procurement 25 Mar 11:42 PM (13 days ago)

By MATT McCORD

American manufacturing is making a comeback. Driven by tariffs, supply chain instability, and shifting economic priorities, companies are reshoring production—reinvesting in U.S. labor and operations.

But there’s one major obstacle still standing in the way: the crushing cost of American healthcare.

For decades, U.S. employers have overpaid for healthcare without improving outcomes. Ballooning insurance premiums bloated administrative costs, and an opaque, middleman-driven system have left businesses with the highest healthcare costs in the world—twice as much as top global competitors.

If manufacturing is returning, shouldn’t we be demanding a more efficient and productive healthcare model to support it? The same industries that once offshored to escape labor costs must now confront the reality that the old way of buying healthcare is broken.

The Consolidated Appropriations Act (CAA) & The Growing Fiduciary Risk

The game has changed. The Consolidated Appropriations Act (CAA) of 2021 imposes strict new fiduciary requirements on employers that sponsor health plans. Companies can no longer blindly trust big insurance carriers or PBMs to act in their best interest.

If businesses fail to properly manage their healthcare spend, they are now liable for excessive costs, lack of transparency, and conflicts of interest.

🔴 This isn’t just theoretical—JP Morgan Chase is now facing a class-action lawsuit over how it managed its employee health plan, with board members named as defendants.

Employers have always scrutinized office supply costs, travel budgets, and vendor contracts—yet they’ve handed over healthcare procurement to third-party insurers with zero accountability.

Now, that lack of oversight is a legal risk.

Why Employers Need a Chief Health & Benefits Officer (CHBO)

Every major business function has an executive leader ensuring strategy, efficiency, and accountability:

So why do we continue to let third-party insurers and middlemen dictate healthcare purchasing without a dedicated executive overseeing the strategy?

Mark Cuban recently called for a new C-suite role: the Healthcare CEO (HCEO). A more appropriate and less confusing term may be the Chief Health & Benefits Officer (CHBO).  This leader would act as a fiduciary to the company, ensuring that its health benefits strategy delivers better outcomes at lower costs—just like a CFO does with financial oversight.

This isn’t a job for HR.

Most CHROs are already managing compensation, talent strategy, DEI, workforce development, compliance, and more. Expecting HR to also master complex healthcare contracting, negotiate with PBMs, and enforce fiduciary accountability is unrealistic and unfair.

A Chief Health & Benefits Officer would ensure:

✔ Walking away from wasteful industry incumbents (big insurance carriers, opaque PBMs, overpriced hospital networks).
✔ Building custom health benefit plans with direct contracts and value-based care.
✔ Using a pass-through PBM to ensure drug pricing transparency and lower costs.
✔ Eliminating middlemen that add cost without improving care.
✔ Negotiating like a CFO—treating healthcare as a business expense, not a sunk cost.

The Wrong Approach: Cost Shifting is Not a Solution

For years, businesses have responded to rising healthcare costs by pushing the financial burden onto employees—higher deductibles, increased out-of-pocket expenses, and restrictive networks.

But a workforce buried in medical debt, avoiding care, or battling chronic conditions without treatment is not a productive workforce. Instead of asking,
❌ “How much more can we make employees pay?”
we should be asking,
✅ “How much can we save by purchasing healthcare smarter?”

A Fiduciary Approach to Healthcare Purchasing

Just as a CFO would never let a company overpay for raw materials, a CHBO would never let a company overpay for healthcare.

This means adopting modern, fiduciary-driven healthcare procurement strategies such as:

✔ Transparent pricing and direct contracting with high-quality providers.
✔ Pass-through PBMs that eliminate spread pricing and rebate traps.
✔ Advanced primary care and on-site clinics that reduce hospitalizations and ER visits.
✔ Customizable health plans that fit the company’s workforce needs—not a one-size-fits-all insurance carrier plan.

The best companies don’t tolerate inefficiency in any other major expense, so why should healthcare be any different?

Call to Action: It’s Time for Bold Action

The legal risks of ignoring healthcare procurement have never been higher.

Companies that embrace CHBO leadership and fiduciary-driven healthcare purchasing will gain a massive competitive advantage. They’ll spend less on waste, provide better benefits, and attract top talent.

The companies that stick with the status quo? They’ll continue overpaying, facing lawsuits, and struggling with rising costs.

Manufacturing is returning to America. But without fixing the broken healthcare system, we risk driving it away again.

It’s time for bold leadership. It’s time for the CHBO.

Matt McCord, MD is an anesthesiologist and founder of Opioid Free Solutions and Benesan.org, helping employers address overprescribing while modernizing health benefits purchasing

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Home, Alone 24 Mar 11:09 PM (14 days ago)

By KIM BELLARD

News flash: America is not a very happy place these days.

No, I’m not talking about the current political divide (which is probably more accurately described as a chasm), at least not directly. I’m referring to the latest results from the World Happiness Report, which found that the U.S. has slid to 24th place in the world, its lowest position ever. We were 11th in 2011, the first such report.

Nordic countries scored the highest yet again, taking half of the top ten counties, with Finland repeating for the eighth year in a row as the happiest country. America’s nearest neighbors Mexico (10th) and Canada (18th) are happier places, tariffs or not.

The researchers declare: “Belief in the kindness of others is much more closely tied to happiness than previously thought.” They specifically cite the belief that others would return a lost wallet is a strong predictor of a country’s happiness, while noting that such returns are twice as likely as people believe them to be.

John F. Helliwell, an economist at the University of British Columbia, a founding editor of the World Happiness Report, said:

The wallet data are so convincing because they confirm that people are much happier living where they think people care about each other. The wallet dropping experiments confirm the reality of these perceptions, even if they are everywhere too pessimistic.

The U.S., as it turned out, ranked only 52nd in believing a stranger would return a lost wallet, and even only 25th that the police would. We were slightly more optimistic (17th) that our neighbors would.  

Sharing meals with others is also strongly linked to happiness. “The extent to which you share meals is predictive of the social support you have, the pro-social behaviors you exhibit and the trust you have in others,” Jan-Emmanuel De Neve, a University of Oxford professor and an author of the report, told The New York Times.

Unfortunately, the number of people dining alone in the U.S. has increased 53% over the past two decades. According to the Ajinomoto Group, among American adults under 25, it has jumped 80%.

Young Americans are helped drive our dismal results generally. “The decline in the U.S. in 2024 was at least partly attributable to Americans younger than age 30 feeling worse about their lives,” Ilana Ron-Levey, managing director at Gallup, told CNN. “Today’s young people report feeling less supported by friends and family, less free to make life choices and less optimistic about their living standards.”

Eighteen percent (18%) of young U.S. adults (18-29) report not having anyone they feel close to, the highest of all the U.S. age groups, and those same young adults also have lower quality of connections than older U.S. respondents. The report speculates: “Although not definitive, this provides intriguing preliminary evidence that relatively low connection among young people might factor into low wellbeing among young Americans.”

In fact, if the U.S. was measured just by the happiness of our young adults, we wouldn’t even rank in the top 60 countries. “It is really disheartening to see this, and it links perfectly with the fact that it’s the well-being of youth in America that’s off a cliff, which is driving the drop in the rankings to a large extent,” Professor De Neve said.

Researchers also point to inequality as an important factor. “In these Nordic Scandinavian countries, a rising tide lifts all boats, so the levels of economic inequality are much less, and that reflects in well-being as well,” Professor De Neve said. “In Finland, most people will rate [their happiness] as seven or an eight, whereas if you look at the distribution of well-being in the States, there’s a lot of 10s out there, but there’s a lot of ones as well.”

No wonder. According to The Urban Institute:

Wealth inequality is higher in the United States than in almost any other developed country and has risen for much of the past 60 years. Racial wealth inequities have persisted for generations, reflecting the long-standing effects of racist policies, not individual intentions or deficits.

So, no, we’re not all in this together, especially with the bottom 50% having a mere 2.4% of all household wealth, one of the lowest points we’ve seen. Americans also say we’re deeply divided both politically and on values (which, of course, are not unrelated).

Professor Jan-Emmanuel De Neve summarized some key takeaways from their report:

This year’s report pushes us to look beyond traditional determinants like health and wealth. It turns out that sharing meals and trusting others are even stronger predictors of wellbeing than expected. In this era of social isolation and political polarisation we need to find ways to bring people around the table again — doing so is critical for our individual and collective wellbeing.

“The fact that we’re increasingly socially isolated means also that we’re not testing our ideas about the world with other people,” Dr. De Neve explained to the NYT. “And the more you sit around the table with other people who might have somewhat different views, the more you start moderating your own views. And the increasing lack of social interaction and social isolation as a result, for a lot of people — amplified by echo chambers — makes people more radical.”

If you’ve read Robert Putman’s classic Bowling Alone (2000) – and, if you haven’t, stop reading this, go buy a copy, and read it – then none of this will be a surprise. Professor Putnam described how, even before the advent of social media, the U.S. went from a society that did a wide variety of things together into one that tended to be more insular, at the cost of much of our social capital.  We could sure use that social capital now.

Sure, there’s a lot to be unhappy about in today’s America. Most Americans don’t think the country is on the right track. We don’t trust our various institutions. We use social media, but we’re very worried about its impact – much more so than the rest of the world. Eight percent of us have no close friends. 

Look, I can understand being behind Finland, Denmark, even New Zealand in overall happiness, but Slovenia or the U.A.E.? Seriously. We need to put our phones down, stop arguing about politics, go out to eat with friends, and, for goodness’ sake, if you find a wallet, be sure to return it to its owner.Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

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