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A Manifesto for Healthcare’s Disruptive Innovation of the Decade: Open EHR Technology Platform(s) and Ecosystem


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Opening Keynote at 2010 Healthcare Unbound conference

"A Manifesto for Healthcare’s Disruptive Innovation of the Decade: Open EHR Technology Platform(s) and Ecosystem"

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A Manifesto for Healthcare’s Disruptive Innovation of the Decade: Open EHR Technology Platform(s) and Ecosystem

  1. 1. Opening Keynote A Manifesto for Healthcare’s Disruptive Innovation of the Decade: Open EHR Technology Platform(s) and Ecosystem Vince Kuraitis JD, MBA Better Health Technologies, LLC blog (208) 395-1197
  2. 2. Overview <ul><li>A Case Study in Disruptive Innovation: Apple iPhone & Google Android </li></ul><ul><li>A Manifesto for Healthcare: Open EHR Tech Platform(s) and Ecosystem </li></ul><ul><ul><li>Yesterday -- Closed </li></ul></ul><ul><ul><li>Today -- Walled Garden </li></ul></ul><ul><ul><li>Tomorrow -- Open </li></ul></ul><ul><li>Implications for the Healthcare Unbound Community </li></ul><ul><li>Note: Graphics referencing articles/reports contain hyperlinks to the original source. </li></ul>
  3. 3. Is your company a platform? an application? both? <ul><li>Simple view of apps </li></ul><ul><ul><li>Apps need access to data about patient </li></ul></ul><ul><ul><li>Perform process/intervention </li></ul></ul><ul><ul><li>Deliver data back to health record </li></ul></ul><ul><li>Provocative assertion: Almost every healthcare service or product can function as an “app” </li></ul>“ Chances are you’re an app”
  4. 4. I. A Case Study in Disruptive Innovation: Apple iPhone & Google Android 2 Success Stories Growth Value Competitive Ecosystem
  5. 6. iPhone + Android Share of Smartphone Internet Usage April 08: 6% February 10: 86%
  6. 7. Walled Garden
  7. 8. What’s a Walled Garden (WG)? <ul><li>Controls users’ access to content and services </li></ul><ul><li>Restricts the user’s navigation within particular areas (applications)  </li></ul><ul><li>Not all alike: differing heights and levels of permeability to the walls. </li></ul>
  8. 9. Walled Garden (WG): Apple iPhone <ul><li>Chronology </li></ul><ul><ul><li>March 7, 2007: Apple introduces iPhone “product” </li></ul></ul><ul><ul><li>March 2, 2008: Apple opens API to developers </li></ul></ul><ul><ul><li>March 6, 2008: </li></ul></ul><ul><ul><ul><li>100,000 downloads of SDK </li></ul></ul></ul><ul><ul><ul><li>Kleiner, Perkins announces $100 M investment fund </li></ul></ul></ul><ul><ul><li>November 4, 2009: 100 K apps </li></ul></ul><ul><ul><li>July 2010: 225 K apps </li></ul></ul>
  9. 10. <ul><li>Business model </li></ul><ul><ul><li>Open API </li></ul></ul><ul><ul><li>Virtually every other aspect closed </li></ul></ul><ul><ul><ul><li>Integrated hardware/software platform </li></ul></ul></ul><ul><ul><ul><li>Non-swappable applications </li></ul></ul></ul><ul><ul><ul><li>Exclusive distribution of apps. </li></ul></ul></ul><ul><ul><ul><li>Restriction on carrier choice </li></ul></ul></ul><ul><ul><ul><li>Restrictions and controls on developers </li></ul></ul></ul><ul><ul><li>Multiple revenue sources -- HW $$, developer $$, app store </li></ul></ul><ul><ul><li>Highly controlled user experience </li></ul></ul>
  10. 11. iPhone Revenue Q2:07 $5M Q1:10 $5.5B
  11. 13. Google Android Operating System-- Open Platform <ul><li>Open Handset Alliance: 30+ companies </li></ul><ul><ul><li>Google Android open source SW </li></ul></ul><ul><ul><li>Multiple handset developers bring hardware </li></ul></ul><ul><li>Open API </li></ul><ul><li>20+ smartphones on the market use Android OS </li></ul><ul><li>70+ K Android apps </li></ul><ul><li>Google maintains “control points”, e.g., see </li></ul>
  12. 14. Google can give away Android because... <ul><ul><li>“ ...we make money, and lots of it, it turns out, from advertising on mobile phones.” </li></ul></ul><ul><ul><li>Eric Schmidt, CEO, Google </li></ul></ul>
  13. 16. Result: A Vibrant, Competitive Ecosystem
  14. 17. II. A Manifesto for Healthcare: Open EHR Tech Platform(s) and Ecosystem
  15. 18. Modularity: Dis-Integration of the Computer Industry Source: Venkatraman, N. Winning in a Network Centric Era, 2006
  16. 19. From EMR 1.0 ...
  17. 20. .... EHR 2.0/ Clinical Groupware v1.1, June 2009
  18. 21. Evolution of EMR/EHR Technology <ul><li>Yesterday: Closed/Monolithic </li></ul><ul><li>Today: Walled Garden EHR Platforms </li></ul><ul><li>Tomorrow?: Open EHR Technology Platform(s) with Plug-and-Play Modular Apps </li></ul>
  19. 22. From 1) Closed to 2) Walled Gardens to 3) Open Platform(s) 1 2 3
  20. 24. Open <ul><li>Disagreement about terminology </li></ul><ul><li>Openness not synonymous with </li></ul><ul><ul><li>Free </li></ul></ul><ul><ul><li>Open source </li></ul></ul><ul><ul><li>open not same as &quot;good&quot;; closed not &quot;bad&quot; </li></ul></ul><ul><li>Will WG platforms be innovative? Some. </li></ul><ul><ul><li>Acknowledge -- Many benefits of closed system </li></ul></ul><ul><ul><ul><li>Control over user experience </li></ul></ul></ul><ul><ul><ul><li>Security, privacy </li></ul></ul></ul><ul><ul><li>But, best case scenario is competition between WG and Open EHR platforms </li></ul></ul><ul><li>Many misc examples of platform control, e.g., </li></ul><ul><ul><li>iPhone battery not user replaceable </li></ul></ul><ul><ul><li>Proprietary 30 PIN cable vs. USB </li></ul></ul><ul><li>Customer POV of interoperability, modularity, plug-and-play: &quot;It just works&quot; </li></ul>
  21. 25. A taxonomy of “open” (one example) <ul><li>1) Open source – and especially it’s impact on devices – Android </li></ul><ul><li>2) Open standards – W3C standards </li></ul><ul><li>3) Open APIs i.e. Application Programming Interfaces – for instance access to Location APIs </li></ul><ul><li>4) Open access (freedom to contact anyone on the network), </li></ul><ul><li>5) Open choice of enablers (for example – the ability to choose your billing system), </li></ul><ul><li>6) Data portability (ownership of your data) </li></ul><ul><li>7) The ability to access any application (i.e. not just the provider’s application) a.k.a the classic ‘Walled Garden’ debate – On deck/ Off deck ‘Open’ in relationship to the Cloud </li></ul><ul><li>9) Impact on developers and a shift in value to the edge of the network </li></ul><ul><li>10) Low barriers of entry for third party developers </li></ul>
  22. 26. Maximizing vs. Optimizing Openness?
  23. 27. 2) TODAY: “Walled Garden” EHR Platforms <ul><li>AMA/Dell AMA to team with Dell for EHR info platform 3/10 </li></ul><ul><li>AT&T AT&T Expands Healthcare Community Online to Improve Patient Care 2/10 </li></ul><ul><li>Axolotl Axolotl Corp Showcases New SOA Technology at HIMSS 2010 3/10 </li></ul><ul><li>Covisint Covisint Jumps onto PaaS Bandwagon 11/09 </li></ul><ul><li>Eclipsys Eclipsys Introduces Open Platform to Transform Health IT and Drive Electronic Health Record Adoption 3/10 </li></ul><ul><li>GE GE IT CEO touts debut of next-gen clinical knowledge platform, eHealth Platform 3/10 </li></ul><ul><li>Henry Schein Henry Schein Announces the Launch of Innovative Henry Schein ConnectHealth (TM) Collaborative 3/10 </li></ul><ul><li>Medecision MEDecision Webinar Will Introduce New InFrame Collaborative Health Information Service Technology 3/10 </li></ul><ul><li>Medicity Medicity Opens Its Health Information Exchange Platform to Third-party Application Development 11/09 </li></ul><ul><li>Microsoft/Eclipsys Microsoft and Eclipsys Announce Health Care IT Alliance 2/10 </li></ul><ul><li>Navinet NaviNet Offers End-to-End Healthcare Communications Platform 2/10 </li></ul><ul><li>Quest Diagnostics Quest Diagnostics Unveils Care360 EHR 3/10 </li></ul><ul><li>Verizon Verizon Launches IT Platform to Help Accelerate Adoption of Electronic Health Care Records 3/10 </li></ul>
  24. 28. Will WG platforms result in innovation? <ul><li>13+ platforms! </li></ul><ul><ul><li>Cost/time to get up learning curve with each platform? </li></ul></ul><ul><ul><li>How easy is the API to learn/use? </li></ul></ul><ul><ul><li>How are revenues split? </li></ul></ul><ul><ul><li>Which platform(s) have market viability? </li></ul></ul><ul><li>Likely winners unclear </li></ul><ul><li>High transaction costs of exploring options </li></ul><ul><li>Wait and see? </li></ul>How will app vendors view WG platforms?
  25. 29. From 1) Closed to 2) Walled Gardens to 3) Open Platform(s) 1 2 3
  26. 30. 3) Tomorrow?: Open EHR Technology Platforms with Plug-and-Play Modular Apps <ul><li>Open at many levels (not necessarily all) </li></ul><ul><ul><li>API </li></ul></ul><ul><ul><li>Patient ownership of data </li></ul></ul><ul><ul><li>Data portability </li></ul></ul><ul><ul><li>Open standards </li></ul></ul><ul><ul><li>Open source </li></ul></ul><ul><ul><li>Cross-platform apps </li></ul></ul><ul><ul><li>Low barriers to entry/restrictions for developers </li></ul></ul><ul><ul><li>etc. </li></ul></ul>
  27. 31. <ul><li>Technology platforms that support substitutable applications should be promoted. </li></ul><ul><li>Messages and protocols for data exchange should be allowed to emerge on demand in a market-driven approach, and specified transparently at every level. </li></ul><ul><li>Protocols and application programming interfaces should allow the possibility of multiple platforms co-existing. </li></ul><ul><li>Application programming interfaces should be open. </li></ul><ul><li>Substitutable application or platform vendors should not have control over what is installed on the platform </li></ul><ul><li>Application installation should be turnkey. </li></ul><ul><li>The intellectual property of platforms and applications should be kept separate. </li></ul><ul><li>All applications should be removable and none should be required to run a platform. </li></ul><ul><li>The platform should have a highly efficient delivery mechanism for applications. </li></ul><ul><li>Certification requirements for platforms and applications should be kept minimal to maximize substitutability. </li></ul>Android-like
  28. 32. 3 Elements for Disruptive Innovation <ul><li>Technological enabler . Typically, sophisticated technology whose purpose is to simplify, it routinizes the solution to problems that previously required unstructured processes of intuitive experimentation to resolve. </li></ul><ul><li>Business model innovation. Can profitably deliver these simplified solutions to customers in ways that make them affordable and conveniently accessible. </li></ul><ul><li>Value network. A commercial infrastructure whose constituent companies have consistently disruptive, mutually reinforcing economic models. </li></ul>MIA
  29. 33. ...early spring flowers ready to burst forth in a blossom of innovation
  30. 34. Drivers Toward an Open EHR Technology Platform <ul><li>The Office of the National Coordinator for Health IT (ONC). </li></ul><ul><ul><li>… we believe that it will be common in the near future for Certified EHR Technology to be assembled from several replaceable and swappable EHR Modules. Health & Human Services, Interim Final Rule on Standards , December 2009 p.41 </li></ul></ul><ul><li>Google Health and Microsoft HealthVault </li></ul><ul><li>The Clinical Groupware Collaborative </li></ul><ul><li>Free or freemium EHR offerings such as Practice Fusion </li></ul><ul><li>Free and open source software (FOSS) e.g., Mirth , VISTA </li></ul><ul><li>openEHR </li></ul><ul><li>NHIN-Direct </li></ul><ul><li>ONC SHARP Grant for Childrens Hospital Boston and Harvard Medical School </li></ul><ul><li>Application vendors </li></ul><ul><li>WG platforms (...migration toward openness) </li></ul>
  31. 35. III. Implications for the Healthcare Unbound Community
  32. 36. Value Creation vs. Value Capture Platform or App?
  33. 37. What’s the disruptive opportunity in an open EHR technology platform? <ul><li>Value creation/capture battle between platforms & apps </li></ul><ul><ul><li>Platform owners (e.g., Apple iPhone) want to capture the value by maintaining tight control over their platforms </li></ul></ul><ul><ul><li>Application vendors are incentivized to commoditize the platform so that value creation and value capture can migrate to the applications themselves </li></ul></ul>
  34. 38. 1) Yesterday: HU Companies (Apps with no platform)
  35. 39. 2) Today: Walled Garden EHR Platform/Apps Platform A Size = Value capture opportunity
  36. 40. 3) Tomorrow: Open EHR Technology Platform/Apps Platform A Size = Value capture opportunity
  37. 41. Beneficiaries of Open EHR Technology Platform(s) <ul><li>Patients </li></ul><ul><li>Doctors & hospitals: competition, lower prices, no lock-in </li></ul><ul><li>Payers </li></ul><ul><ul><li>Government </li></ul></ul><ul><ul><li>Commercial </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><li>1000s of app vendors </li></ul><ul><li>Other care providers </li></ul>
  38. 42. The Value of the Clinical Groupware Collaborative
  39. 43. Stages 2 & 3 of HITECH “Meaningful Use” will be a bonanza for the HU community
  40. 44. A Thousand Flowers of Innovation In Full Blossom
  41. 45. END