by Vince Kuraitis and Neil P. Jennings of Untangle Well being
Right here’s a top level view of at the moment’s weblog publish:
- A Temporary Recap: What are UDHPs?
- Thesis: EHRs Can Broaden to Change into UDHPs
- EHRs At the moment Personal the Buyer Relationship
- Many Clients Have an “EHR-First” Desire for New Purposes
- Epic and Oracle Well being are Making Robust Actions Towards Turning into UDHPs
- Antithesis: EHRs Can NOT Change into Efficient EHRs
- EHRs Carry a Lot of Baggage
- Clients are Skeptical
- EHR Analytics Are NOT Optimized To Obtain Crucial Well being System Goals
- EHR Switching Prices are Diminishing
- Cloud Native Platforms Speed up Innovation and Efficiency
- It’s Not in EHR DNA to Change into A Broad-Primarily based Platform
- Synthesis and Conclusion
It is a lengthy publish…over 4,000 phrases…so we’ve clearly obtained so much to say on the matter. Hope you introduced snacks!
A Temporary Recap: What are UDHPs? (Unified Digital Well being Platforms)
In our previous extensive post on UDHPs, we described them as a brand new class of enterprise software program. A December 2022 Gartner Market Information report characterised the long-term potential:
The [U]DHP shift will emerge as essentially the most cost-effective and technically environment friendly strategy to scale new digital capabilities inside and throughout well being ecosystems and can, over time, exchange the dominant period of the monolithic digital well being document (EHR).
The DHP Reference Structure is illustrated in a blog post by Better. Notice that UDHPs are visually depicted as “sitting on high” of EHRs and different siloed sources of well being information:
We famous that just about any sort of huge healthcare group — well being programs, well being plans, pharma corporations, medical gadget corporations, and so on. — had a necessity for UDHPs. Nonetheless, at the moment’s focus is extra slim — we restrict the dialogue to UDHPs in hospitals and well being programs, primarily within the U.S. We use the time period “well being system” to embody hospitals and regional well being supply programs.
On this publish, we deal with the 2 largest EHR distributors within the U.S. — Epic and Oracle Well being; they’ve a combined market share of 65% of hospitals and 77% of hospital beds.
Within the remaining sections, we are going to lay out arguments on each side of the difficulty of whether or not EHRs can (or can’t) develop to develop into UDHPs. The graphic beneath is our crack at a visible abstract. The balloons signify the thesis – that EHRs can develop to develop into UDHPs; the anchors signify the antithesis – that EHRs cannot develop to develop into UDHPs.
Thesis: EHRs Can Broaden To Turning into UDHPs
Let’s take a look at the case for EHRs increasing to develop into efficient UDHPs.
1) EHRs At the moment Personal the Buyer Relationship
Fueled by federal HITECH incentives and mandates, well being programs have made important investments of their current EHRs:
- As of 2021, 96% of non-federal acute care hospitals within the U.S. had adopted a licensed EHR.
- They made large capital commitments to buy and set up their EHR, typically tons of of hundreds of thousands of {dollars}.
- Many current scientific workflows are constructed on EHRs.
- A majority of a affected person’s scientific information in a well being system resides inside their EHR.
Based on SoftwareReviews, Epic and (Oracle) Cerner Millennium EHRs obtain good to excessive rankings from well being system clients.
Thus, any new vendor making an attempt to promote new healthcare enterprise software program (i.e., a UDHP) will face a excessive hurdle: “We have already got an EHR…why ought to we think about you?”
2) Many Clients Have an “EHR-First” Desire for New Purposes
Well being programs have been attempting to remain afloat in a veritable tsunami of point solutions. This creates a variety of challenges, together with:
- Complexity and integration challenges
- Regulatory and compliance dangers
- Fragmentation of care
- Consumer adoption and coaching
- Price and ROI considerations
As proven within the graphic beneath, a 2024 Bain & Company/KLAS survey of well being programs discovered that 81% more and more plan to look to current distributors earlier than contemplating choices from new distributors.
Extra particularly, the survey discovered that 79% plan to look to their EHR vendor first for brand spanking new options earlier than seeking to others.
University Hospitals is an instance of a well being system with an EHR-First technique. Based on Robert Eardley, CIO, this tenet ensures the well being system prioritizes instruments and improvements obtainable inside its Epic digital well being document platform at any time when possible.
3) Epic and Oracle Are Making Robust Actions Towards Turning into UDHPs
Maybe the perfect argument that EHRs are able to changing into Unified Digital Well being Platforms is that Epic and Oracle Well being are already making daring strikes. Let’s check out them individually.
Epic’s EHR Enlargement Plans
Epic is greater than a primary EHR — it affords current clients a broad base of capabilities. Interop guru Brendan Keeler has written extensively about Epic. In his article “An Epic Saga: The Origin Story” he describes how Epic grew to its present measurement. The Appendix gives an intensive checklist of “Epic Modules.”
In an insightful 2024 analysis of Epic’s dominant market position, Seth Joseph included a listing of Products You Can Replace with Epic. The checklist included over 150 capabilities “that will help you establish areas the place you might use your Epic software program to both exchange or keep away from buying area of interest purposes…”
Epic is also increasing new choices to new buyer classes. Within the article “Epic Beyond the Provider Empire“, Brendan Keeler gives an in depth checklist:
Well being Grid — software program offered to
- Labs
- Medical gadget corporations
- Payers
- Telehealth corporations
- Scientific trials
Well being Grid Adjoining choices
- Cosmos — “a large scientific dataset created by pooling data from Epic well being programs”
- Payer Gateway — a “lighter-weight service for payers that allows them to obtain scientific information from Epic healthcare organizations”
- Chart Gateway — “Epic’s service that streamlines how life insurance coverage corporations get medical data from Epic healthcare organizations”
- EpicCare Hyperlink — “a web-based portal product that lets Epic healthcare organizations supply non-Epic suppliers a strategy to work together with them.”
Different stuff
- Provide Store — companies choices
- Revcyclers — “Third events working with Epic and supply billing companies to assist enhance income cycle outcomes”
- Cornerstone Companions — deep relationships with Microsoft and InterSystems
However wait…there’s extra. At HIMSS 2025, Epic announced further AI capabilities within the works and that it’s growing a healthcare-specific enterprise useful resource planning (ERP) system. Whereas we view an ERP as an enormous stretch, it’s additionally a possible game-changer for Epic.
Utilizing a framework created by David Yuan of Tidemark, Brendan Keeler capsulized Epic’s broader platform technique:
With additions just like the ERP, Epic is clearly evolving past a standard EHR system, however is it sufficient to fulfill the UDHP wants of contemporary well being programs?
Oracle Well being Goes Past Being a Conventional EHR
In October 2024, Oracle announced a brand new EHR. As described by the corporate, Oracle Health has many traits that make it look extra like a UDHP than a standard EHR. It goals to go considerably past the capabilities of a standard EHR:
- Embedded Synthetic Intelligence (AI): Not like EHRs the place AI is usually a bolt-on, Oracle’s new system is designed with AI as a core element, built-in throughout the complete scientific workflow. This features a Scientific AI Agent, AI-driven insights on the level of care, AI-powered summaries, and customized care plans.
- Enhanced Consumer Expertise: Recognizing the clinician burden related to conventional EHRs, the brand new system emphasizes an intuitive and user-friendly design with options like voice-driven navigation and search, multimodal search, and a customizable interface.
- Oracle Well being Information Intelligence is an AI and analytics resolution embedded inside the EHR, enabling integration of disparate information sources, real-time insights, and inhabitants well being administration instruments.
- Subsequent-Technology Oracle Cloud Infrastructure affords benefits of enhanced safety, scalability, and efficiency, and higher information change.
- Affected person Engagement Instruments: The brand new EHR features a reimagined affected person portal centered on empowering sufferers to entry and management their medical historical past, facilitating communication with suppliers, and enabling self-service capabilities for sufferers to handle appointments, pay payments, and entry well being data.
- Give attention to Worth-Primarily based Care: The system is designed to help value-based care fashions by streamlining data change between payers and suppliers, enhancing care coordination, and offering insights into value and useful resource allocation.
Oracle Well being goals to maneuver past being a system of document to changing into a system of motion — an clever, built-in platform that actively assists clinicians, engages sufferers, and drives higher outcomes in a extra environment friendly and safe method. Oracle’s most recent announcement of a platform partnership with Cleveland Clinic and G42 is in line with the migration towards changing into a UDHP.
Oracle Well being continues to be in its early levels of a roll-out, with an early adopter program launched in 2025. Due to this fact, in depth, broadly revealed surveys and large-scale buyer suggestions about this new platform aren’t but obtainable.
Antithesis: EHRs Can NOT Change into Efficient UDHPs
Now let’s study arguments suggesting that EHRs aren’t able to changing into well being programs’ “platform of platforms” — a UDHP.
1) EHRs Carry a Lot of Baggage
At present’s EHRs are criticized on a lot of fronts: errors and safety issues, cost, lack of competition, lack of interoperability, and lack of usability for clinicians. COVID-19 highlighted most of the weaknesses in EHRs as being “giant, sluggish monoliths that don’t shortly adapt to new, emergent calls for on their design and workflow.”
However what concerning the excessive satisfaction scores beforehand cited? EHRs usually tend to think about well being system directors as their “clients.” As famous above, clinician “person” satisfaction is usually low.
Distributors even have allowed clients to customise EHR implementations. Native customization results in substantial variations in how the system operates from one web site to a different. The usually-used colloquial phrase is that there are “50 dialects of Epic.” Whereas some extent of EHR customization is important and might improve clinician buy-in, over-customization can lead to problem interoperating, as information definitions and workflows can differ drastically. With every EHR occasion doubtlessly distinctive, extending EHRs to develop into UDHPs carries ahead organization-specific configurations which can lead to substantial longitudinal upkeep (for both the well being system or the companions linked to the EHR).
Lastly, Epic’s distinctive measurement and dominant market place may entice antitrust challenges from authorities regulators. Even at the moment, as Seth Joseph documents, Epic is already attracting lawsuits from a number of “smaller, adjoining distributors.” As Epic provides ERP and Cerner and Epic proceed including adjoining options and capabilities, they’re increasing their positions, doubtlessly garnering further regulatory oversight.
2) Clients are Skeptical
Even whereas many well being programs may need an “EHR-First” integration desire, many are additionally skeptical of their EHR vendor’s guarantees and their means to combine new apps. Sage Development Companions report entitled The New Healthcare C-Suite Agenda: 2024-25 addressed the difficulty:
C-Suites are at a expertise crossroads: Only a few are happy with their EMR vendor, the market is flooded with level options however integrations are irritating staff extra, and regardless of the coverage relaxations round telehealth over the past three years, telehealth and in-home hospital instruments should not nicely built-in with EMRs.
When requested “How nicely does your present vendor reside as much as the guarantees it makes concerning the EMR, solely 26% responded “extraordinarily nicely” or “very nicely.”
Maybe most significantly, “𝐨𝐧𝐥𝐲 𝟏𝟕% 𝐨𝐟 𝟐𝟎𝟐𝟑 𝐫𝐞𝐬𝐩𝐨𝐧𝐝𝐞𝐧𝐭𝐬 “𝐬𝐭𝐫𝐨𝐧𝐠𝐥𝐲 𝐚𝐠𝐫𝐞𝐞” 𝐭𝐡𝐚𝐭 𝐭𝐡𝐞 𝐄𝐌𝐑 𝐰𝐢𝐥𝐥 𝐦𝐞𝐞𝐭 𝐭𝐡𝐞 𝐦𝐚𝐣𝐨𝐫𝐢𝐭𝐲 𝐨𝐟 𝐭𝐡𝐞𝐢𝐫 𝐨𝐫𝐠𝐚𝐧𝐢𝐳𝐚𝐭𝐢𝐨𝐧’𝐬 𝐧𝐞𝐞𝐝𝐬 𝐦𝐨𝐯𝐢𝐧𝐠 𝐟𝐨𝐫𝐰𝐚𝐫𝐝, down from 25% in 2022.”
3) EHR Analytics Are NOT Optimized To Obtain Crucial Well being System Goals
Any particular person EHR can NOT be seen because the “supply of fact” for a affected person’s scientific historical past:
A number of EHR Distributors. Each within the U.S. and overseas, bigger well being programs typically are Frankenstein’s monsters stitched collectively from numerous acquisitions. Thus, they regularly sport a patchwork of competing EHRs. A HIMSS Analytics study discovered that the typical well being system has 18 completely different EHR distributors throughout inpatient and outpatient settings.
A number of Level Options and Sources of Information. Affected person information in well being programs is unfold throughout a number of programs, not simply EHRs.
Affected person and Information “Leakage.” At present’s sufferers are extra motivated by comfort than loyalty to at least one well being system; affected person leakage throughout care suppliers is critical. A research in International Journal of Medical Informatics discovered that “solely 4.5 % of expenditure-weighted particular person Medicare beneficiaries had their MU medical data related to a single vendor, whereas 19.8 % of expenditure-weighted beneficiaries had their MU medical data saved in 8 or extra distributors.”
Affected person Well being and Care Information is More and more Outdoors of EHRs. A McKinsey study examined how a lifetime of affected person well being and care information is more likely to be created (see the graphic beneath).
By including the numbers in the suitable column, you’ll see that an individual generates an estimated whole of 1,106.4 terabytes of well being information over the course of a lifetime. Nonetheless, solely 0.4 terabytes — or 0.04% — is scientific information, i.e., more likely to reside in at the moment’s EHRs.
The implication: EHRs are more likely to include solely a fraction of a affected person’s well being and care information. Optimum end-to-end analytical programs for affected person information — ones designed for each prevention and care – might want to pull information from throughout a various vary of sources. These capabilities don’t exist in at the moment’s EHRs.
We’ve famous that the roots of EHRs are as programs of document to doc processes for fee-for-service billing, nevertheless it goes deeper than that.
Pushed by early incentives like Significant Use, EHR design closely prioritized billing for particular person companies and administrative duties. Consequently, their structure emphasised documenting the quantity of care delivered for reimbursement, relatively than the worth of affected person outcomes and effectivity.
The restricted interoperability inherent in lots of early EHR programs fostered information silos. This fragmentation made it tough to realize the great, holistic affected person view important for efficient value-based care (VBC) and value-based funds (VBP), care coordination, inhabitants well being administration, whole value of care measurement and administration, and different capabilities wanted for cutting-edge well being programs.
In flip, conventional EHRs sometimes lacked entry to longitudinal claims information and the subtle analytics essential to robustly measure prices and affected person outcomes. Additionally they regularly lacked standardized mechanisms for capturing patient-reported outcomes (PROs) and didn’t streamline scientific workflows to particularly help value-focused care supply. In consequence, these programs weren’t inherently designed to optimize for the ideas and various cost fashions of VBC.
Whereas EHR expertise has superior, these foundational limitations proceed to current important hurdles for well being programs navigating the advanced transition in direction of VBC and inhabitants well being. Addressing these inherent design constraints is essential for realizing the total potential of digital well being in a future-proofed, value-driven healthcare panorama.
4) EHR Switching Prices are Diminishing
Up to now, switching EHRs was akin to shifting homes throughout a blizzard…with three toddlers and a herd of goats. Excessive switching prices created a defensive moat to guard EHRs from opponents, both different EHRs or a brand new class of UDHPs.
Nonetheless, authorities coverage, laws, and regulation over the previous 20 years have promoted interoperability and applicable change of affected person information. The HITECH Act, the twenty first Century Cures Act, the promotion of HL7 FHIR APIs, and the creation of TEFCA exemplify this development.
As affected person information turns into extra fluid and readily shareable throughout completely different programs, switching prices are diminished. That is much more pronounced exterior the U.S., the place requirements like openEHR – a standardized scientific information mannequin which separates information from purposes – are gaining traction, demonstrating the potential of knowledge standardization to ease system transitions. The EU Data Act mandates the flexibility to modify information suppliers seamlessly.
Moreover, the evolution in direction of a UDHP doesn’t essentially require a whole and fast EHR alternative. As we mentioned in a previous blog post, UDHPs will be architected to combine with and leverage current information repositories, together with EHRs. This incremental method to UDHP adoption can considerably cut back the perceived and precise prices of transitioning to a extra unified digital well being ecosystem.
5) Cloud Native Platforms Speed up Innovation and Efficiency
The roots of EHRs are as programs of document to doc fee-for-service billing processes, changing on-site processes with (sometimes) on-prem software program. UDHPs, alternatively, are sometimes cloud native software program, permitting broad scalability, availability, and performing as hubs for innovation. With CHIME’s 2024 survey suggesting “24% of CIOs highlighted applicational rationalization and optimization a high precedence,” this begs the query: the place ought to this software rationalization and optimization happen?
Cloud native software program is a robust contender, providing most of the CIO-sought advantages and the flexibility to scale in a cost-transparent method. Neil’s latest piece “Head in the Cloud: Today’s Healthcare Executive” covers the shift to cloud-first infrastructure because of extra than simply market wants, but additionally a change in management. Because the Epic-selecting CIOs of the 2010s are retiring, a brand new technologist profile is rising and leaning cloud-first.
To be clear, we’re not referring to easily lifting-and-shifting an EHR from on-prem to the cloud. Whereas altering internet hosting suppliers and areas can add incremental advantages to efficiency, value of possession, and scalability, the total advantages of cloud-first platforms should not achieved by migrating legacy software program.
To get the total advantages of a cloud-first method, there’ll should be a re-architecture of programs. It is a giant activity, however we have now most of the items at the moment, with scalable databases, Grasp-Information-Administration merchandise, EMPI merchandise, and headless EHRs (ONC Licensed EHRs of document that let clients to reskin the affected person and provider-facing experiences). Some main organizations are already creating cloud-hosted centralized information platforms that create a single supply of fact, brokering information throughout their technical ecosystem. Beneath, we’ll cowl some main advantages of this extra encompassing cloud-first method.
The place EHR distributors have traditionally moved slowly, cloud service suppliers are quickly including shared companies and tooling. With their consumption-based pricing fashions, they’re immediately incentivized to allow and encourage onboarding new customers, use instances, purposes, and databases. Not everybody will want or need to construct from scratch within the cloud, and as highlighted within the earlier publish, cloud-hosted ERP platforms are additionally rising to the event to fulfill UDHP wants.
Past the checklist of advantages above, it’s the method of those new service suppliers that encourages us to query whether or not EHRs can stay UDHPs in the long run. The cloud service suppliers (or hyperscalers) and ERPs are keen to combine with anybody, host and provision something anyplace, and supply centralized, distributed accessible, – and in addition open – programs. AWS and Azure, for instance, would fortunately host your Epic occasion, connect with your athenaHealth tablespace, and your level options. Please, proceed including extra!
And, they’ve essentially the most superior, scalable databases and information platforms to accommodate that information. This makes the following technology of level options, CDS options, or AI-derived brokers even simpler to create as cloud-first, as the information are already there, centralized, and accessible.
EHR clients are additionally flocking to cloud distributors already, seeing advantages in internet hosting prices, scalability, testing, and different areas. From KLAS’ Epic within the Public Cloud 2024 report: “The bulk [of survey respondents] make the most of a cloud supplier for Epic catastrophe restoration, and this typically serves because the preliminary step within the Epic cloud migration journey.” IDC takes it a step additional of their 2024-2025 Well being Information Platforms for Suppliers Vendor Evaluation, introducing multi-cloud implementations as a attainable route, stating that “Practically half (49.2%) of U.S. healthcare suppliers will prioritize IT modernization initiatives extending into 2025. This emphasizes the necessity for platforms that scale successfully and combine seamlessly with current and rising programs within the healthcare ecosystem. Multicloud adaptability can be important to attaining this.“
This implies one reply to the query of the place software rationalization and optimization ought to happen: within the cloud. The cloud distributors are keen and capable of accommodate any EHR and are aligning incentives to speed up cloud adoption. If these cloud platforms can handle healthcare’s information complexity, what’s stopping them from being the UDHPs accelerating innovation in healthcare?
6) It’s Not in EHR DNA to Change into a Broad-Primarily based Platform
EHRs are set of their methods – kinda like your uncle who nonetheless makes use of a flip telephone. Not like lots of at the moment’s most profitable tech corporations, EHRs should not “platform native.” We checklist some potential methods this might inhibit an EHR’s growth towards changing into a UDHP:
“Software program Pondering” vs. “Platform Pondering.” To really perceive the transformative potential of Unified Digital Well being Platforms, it’s essential to differentiate between conventional “software program pondering” and extra expansive “platform pondering.” By their very definition, UDHPs aren’t merely new software program; they signify a elementary shift in direction of a platform enterprise mannequin, full with a new set of rules requiring a special mindset for fulfillment.
Seth Joseph astutely noticed that EHRs nonetheless consider themselves as software program corporations, whereas the larger alternative is emigrate from being “a software program vendor within the market to {the marketplace} itself.” This transition necessitates a elementary change in how these programs are conceived, constructed, and operated.
Enlargement By In-Home Improvement vs. Enlargement By M&A. Traditionally, Epic has largely favored growth by way of in-house growth relatively than embracing the platform technique of development by way of acquisitions and fostering an exterior ecosystem. Judy Faulkner, the influential founding father of Epic, has famously said Epic won’t ever be offered and has additionally traditionally maintained a stance in opposition to buying different corporations.
This inward focus contrasts sharply with the method of established platform giants who’ve made tons of of acquisitions:
Alphabet (Google) — 200+
Amazon — 125+
Meta — 100+
Microsoft — 275+
To scale successfully and exponentially, it’s essential to take an ecosystem-first method.
Foot-Dragging On Interoperability vs. Interoperability by Default. The early historic method of many EHR distributors has been characterised as foot-dragging on interoperability, a stark distinction to the “interoperability by default” ethos of profitable platform companies.
Constructing One Firm vs. Constructing an Ecosystem of Companions. Lastly, till the previous decade the standard EHR mannequin was operated beneath the idea that exterior builders weren’t actually needed, a viewpoint diametrically against the platform enterprise mannequin the place builders are central.
In 2017, Epic opened its app retailer to a sluggish begin. Epic was seen as unresponsive by many app builders. We additionally bear in mind builders claiming that Epic was not respecting their mental property rights, i.e., “Your IP is now our IP.”
Epic has since developed rather more vibrant developer applications. In but another blog post, Brendan Keeler describes and charges builders’ choices in working with Epic. He concludes by advising devs to “mood your expectations.”
Synthesis and Conclusion:
OK, we’ll admit that the Thesis/Antithesis factor was a little dramatic. Let’s revisit the wording:
- Thesis: EHRs Can Broaden To Turning into UDHPs
- Antithesis: EHRs Can’t Change into Efficient UDHPs
We’ll additionally concede that the wording is a bit deceptive — it implies black/white situations beneath which EHRs both will or won’t develop into UDHPs. The fact, as all the time, is messier than a binary alternative. It’s not ‘EHRs will completely develop into UDHPs’ or ‘EHRs are doomed to the dustbin of historical past.’ It’s extra like…shades of grey, with a wholesome dose of ‘we’ll see.’”
The UDHP market could be very early — the Gartner report that we cited in our previous blog post on UDHPs estimated that the market is barely 5% penetrated and that UDHP adoption will take 5 to 10 years.
As we’ve famous, UDHPs will be adopted incrementally and over time. UDHPs can accommodate EHRs as parts, and UDHPs and EHRs should not mutually unique: we don’t see EHRs as going away any time quickly.
We count on that completely different organizations will make completely different selections, relying on a lot of elements equivalent to:
- Dimension and sources. Bigger well being programs seemingly will see larger wants for a UDHP; smaller programs extra seemingly will look to their EHR for integrations.
- Organizational complexity and geographic footprint. Multi-state footprints, a mixture of care settings throughout the acuity spectrum, and vast ranges of specialties all add complexity, required connections, and extra alternative with a UDHP method.
- Present EHR vendor. Some EHR distributors may succeed at growing UDHP capabilities, others may not. TBD.
- Pricing of UDHPs vs. EHRs. TBD.
- Evolution of UDHP capabilities and market acceptance. TBD.
- UDHP vendor and market evolution. In our earlier publish, we highlighted over 20 UDHP vendor “candidates”, and later steered that this quantity would shrink drastically.
In our subsequent publish on this collection, we’ll phase the healthcare supplier market to judge for whom (which hospitals and well being programs) the EHR may function the UDHP and when it is smart to decide on a cloud-first resolution.
Vince Kuraitis JD/MBA is an unbiased advisor with over 35 years’ expertise throughout 150+ healthcare & tech corporations. Neil Jennings is Vice President, Consulting at Untangle Health. Vince publishes The Healthcare Platform Blog, the place this publish first appeared. The authors need to thank a number of colleagues for his or her evaluate and commentary on an earlier draft of this publish: Michael Byczkowski, International Head of Healthcare at SAP; Brendan Keeler, Interoperability Observe Lead at HTD Well being; Sandra Raup, President at Datuit; and Chris Notaro, CEO of Untangle Well being.
