In late 2008, I was working on the concept for what would become CareCloud. All my years of working in or developing software for business was weighing me down at the time and constraining my thinking. I needed to depart from the norm. Entering the world of consumer technology afforded me a new way to think about things. Ultimately, the synthesis of iOS, Facebook, Salesforce.com and traditional healthcare IT led to the concept for the company, which is to build a modern, cloud-based platform for healthcare.
A “platform” is a system that can be programmed and therefore customized by outside developers — users — and in that way, adapted to countless needs and niches that the platform’s original developers could not have possibly contemplated, much less had time to accommodate.
I was tired of the same old approaches to software being used to “transform” healthcare, from an industry that so desperately needed transformation but continually bought more and more antiquated software.
Lots of companies call their offering a platform, which leads to massive confusion about the concept. To truly qualify as a platform, I like to use Marc Andreesen’s definition:
Healthcare IT has always been a very different marketplace than general enterprise software. The complexities of the industry make the gestation period for any software company very long. This led to not only installation of a vast amount of legacy software throughout healthcare, but the continued purchase of lots of new legacy software. As counterintuitive as that sounds, in healthcare, customers continue to purchase old technology because it’s their only choice to power their complex functional requirements — newer systems generally don’t get the job done.
To solve this problem and accelerate the pace of innovation, we believe that we need to:
1) Deliver a Platform that offers the core building blocks of healthcare software so that developers, including our own, could reuse them to rapidly build apps;
2) Allow software development and easy integration to happen outside of CareCloud’s engineering department;
3) Provide broad healthcare ecosystem connectivity;
4) Build the environment as a Digital Ecosystem for healthcare whereby users such as doctors and patients were both present and available to each other.
Some really great examples of platforms that changed the game in business and in life include:
Apple — Figured out that common design patterns and core services such as messaging, voice, video, audio, camera and many others were central to myriad day-to-day operations we perform. This is why the iPhone and equivalents replaced more than just our cell phones to become our alarm clock, map, television, flashlight, mirror and so many other things.
Salesforce.com — Figured out that the Customer rather than the General Ledger was the lifeblood of business. Today when we think about purchasing business software, 50% of the decision depends on what the software does and the other 50% concerns whether it lives in the salesforce.com ecosystem. Companies such as Veeva leveraged salesforce.com’s platform in an incredibly astute way and managed to build a multi-billion dollar valuation with minimal venture capital in record time.
On Computing Architecture…
Amazon.com — Realized that traditional computing infrastructure could be delivered as a service, liberating companies large and small from the low-value-ad burden of procuring, configuring and managing their computing environment. In the process, they provide virtually infinite scaling capability at a variable cost so that even the smallest of companies can be positioned for limitless growth. As the days pass, Amazon is turning on new services that can be woven into any company’s infrastructure and even software, making it easier and easier to build new apps and capabilities.
I strongly believe that no industry needs these same concepts applied more than healthcare. This begs the question of whether an Amazon.com, Salesforce.com or other great tech behemoth will ever deliver a healthcare apps-enabling platform. These are some of the greatest companies on the planet with an incredible track record of success and no shortage of capital. That said, some considerations include:
On Ecosystem Connectivity…
I believe any software architect today that is not starting with the premise of “Why not Amazon” or an equivalent cloud computing service simply does not get it. Therefore, my assumption is that anything worthwhile today should be built on Amazon or other. It would be foolish for CareCloud to try and reinvent this Amazon platform, so we believe we should simply build on top. Therefore, the question becomes not whether Amazon will build it, but rather when healthcare-specific capabilities will emerge as a platform built on Amazon.
In Salesforce.com’s case, I believe the core issue is whether the Customer data object can be adapted to serve the core object in healthcare, the Patient. In my opinion, the Patient data object is 2 orders of magnitude more complex for a healthcare organization than a typical Customer is for a business. In business, tracking customer notes, invoices, contracts, sales and customer status is simply easier than tracking chronic conditions, insurance policies, billing, medical records, lab orders/results, medications and many, many more things. Additionally, as the Internet of Things and the genome become more prevalent in managing routine healthcare, the need for big-data enabling capabilities will become the norm.
On Whether a Healthcare IT Incumbent Can Deliver a Platform…
Nothing happens in a vacuum in healthcare. It is a process-intensive, hand-off intensive business that drives complex inter-company transactions and collaboration. These hand-offs often occur outside the walls of the medical facility in an antiquated and very cumbersome way. In most cases, the enabling technology of today was conceived before there was ever a glimmer of a World Wide Web. One of the hardest things in healthcare IT is the management of electronic connectivity to the ecosystem. A platform that can deliver connectivity to the payers, labs, pharmacies, physicians and even patients has the potential of abstracting much of the heavy-lifting that is required to stand up healthcare apps. It is hard to imagine these capabilities growing organically within any of the large technology companies, although it’s not impossible. In the case of most business apps, value is delivered through functionality and intra-business collaboration.
User interface requirements, especially those that pertain to very busy clinicians, are daunting in healthcare. Traditional business platforms, in my opinion, simply don’t do a good enough job in this area. To deliver the optimal user interface for such a user requires design without constraints imposed by the presence of non-healthcare apps in the platform.
We have seen examples of client-server healthcare IT companies launching their own “App Stores.” I find it hard to believe that there would be broad-based adoption of apps developed for closed, installed single-tenant systems or that developers would be broadly drawn to create new apps on outdated and cumbersome technology. There are also a few cloud-based companies that are hamstrung by legacy Web 1.0 architectures that lack a true web-service architecture, elastic computing environment and comprehensive API capabilities.
So 6 years into the CareCloud adventure, we are 100% focused on perfecting our app capabilities as they relate to electronic health records, practice management, revenue cycle management, patient engagement and supporting analytics. This is what our clients are asking for, and this is where our priorities lie. What most people don’t see is the platform that is evolving underneath utilizing a modern, web services architecture.
In conclusion, the pace of change in healthcare is accelerating and the need for a re-platforming has never been greater. The move towards value-based care, risk-based reimbursement, the Internet of Things, consumerization, genomics, in-home monitoring, telemedicine and other factors will drive a reinvention of the core systems that power the industry.
It’s an exciting time. I believe we’re in the early stages of this movement and a lot of great change is on the horizon, driven by all the possibilities of an open, cloud based healthcare platform.
Originally published at https://www.linkedin.com on July 1, 2015.