This is the first article of a series dedicated to Healthcare IT platforms. The following aims to describe the diversity of existing software platforms with a focus on healthcare software platforms as a decision support tool.
The intended audience is people with mid to high level knowledge of healthcare applications and solutions as well as some IT background.
At our company, Efferent Health, we are involved in the construction of a healthcare platform and as part of our analysis we researched the existing offerings.
Before beginning with our analysis, we had to determine what can be considered a healthcare IT platform. We can approach the definition in a few different ways.
Some relevant definitions from the Merriam-Webster dictionary (https://www.merriam-webster.com/dictionary/platform) are:
1: plan, design
2: a declaration of the principles on which a group of persons stands; especially: a declaration of principles and policies adopted by a political party or a candidate
5b: operating system; also: the computer architecture and equipment using a particular operating system
One can see the term is extremely broad (1) but also very constrained when referring to software (5b). For our purposes, the definition 2 will contribute to our analysis.
Looking for a more technical (but still broad) definition, we found one at Techopedia (https://www.techopedia.com/definition/3411/platform):
A platform is a group of technologies that are used as a base upon which other applications, processes or technologies are developed.
This statement seems to fit with any technological area at design level. From a development and implementation perspective, the definition at Bridgera (https://bridgera.com/what-is-a-software-platform/) offers more concrete explanations:
A platform provides low-level functionality ready-made as an accelerator to a consumable solution.
A platform is not a complete solution but requires additional effort to complete the solution.
The benefit of a platform is to provide commodity capabilities faster and cheaper while maintaining the ability to differentiate through customization.
Before entering the IT sphere, it may be helpful to consider the benefits of a technological platform in other areas:
In the automotive industry, a vehicle’s platform design usually starts with the underbody and suspension, that allows to place atop a big variety of engines and cabins, among other components. There are multiple benefits to this: lower inventory of parts, lower design costs, shorter time to market and a more varied range of products.
In the military industry, a platform refers to an infrastructure able to transport and launch weapons, like airplanes and naval ships. Here, it is important to emphasize that the whole weapon arsenal shares some kind of standardized set of interfaces for physically holding as well as communicating with the weapon for target designation and guiding. These standards prevent additional costs for adapting weapons to platforms.
As close as we are getting to our goal definition, we will find that the definition can go different ways, although they share the characteristic of serving as a foundation for more concrete applications, whether they are built by developers on non-developers.
A very detailed explanation of several possible kinds of IT or software platforms are mentioned in the article “The 9 Types of Software Platforms” by Michael Vakulenko and Sameer Singh in their Platform Hunt blog (https://medium.com/platform-hunt/the-8-types-of-software-platforms-473c74f4536a).
The platform list found at Platform Hunt (data.platform-hunt.com) can give more insights into how big companies offer multiple platforms at many levels, covering different needs (Amazon, Google, Microsoft, etc.).
IT platforms are usually stacked either using the same provider (i.e.: Oracle vs. Microsoft) or technology (Windows vs. Linux) or an eclectic combination. The decision on whether using a consistent technology stack or combining components may have a big impact on the project using them, as with multiple vs. single technology providers and partners, training needs, integration efforts, lifecycles and even performance.
A cloud-based website will use many kinds of platforms:
- A hardware computing platform, usually opaque to the end user, may be provided by well-known vendors like HP or Dell, or other white box manufacturers.
- A virtualization platform provides a mid-layer between the hardware and software computing platforms. Popular brands are VMware and Hyper-V.
- A software computing platform, or the operating system, usually any version of Windows or Linux.
- For the operating system, most implementers follow the Open Web Platform recommendations, defined as a collection of technologies that enable the Web.
- The concrete implementation is performed using either a discrete collection of development software pieces, a well-known bundle or stack like LAMP or MEAN, or a consistent branded set like Oracle/MySQL/NetBeans/Java or Microsoft/IIS/SQL/.Net/C#.
Healthcare IT platforms
In the Healthcare IT world, there are several topics to cover before talking about specific platform offerings. Here we have to trade off legacy and emerging standards as well as choose a particular focus.
Healthcare interoperability standards
A single healthcare application cannot cover all the activities of the medical practice and hence needs to exchange information with other systems. For this purpose, it is important to comply with some healthcare IT standards. We can divide those standards into two groups: legacy and emerging.
Among legacy but still solid standards, we can find HL7 v2 and Dicom DIMSE services. Despite their old-fashioned nature, not easily compatible with a modern web application, they are still expected to be around for at least a decade.
In recent years, modern versions of the mentioned standards have emerged and are ready for production. HL7 FHIR (Fast Interoperability Healthcare Resources) and DICOMweb are expected to substitute their legacy versions, as they can be easily integrated with web applications.
Healthcare software application categories
There is a plethora of healthcare software categories and different authors can assign them in different ways. A reliable source for this categorization is KLAS, which is a Healthcare IT research firm.
As seen on KLAS’ website (see https://klasresearch.com/report/2018-best-in-klas-software-and-services/1253) the first level of classification is as follows, with almost 30 sub-categories:
- Inpatient clinical care
- Ambulatory and post-acute care
- Financial/Revenue cycle/HIM
- Value-based care
- Imaging systems
- Payer solutions
Another dimension of classification of software applications is the centricity (not to be confused with the GE Centricity product). It expresses the focus of the vendor on a particular member of the medical practice, rather than a particular activity or application area:
Taking into account all the variables described, some current offerings deserve a more detailed revision.
Philips HealthSuite Platform
This is a new product from Philips, launched in 2016. HealthSuite comprises a cloud infrastructure with a Clinical Data Repository plus some core services (billing, logging, analytics, etc.), which can be accessed through a public REST API.
An important feature is its capability to interoperate with imaging modalities (CT, MR, etc.) as well as small monitoring devices and wearables produced by Philips, and also other healthcare systems like EMRs.
In general, the HealthSuite platform offers an entire backend ecosystem for hosting a healthcare application built by third parties.
Oracle Health Management Platform Solution
This is a patient-centric solution that enables the implementation of EHR with focus on the entire care cycle. Oracle seizes all its technology assets like Fusion, Java and Oracle SOA, for providing the required building blocks for compiling EHR solutions.
On a higher level, it is comprised of three key components: Oracle’s Siebel Healthcare solutions, Oracle Policy Automation and Oracle WebCenter Portal.
It also offers interoperability with their portfolio of CRM and ERP systems, as well as inbound and outbound HL7 interoperability.
In summary, this is a single vendor solution offering with a wider coverage than other healthcare platforms.
Apple’s offering is focused on collecting and storing patients’ health and activity information and presenting it through their well-known user interface across their different devices (tablet, smartphone, smart watch).
HealthKit centralizes the storage of the information for particular users and provides privacy protection. With the proper user’s permission, applications from different vendors can exchange information by using the HealthKit API.
Although bigger platforms claim to be patient-centric, Apple gives to the final user total control of their healthcare data, rather than to organizations or specific applications.
Vonk is an enterprise-grade FHIR Server meant for large and small production environments. Its main purpose is to store clinical information as FHIR resources and its API is also FHIR-compliant. Vonk can use either Microsoft SQL Server, MongoDB or CosmoDB as its storage engine.
Besides the ready-made Vonk server distribution, Firely also offers the possibility of building a customized FHIR server or just a FHIR façade for legacy systems.
Relying on a FHIR repository like Vonk spares important development resources and provides future compatibility.
The SMART Platform
The SMART platform adds an extra layer over a FHIR repository to enable healthcare applications to coexist and communicate. It also exposes an application gallery ala Apple App Store or Google Play.
SMART promotes the use of open source technologies as well as the interaction between compliant applications. Its specification provides security through OAuth and OpenID and the use of profiles as interoperability vocabularies. SMART goes beyond pure-backend platforms and offers facilities for building HTML5-based user interfaces.
In a higher level, SMART exposes an API for Clinical Decision Support (CDS) hooks as a mechanism for enabling clinical workflows.
IT platforms and healthcare IT platforms can have many definitions and be implemented at many levels. Healthcare applications are even more diverse and may have different focuses.
At the implementation level, platforms can embrace different technology stacks or combine several of them.
Most of the concrete healthcare platforms evaluated cover a variety of server-side services as well as integration functions.
We don’t have a recommendation for adopting a specific platform, it may depend on the compatibility with other systems and hardware in use, as well as the ability to cover most of the technical and functional requirements.
As software manufacturers, our interest in this analysis is to determine which aspects have less implemented functionalities and will represent an opportunity for building a more comprehensive platform.