Vandana Karthikeya

Regulation is simply tradeoffs. Regulation typically favors incumbents. If regulatory burden is equal across competitors, it is a smaller portion of a big company's total resources (Epic, Oracle, athenahealth can better deal with new certified health IT requirements than a bootstrapped specialty EHR). New entrants also have larger entry costs in order to meet a compliant MVP when there are regulatory considerations (they must meet those before meeting other customer needs). If you're solely focused on the pro-competitive aspects of health IT regulation (and not on how it's used for national digital infrastructure, social good, etc), there are two coherent takes: If you believe that biggest problem in healthcare is that the consolidation and stagnancy of the EHR market (leading to less innovation, fewer viable EHR choices, and higher prices) and thus wanted to single-mindedly maximize competition in that market, you'd: 1. Keep existing tools to reduce switching costs (population EHI export, bulk FHIR) 2. Remove the other EHR certification program criteria that could act as a barrier to entry to new EHR entrants 3. Keep and strengthen information blocking so that EHRs have an incentive to provide data for migrations 4. Build regulation that goes further on reducing switching costs - a TEFCA SOP for data migration? In this model, you believe that existing dominant EHRs can and will be disrupted by new EHRs - that competition will come from like systems that simply outperform. The reality, though, is that EHRs won't be disrupted by other EHRs. These markets tend to calcify - switching costs almost always outweigh the benefits of a new system of record. And the new system of record is just more of the same. Windows didn't fade away because of their antitrust cases or procompetitive OS regulation - mobile and cloud came. What disrupts EHRs will be a platform shift - a change to how organizations operate in such a way that EHRs aren't needed. I don't know what that will be per se or I'd probably be sprinting towards it (although my current guess is changes to the workforce and nature of work due to AI agents). But what I do know is that if you believe that to be true, you'd gear regulation towards hastening that future. Regulation needs to be geared towards creating an ecosystem of vibrant competition alongside EHRs in that world: 1. All the core primitives for point solutions to interoperate alongside EHRs - RESTFul FHIR APIs, subscriptions, and writeback. 2. Full export of data to allow for backloads, regular data transfer or migration to new platforms (bulk FHIR, population EHI export respectively) 3. Digital patient access to data (TEFCA IAS, single patient EHI export) to promote consumer health tools unyoked to provider organizations 4. Stronger information blocking regulations (with actual enforcement outside of the courts) to act as backstop and continual force to "be more open" So directionally, that's what I'd like to see next.

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This video by @InterSystems introduces the OMOP Platform, a new service by InterSystems designed to support researchers by transforming EHR data into the OMOP format. 👉 https://lnkd.in/gAq42nhm The platform features a FHIR-to-OMOP transformation pipeline and an OMOP repository hosted on #InterSystems #IRIS Cloud #SQL.

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AI in clinical documentation isn’t just about saving time, it’s about accuracy and context. Companies like DeepScribe, Augmedix, and Ambience Healthcare are proving that ambient AI can truly change how clinicians work, reducing burnout while improving the quality of notes that end up in the EHR. The exciting part? We’re seeing NLP models evolve from simple dictation to understanding clinical intent, automatically coding visits, flagging anomalies, and improving revenue integrity. The challenge now is not building smarter models… it’s integrating them securely into complex healthcare ecosystems (Epic, Cerner, athenahealth, etc.). AI in healthcare only works when it fits seamlessly into workflows and meets HIPAA, SOC2, and FHIR standards from day one. 👉 Curious, how do you see AI reshaping clinical workflows in the next 2–3 years? iVerve INC #Healthtech #AIinHealthcare #DigitalHealth #EHR #Interoperability #FHIR #HIPAA

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Oracle Health just dropped a from-scratch, AI-driven, voice-first EHR for ambulatory care — not an upgrade, not a patch — a full rebuild on Oracle Cloud. This move raises two big questions: - Can Oracle keep its current customers from jumping ship? - Will targeting ambulatory care & smaller hospitals (vs. large AMCs) prove a smarter entry point — especially when bundling EMR + ERP?

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Why Healthcare innovation is moving beyond large EHR Platforms? The era of monolithic EHR dominance is quietly reaching its limits. For decades, large EHR platforms have been the backbone of healthcare IT centralizing data, standardizing workflows, and enabling scale. But that same scale has become their constraint. What once drove adoption is now slowing innovation. The complexity of these systems makes them difficult to adapt, expensive to customize, and inherently resistant to rapid change. Healthcare, however, is no longer operating on decade long transformation cycles. The pressure today is immediate: improve clinical outcomes, reduce administrative burden, and unlock efficiency now, not years from now. This shift demands a fundamentally different innovation model. The next wave of breakthrough innovation will not come from large, all-in-one platforms. It will emerge from smaller, highly focused organizations solving specific, high-friction problems with precision. These niche players operate differently. They are built around single problems e.g clinical documentation, coding accuracy, prior authorization, care coordination and they move with speed and clarity. Without the weight of legacy systems, they can iterate quickly, deploy modern AI-native architectures, and integrate seamlessly into existing ecosystems rather than trying to replace them. Importantly, they are not competing with EHRs in the traditional sense they are augmenting them. They sit on top, alongside, or within existing workflows, delivering immediate value without requiring massive system overhauls. This modular, ecosystem driven model is where healthcare is heading. Innovation is becoming composable. Instead of one system attempting to do everything, we will see a network of specialized solutions each best-in-class working together to transform care delivery and operations. In this new landscape, speed, focus, and adaptability win. Smaller organizations can identify problems faster, test solutions in real-world environments, and scale what works while larger incumbents remain constrained by their own complexity. The implication is clear: the future of healthcare innovation will not be defined by the size of the platform, but by the sharpness of the solution. And that future belongs to those who can move fastest at the point of friction. I would be interested to hear how others are thinking about this shift particularly how it’s showing up in real decisions on the ground.

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