We’re excited to announce the first phase of Commure, a company we believe will play a key role in modernizing technologies in healthcare systems around the world. We’ve built a system of innovation tailored specifically for the healthcare industry. Today, we’re opening the Developer Platform, which offers developers an array of APIs and SDKs for building, distributing and deploying software for the healthcare community. Our goal with Commure is to enable thousands of talented developers to create empathy-driven solutions with the potential to positively impact the healthcare experiences and outcomes for millions of people.
In the United States, healthcare is a $3.5T a year industry that’s been made unintelligibly complex by insularity. In 2009, the federally mandated HITECH Act incentivized healthcare providers to adopt electronic healthcare records (EHRs) by 2015. The legislation did not, however, mandate that EHR solutions be user-centric or provide interoperability among healthcare systems. Business incentives discouraged the flow of patients — and their information — between different hospitals; thus, EHR vendors grew on the back of a closed system mentality. Given that their economics are tied to a lack of interoperability, EHRs vehemently fight regulation that would create a more open system. In recent years, too much innovation energy in healthcare technology has been spent on finding efficiencies in billing and administration. We are refocusing that potential on better medicine, more effective physicians, or improved patient experience.
2. The Best of Intentions
The Best of Intentions
The HITECH Act transformed hospitals and doctors offices. Today more than 95% of hospitals and 85.9% of office-based providers are utilizing one of the major EHR systems with the intention of, among other things, improving information sharing and streamlining care. There was, however, a clear disconnect between the digitization of health records and actual innovation in healthcare.
A decade ago, in the rush to computerize, clinical workflows were simply remade digitally from the legacy paper trail, billing codes and all, with no empathy for the highly trained nurses and doctors using them. Today, doctors are burning out, spending up to half their time in front of computer screens. And about one third of all Americans who visited a doctor in 2018 still had to either hand carry test results or redo a test or procedure from a previous appointment.
Along the same timeline, the EHR solutions on the market took a very conservative path for protecting patient data by building highly insular services. As the hospital industry continues to consolidate at a clip of about 100 deals every year, even affiliated healthcare organizations cannot interoperate without significant IT spend. Despite these massive technological investments, many of the major health systems are continually reporting operating losses. In fact, at two major hospital systems, the high capital cost of EHR installations actually contributed to margin compression and a need for layoffs. The net-net here is that after 15 years and tens of billions of dollars of software investment, our healthcare system is less productive and more costly.
In healthcare, privacy protection is imperative. But we have the technology today to secure people’s healthcare data and allow for the safe information sharing needed to create powerful, fully integrated experiences. Other highly regulated industries do this seamlessly, every second. The banking industry, for example, processes trillions of transactions a day. The early work of the Society for Worldwide Interbank Financial Telecommunications (SWIFT) in the 70s defined a standard of interoperability that has enabled messaging between more than 11,000 institutions. TIBCO became one of the first companies to enable communication within the financial markets in real-time, without human intervention. Since then, countless others have developed sophisticated software for the industry that has enabled global financial growth. For the healthcare industry to evolve in the way we need it to, we should look towards and trust the same powerful, secure infrastructure that has enabled innovation in analogous industries.
3. Time for Something New
Time for Something New
Today, the healthcare CEO faces a conundrum. In the short term, they are consolidating to drive economies of scale. They want to innovate, to provide superlative services and the best possible outcomes. But, they’ve spent billions over the last decade on healthcare IT with arguably little return.
In some ways, Silicon Valley has shirked its responsibility to healthcare. Yes, we’ve spun up some incredible consumer-facing healthcare services companies like some in our portfolio: Color, Livongo, Oscar, and Mindstrong. But when it comes to system-wide innovation, illogically, we’ve been reticent to take on the challenge. We failed to appreciate the nuances of building for a sector where free market principles don’t exist. Rather than sorting through the complexity — and forming the right interdisciplinary teams to do so — we chose to innovate elsewhere.
It’s time to change that mindset. We as an industry have the technologies and the understanding of how to build something flexible and yet secure. There’s a clear need and literally thousands of people who are looking to take on a technical challenge that matters. And that’s why two years ago, I jumped head first into building Commure to catalyze innovation across the healthcare industry.
Commure’s tech stack was built as a FHIR-native platform. FHIR is an open API standard specific for healthcare that’s supported by major technology vendors serving the healthcare industry and the US government. We’re championing FHIR at Commure because we believe this standard will be key to innovation in health tech. By developing for this open and supported API as opposed to legacy bespoke options, it’ll be faster and cheaper to build applications that are safe, secure, and play well with other applications and health systems. My co-founder and Commure CTO, Eugene Kuznetsov, describes the architecture here in detail.
We built Commure to support the work of software engineers and teams who are looking to move the needle in healthcare. We built it for doctors who code and who are intimately acquainted with the challenges their profession faces in the day to day. And we built it for the established vendors who want to move technology forward by embracing those that will bring a fresh point of view to an otherwise staid industry.
With Commure, we’re looking to partner, not disrupt. We’re not moving fast nor breaking things. This is an open, robust and secure platform that will let teams bring the same consumer design and business model innovation to care that has been used to reorganize content, community, and commerce online over the past 15 plus years. We are cognizant that the stakes are high in healthcare. Privacy, security, and data use all deserve considerable focus.
Importantly, we’re not building Commure in a vacuum. From the very beginning we have partnered with forward-leaning health leaders whose systems collectively serve over 30 million people each year. We’re working hard to earn their trust and fully understand what goes into achieving their goals of delivering safe, quality care.
I strongly believe that the opportunities for developers are tremendous in the healthcare space. Speaking from recent experience, working along with Glen Tullman and Lee Shapiro, we were able to take Livongo from a whiteboard concept through to become a $2.7B public company that helps more than 250,000 people with chronic conditions live better, healthier lives in just six years.
Success for us at Commure and General Catalyst will be seeing 1,000 Livongos bloom using our technology and knowing that we’ve affected positive change for one of the most important aspects of all of our lives. If you’re inspired to build health solutions that have the potential for societal-level impact, develop on Commure or join our team!
Managing Director, General Catalyst