by Vince Kuraitis and Neil P. Jennings of Untangle Well being
Right here’s a top level view of as we speak’s weblog submit:
- A Temporary Recap: What are UDHPs?
- Thesis: EHRs Can Increase to Turn into UDHPs
- EHRs Presently Personal the Buyer Relationship
- Many Clients Have an “EHR-First” Choice for New Functions
- Epic and Oracle Well being are Making Sturdy Actions Towards Turning into UDHPs
- Antithesis: EHRs Can NOT Turn into Efficient EHRs
- EHRs Carry a Lot of Baggage
- Clients are Skeptical
- EHR Analytics Are NOT Optimized To Obtain Important Well being System Aims
- EHR Switching Prices are Diminishing
- Cloud Native Platforms Speed up Innovation and Efficiency
- It’s Not in EHR DNA to Turn into A Broad-Primarily based Platform
- Synthesis and Conclusion
It is a lengthy submit…over 4,000 phrases…so we’ve clearly obtained so much to say on the matter. Hope you introduced snacks!
A Temporary Recap: What are UDHPs? (Unified Digital Well being Platforms)
In our previous extensive post on UDHPs, we described them as a brand new class of enterprise software program. A December 2022 Gartner Market Information report characterised the long-term potential:
The [U]DHP shift will emerge as essentially the most cost-effective and technically environment friendly approach to scale new digital capabilities inside and throughout well being ecosystems and can, over time, change the dominant period of the monolithic digital well being document (EHR).
The DHP Reference Structure is illustrated in a blog post by Better. Be aware that UDHPs are visually depicted as “sitting on prime” of EHRs and different siloed sources of well being information:
We famous that just about any kind of huge healthcare group — well being programs, well being plans, pharma firms, medical gadget firms, and so forth. — had a necessity for UDHPs. Nevertheless, as we speak’s focus is extra slender — we restrict the dialogue to UDHPs in hospitals and well being programs, primarily within the U.S. We use the time period “well being system” to embody hospitals and regional well being supply programs.
On this submit, we deal with the 2 largest EHR distributors within the U.S. — Epic and Oracle Well being; they’ve a combined market share of 65% of hospitals and 77% of hospital beds.
Within the remaining sections, we’ll lay out arguments on each side of the problem of whether or not EHRs can (or can’t) develop to develop into UDHPs. The graphic under is our crack at a visible abstract. The balloons signify the thesis – that EHRs can develop to develop into UDHPs; the anchors signify the antithesis – that EHRs can’t develop to develop into UDHPs.
Thesis: EHRs Can Increase To Turning into UDHPs
Let’s take a look at the case for EHRs increasing to develop into efficient UDHPs.
1) EHRs Presently Personal the Buyer Relationship
Fueled by federal HITECH incentives and mandates, well being programs have made important investments of their current EHRs:
- As of 2021, 96% of non-federal acute care hospitals within the U.S. had adopted a licensed EHR.
- They made large capital commitments to buy and set up their EHR, usually a whole bunch of thousands and thousands of {dollars}.
- Many current scientific workflows are constructed on EHRs.
- A majority of a affected person’s scientific information in a well being system resides inside their EHR.
Based on SoftwareReviews, Epic and (Oracle) Cerner Millennium EHRs obtain good to excessive scores from well being system prospects.
Thus, any new vendor making an attempt to promote new healthcare enterprise software program (i.e., a UDHP) will face a excessive hurdle: “We have already got an EHR…why ought to we take into account you?”
2) Many Clients Have an “EHR-First” Choice for New Functions
Well being programs have been making an attempt to remain afloat in a veritable tsunami of point solutions. This creates a spread of challenges, together with:
- Complexity and integration challenges
- Regulatory and compliance dangers
- Fragmentation of care
- Person adoption and coaching
- Price and ROI issues
As proven within the graphic under, a 2024 Bain & Company/KLAS survey of well being programs discovered that 81% more and more plan to look to current distributors earlier than contemplating choices from new distributors.
Extra particularly, the survey discovered that 79% plan to look to their EHR vendor first for brand new options earlier than seeking to others.
University Hospitals is an instance of a well being system with an EHR-First technique. Based on Robert Eardley, CIO, this tenet ensures the well being system prioritizes instruments and improvements out there inside its Epic digital well being document platform at any time when possible.
3) Epic and Oracle Are Making Sturdy Actions Towards Turning into UDHPs
Maybe the perfect argument that EHRs are able to changing into Unified Digital Well being Platforms is that Epic and Oracle Well being are already making daring strikes. Let’s check out them individually.
Epic’s EHR Enlargement Plans
Epic is greater than a primary EHR — it presents current prospects a broad base of capabilities. Interop guru Brendan Keeler has written extensively about Epic. In his article “An Epic Saga: The Origin Story” he describes how Epic grew to its present measurement. The Appendix supplies an in depth checklist of “Epic Modules.”
In an insightful 2024 analysis of Epic’s dominant market position, Seth Joseph included an inventory of Products You Can Replace with Epic. The checklist included over 150 capabilities “that can assist you determine areas the place you can use your Epic software program to both change or keep away from buying area of interest purposes…”
Epic is also increasing new choices to new buyer classes. Within the article “Epic Beyond the Provider Empire“, Brendan Keeler supplies an in depth checklist:
Well being Grid — software program bought to
- Labs
- Medical gadget firms
- Payers
- Telehealth firms
- Medical trials
Well being Grid Adjoining choices
- Cosmos — “an enormous scientific dataset created by pooling info from Epic well being programs”
- Payer Gateway — a “lighter-weight service for payers that allows them to obtain scientific information from Epic healthcare organizations”
- Chart Gateway — “Epic’s service that streamlines how life insurance coverage firms get medical data from Epic healthcare organizations”
- EpicCare Hyperlink — “a web-based portal product that lets Epic healthcare organizations provide non-Epic suppliers a approach to work together with them.”
Different stuff
- Provide Store — companies choices
- Revcyclers — “Third events working with Epic and supply billing companies to assist enhance income cycle outcomes”
- Cornerstone Companions — deep relationships with Microsoft and InterSystems
However wait…there’s extra. At HIMSS 2025, Epic announced further AI capabilities within the works and that it’s growing a healthcare-specific enterprise useful resource planning (ERP) system. Whereas we view an ERP as an enormous stretch, it’s additionally a possible game-changer for Epic.
Utilizing a framework created by David Yuan of Tidemark, Brendan Keeler capsulized Epic’s broader platform technique:
With additions just like the ERP, Epic is clearly evolving past a standard EHR system, however is it sufficient to satisfy the UDHP wants of contemporary well being programs?
Oracle Well being Goes Past Being a Conventional EHR
In October 2024, Oracle announced a brand new EHR. As described by the corporate, Oracle Health has many traits that make it look extra like a UDHP than a standard EHR. It goals to go considerably past the capabilities of a standard EHR:
- Embedded Synthetic Intelligence (AI): In contrast to EHRs the place AI is commonly a bolt-on, Oracle’s new system is designed with AI as a core part, built-in throughout all the scientific workflow. This features a Medical AI Agent, AI-driven insights on the level of care, AI-powered summaries, and customized care plans.
- Enhanced Person Expertise: Recognizing the clinician burden related to conventional EHRs, the brand new system emphasizes an intuitive and user-friendly design with options like voice-driven navigation and search, multimodal search, and a customizable interface.
- Oracle Well being Information Intelligence is an AI and analytics answer embedded inside the EHR, enabling integration of disparate information sources, real-time insights, and inhabitants well being administration instruments.
- Subsequent-Technology Oracle Cloud Infrastructure presents benefits of enhanced safety, scalability, and efficiency, and higher information change.
- Affected person Engagement Instruments: The brand new EHR features a reimagined affected person portal targeted on empowering sufferers to entry and management their medical historical past, facilitating communication with suppliers, and enabling self-service capabilities for sufferers to handle appointments, pay payments, and entry well being info.
- Give attention to Worth-Primarily based Care: The system is designed to assist value-based care fashions by streamlining info change between payers and suppliers, bettering care coordination, and offering insights into price and useful resource allocation.
Oracle Well being goals to maneuver past being a system of document to changing into a system of motion — an clever, built-in platform that actively assists clinicians, engages sufferers, and drives higher outcomes in a extra environment friendly and safe method. Oracle’s most recent announcement of a platform partnership with Cleveland Clinic and G42 is in step with the migration towards changing into a UDHP.
Oracle Well being remains to be in its early levels of a roll-out, with an early adopter program launched in 2025. Due to this fact, in depth, broadly revealed surveys and large-scale buyer suggestions about this new platform aren’t but out there.
Antithesis: EHRs Can NOT Turn into Efficient UDHPs
Now let’s study arguments suggesting that EHRs aren’t able to changing into well being programs’ “platform of platforms” — a UDHP.
1) EHRs Carry a Lot of Baggage
Right this moment’s EHRs are criticized on numerous fronts: errors and safety issues, cost, lack of competition, lack of interoperability, and lack of usability for clinicians. COVID-19 highlighted lots of the weaknesses in EHRs as being “giant, sluggish monoliths that don’t rapidly adapt to new, emergent calls for on their design and workflow.”
However what in regards to the excessive satisfaction scores beforehand cited? EHRs usually tend to take into account well being system directors as their “prospects.” As famous above, clinician “person” satisfaction is usually low.
Distributors even have allowed prospects to customise EHR implementations. Native customization results in substantial variations in how the system operates from one website to a different. The customarily-used colloquial phrase is that there are “50 dialects of Epic.” Whereas a point of EHR customization is important and may improve clinician buy-in, over-customization may end up in issue interoperating, as information definitions and workflows can differ enormously. With every EHR occasion doubtlessly distinctive, extending EHRs to develop into UDHPs carries ahead organization-specific configurations which can lead to substantial longitudinal upkeep (for both the well being system or the companions linked to the EHR).
Lastly, Epic’s distinctive measurement and dominant market place may entice antitrust challenges from authorities regulators. Even as we speak, as Seth Joseph documents, Epic is already attracting lawsuits from a number of “smaller, adjoining distributors.” As Epic provides ERP and Cerner and Epic proceed including adjoining options and capabilities, they’re increasing their positions, doubtlessly garnering further regulatory oversight.
2) Clients are Skeptical
Even whereas many well being programs may need an “EHR-First” integration desire, many are additionally skeptical of their EHR vendor’s guarantees and their skill to combine new apps. Sage Development Companions report entitled The New Healthcare C-Suite Agenda: 2024-25 addressed the problem:
C-Suites are at a expertise crossroads: Only a few are happy with their EMR vendor, the market is flooded with level options however integrations are irritating workers extra, and regardless of the coverage relaxations round telehealth over the last three years, telehealth and in-home hospital instruments usually are not properly built-in with EMRs.
When requested “How properly does your present vendor dwell as much as the guarantees it makes in regards to the EMR, solely 26% responded “extraordinarily properly” or “very properly.”
Maybe most significantly, “𝐨𝐧𝐥𝐲 𝟏𝟕% 𝐨𝐟 𝟐𝟎𝟐𝟑 𝐫𝐞𝐬𝐩𝐨𝐧𝐝𝐞𝐧𝐭𝐬 “𝐬𝐭𝐫𝐨𝐧𝐠𝐥𝐲 𝐚𝐠𝐫𝐞𝐞” 𝐭𝐡𝐚𝐭 𝐭𝐡𝐞 𝐄𝐌𝐑 𝐰𝐢𝐥𝐥 𝐦𝐞𝐞𝐭 𝐭𝐡𝐞 𝐦𝐚𝐣𝐨𝐫𝐢𝐭𝐲 𝐨𝐟 𝐭𝐡𝐞𝐢𝐫 𝐨𝐫𝐠𝐚𝐧𝐢𝐳𝐚𝐭𝐢𝐨𝐧’𝐬 𝐧𝐞𝐞𝐝𝐬 𝐦𝐨𝐯𝐢𝐧𝐠 𝐟𝐨𝐫𝐰𝐚𝐫𝐝, down from 25% in 2022.”
3) EHR Analytics Are NOT Optimized To Obtain Important Well being System Aims
Any particular person EHR can NOT be considered because the “supply of fact” for a affected person’s scientific historical past:
A number of EHR Distributors. Each within the U.S. and overseas, bigger well being programs usually are Frankenstein’s monsters stitched collectively from numerous acquisitions. Thus, they incessantly sport a patchwork of competing EHRs. A HIMSS Analytics study discovered that the common well being system has 18 totally different EHR distributors throughout inpatient and outpatient settings.
A number of Level Options and Sources of Information. Affected person information in well being programs is unfold throughout a number of programs, not simply EHRs.
Affected person and Information “Leakage.” Right this moment’s sufferers are extra motivated by comfort than loyalty to 1 well being system; affected person leakage throughout care suppliers is important. A examine in International Journal of Medical Informatics discovered that “solely 4.5 % of expenditure-weighted particular person Medicare beneficiaries had their MU medical data related to a single vendor, whereas 19.8 % of expenditure-weighted beneficiaries had their MU medical data saved in 8 or extra distributors.”
Affected person Well being and Care Information is More and more Outdoors of EHRs. A McKinsey study examined how a lifetime of affected person well being and care information is prone to be created (see the graphic under).
By including the numbers in the suitable column, you’ll see that an individual generates an estimated complete of 1,106.4 terabytes of well being information over the course of a lifetime. Nevertheless, solely 0.4 terabytes — or 0.04% — is scientific information, i.e., prone to reside in as we speak’s EHRs.
The implication: EHRs are prone to include solely a fraction of a affected person’s well being and care information. Optimum end-to-end analytical programs for affected person information — ones designed for each prevention and care – might want to pull information from throughout a various vary of sources. These capabilities don’t exist in as we speak’s EHRs.
We’ve famous that the roots of EHRs are as programs of document to doc processes for fee-for-service billing, nevertheless it goes deeper than that.
Pushed by early incentives like Significant Use, EHR design closely prioritized billing for particular person companies and administrative duties. Consequently, their structure emphasised documenting the quantity of care delivered for reimbursement, quite than the worth of affected person outcomes and effectivity.
The restricted interoperability inherent in lots of early EHR programs fostered information silos. This fragmentation made it tough to attain the excellent, holistic affected person view important for efficient value-based care (VBC) and value-based funds (VBP), care coordination, inhabitants well being administration, complete price of care measurement and administration, and different capabilities wanted for cutting-edge well being programs.
In flip, conventional EHRs sometimes lacked entry to longitudinal claims information and the subtle analytics essential to robustly measure prices and affected person outcomes. Additionally they incessantly lacked standardized mechanisms for capturing patient-reported outcomes (PROs) and didn’t streamline scientific workflows to particularly assist value-focused care supply. Consequently, these programs weren’t inherently designed to optimize for the rules and various fee fashions of VBC.
Whereas EHR expertise has superior, these foundational limitations proceed to current important hurdles for well being programs navigating the advanced transition in direction of VBC and inhabitants well being. Addressing these inherent design constraints is essential for realizing the complete potential of digital well being in a future-proofed, value-driven healthcare panorama.
4) EHR Switching Prices are Diminishing
Prior to now, switching EHRs was akin to transferring homes throughout a blizzard…with three toddlers and a herd of goats. Excessive switching prices created a defensive moat to guard EHRs from opponents, both different EHRs or a brand new class of UDHPs.
Nevertheless, authorities coverage, laws, and regulation over the previous 20 years have promoted interoperability and applicable change of affected person information. The HITECH Act, the twenty first Century Cures Act, the promotion of HL7 FHIR APIs, and the creation of TEFCA exemplify this pattern.
As affected person information turns into extra fluid and readily shareable throughout totally different programs, switching prices are diminished. That is much more pronounced exterior the U.S., the place requirements like openEHR – a standardized scientific information mannequin which separates information from purposes – are gaining traction, demonstrating the potential of knowledge standardization to ease system transitions. The EU Data Act mandates the power to modify information suppliers seamlessly.
Moreover, the evolution in direction of a UDHP doesn’t essentially require an entire and quick EHR substitute. As we mentioned in a previous blog post, UDHPs might be architected to combine with and leverage current information repositories, together with EHRs. This incremental strategy to UDHP adoption can considerably scale back the perceived and precise prices of transitioning to a extra unified digital well being ecosystem.
5) Cloud Native Platforms Speed up Innovation and Efficiency
The roots of EHRs are as programs of document to doc fee-for-service billing processes, changing on-site processes with (sometimes) on-prem software program. UDHPs, however, are sometimes cloud native software program, permitting broad scalability, availability, and performing as hubs for innovation. With CHIME’s 2024 survey suggesting “24% of CIOs highlighted applicational rationalization and optimization a prime precedence,” this begs the query: the place ought to this utility rationalization and optimization happen?
Cloud native software program is a powerful contender, providing lots of the CIO-sought advantages and the power to scale in a cost-transparent approach. Neil’s current piece “Head in the Cloud: Today’s Healthcare Executive” covers the shift to cloud-first infrastructure because of extra than simply market wants, but in addition a change in management. Because the Epic-selecting CIOs of the 2010s are retiring, a brand new technologist profile is rising and leaning cloud-first.
To be clear, we aren’t referring to easily lifting-and-shifting an EHR from on-prem to the cloud. Whereas altering internet hosting suppliers and areas can add incremental advantages to efficiency, price of possession, and scalability, the complete advantages of cloud-first platforms usually are not achieved by migrating legacy software program.
To get the complete advantages of a cloud-first strategy, there’ll should be a re-architecture of programs. It is a giant job, however we now have lots of the items as we speak, with scalable databases, Grasp-Information-Administration merchandise, EMPI merchandise, and headless EHRs (ONC Licensed EHRs of document that let prospects to reskin the affected person and provider-facing experiences). Some main organizations are already creating cloud-hosted centralized information platforms that create a single supply of fact, brokering information throughout their technical ecosystem. Beneath, we’ll cowl some main advantages of this extra encompassing cloud-first strategy.
The place EHR distributors have traditionally moved slowly, cloud service suppliers are quickly including shared companies and tooling. With their consumption-based pricing fashions, they’re immediately incentivized to allow and encourage onboarding new customers, use circumstances, purposes, and databases. Not everybody will want or need to construct from scratch within the cloud, and as highlighted within the earlier submit, cloud-hosted ERP platforms are additionally rising to the event to satisfy UDHP wants.
Past the checklist of advantages above, it’s the strategy of those new service suppliers that encourages us to query whether or not EHRs can stay UDHPs in the long run. The cloud service suppliers (or hyperscalers) and ERPs are prepared to combine with anybody, host and provision something anyplace, and supply centralized, distributed accessible, – and in addition open – programs. AWS and Azure, for instance, would fortunately host your Epic occasion, connect with your athenaHealth tablespace, and your level options. Please, proceed including extra!
And, they’ve essentially the most superior, scalable databases and information platforms to accommodate that information. This makes the following era of level options, CDS options, or AI-derived brokers even simpler to create as cloud-first, as the info are already there, centralized, and accessible.
EHR prospects are additionally flocking to cloud distributors already, seeing advantages in internet hosting prices, scalability, testing, and different areas. From KLAS’ Epic within the Public Cloud 2024 report: “The bulk [of survey respondents] make the most of a cloud supplier for Epic catastrophe restoration, and this usually serves because the preliminary step within the Epic cloud migration journey.” IDC takes it a step additional of their 2024-2025 Well being Information Platforms for Suppliers Vendor Evaluation, introducing multi-cloud implementations as a doable route, stating that “Practically half (49.2%) of U.S. healthcare suppliers will prioritize IT modernization initiatives extending into 2025. This emphasizes the necessity for platforms that scale successfully and combine seamlessly with current and rising programs within the healthcare ecosystem. Multicloud adaptability will probably be important to reaching this.“
This means one reply to the query of the place utility rationalization and optimization ought to happen: within the cloud. The cloud distributors are prepared and capable of accommodate any EHR and are aligning incentives to speed up cloud adoption. If these cloud platforms can handle healthcare’s information complexity, what’s stopping them from being the UDHPs accelerating innovation in healthcare?
6) It’s Not in EHR DNA to Turn into a Broad-Primarily based Platform
EHRs are set of their methods – kinda like your uncle who nonetheless makes use of a flip cellphone. In contrast to lots of as we speak’s most profitable tech firms, EHRs usually are not “platform native.” We checklist some potential methods this might inhibit an EHR’s growth towards changing into a UDHP:
“Software program Considering” vs. “Platform Considering.” To really perceive the transformative potential of Unified Digital Well being Platforms, it’s essential to differentiate between conventional “software program considering” and extra expansive “platform considering.” By their very definition, UDHPs aren’t merely new software program; they signify a basic shift in direction of a platform enterprise mannequin, full with a new set of rules requiring a special mindset for achievement.
Seth Joseph astutely noticed that EHRs nonetheless consider themselves as software program firms, whereas the larger alternative is emigrate from being “a software program vendor within the market to {the marketplace} itself.” This transition necessitates a basic change in how these programs are conceived, constructed, and operated.
Enlargement By means of In-Home Growth vs. Enlargement By means of M&A. Traditionally, Epic has largely favored growth by way of in-house growth quite than embracing the platform technique of development by way of acquisitions and fostering an exterior ecosystem. Judy Faulkner, the influential founding father of Epic, has famously acknowledged Epic won’t ever be bought and has additionally traditionally maintained a stance in opposition to buying different firms.
This inward focus contrasts sharply with the strategy of established platform giants who’ve made a whole bunch of acquisitions:
Alphabet (Google) — 200+
Amazon — 125+
Meta — 100+
Microsoft — 275+
To scale successfully and exponentially, it’s essential to take an ecosystem-first strategy.
Foot-Dragging On Interoperability vs. Interoperability by Default. The early historic strategy of many EHR distributors has been characterised as foot-dragging on interoperability, a stark distinction to the “interoperability by default” ethos of profitable platform companies.
Constructing One Firm vs. Constructing an Ecosystem of Companions. Lastly, till the previous decade the standard EHR mannequin was operated beneath the belief that exterior builders weren’t really essential, a viewpoint diametrically against the platform enterprise mannequin the place builders are central.
In 2017, Epic opened its app retailer to a sluggish begin. Epic was considered as unresponsive by many app builders. We additionally keep in mind builders claiming that Epic was not respecting their mental property rights, i.e., “Your IP is now our IP.”
Epic has since developed way more vibrant developer packages. In but another blog post, Brendan Keeler describes and charges builders’ choices in working with Epic. He concludes by advising devs to “mood your expectations.”
Synthesis and Conclusion:
OK, we’ll admit that the Thesis/Antithesis factor was a little dramatic. Let’s revisit the wording:
- Thesis: EHRs Can Increase To Turning into UDHPs
- Antithesis: EHRs Can’t Turn into Efficient UDHPs
We’ll additionally concede that the wording is a bit deceptive — it implies black/white eventualities beneath which EHRs both will or won’t develop into UDHPs. The fact, as all the time, is messier than a binary selection. It’s not ‘EHRs will completely develop into UDHPs’ or ‘EHRs are doomed to the dustbin of historical past.’ It’s extra like…shades of grey, with a wholesome dose of ‘we’ll see.’”
The UDHP market could be very early — the Gartner report that we cited in our previous blog post on UDHPs estimated that the market is just 5% penetrated and that UDHP adoption will take 5 to 10 years.
As we’ve famous, UDHPs might be adopted incrementally and over time. UDHPs can accommodate EHRs as parts, and UDHPs and EHRs usually are not mutually unique: we don’t see EHRs as going away any time quickly.
We anticipate that totally different organizations will make totally different choices, relying on numerous components reminiscent of:
- Dimension and assets. Bigger well being programs probably will see better wants for a UDHP; smaller programs extra probably will look to their EHR for integrations.
- Organizational complexity and geographic footprint. Multi-state footprints, a mixture of care settings throughout the acuity spectrum, and broad ranges of specialties all add complexity, required connections, and extra alternative with a UDHP strategy.
- Present EHR vendor. Some EHR distributors may succeed at growing UDHP capabilities, others may not. TBD.
- Pricing of UDHPs vs. EHRs. TBD.
- Evolution of UDHP capabilities and market acceptance. TBD.
- UDHP vendor and market evolution. In our earlier submit, we highlighted over 20 UDHP vendor “candidates”, and later steered that this quantity would shrink drastically.
In our subsequent submit on this collection, we’ll section the healthcare supplier market to guage for whom (which hospitals and well being programs) the EHR may function the UDHP and when it is sensible to decide on a cloud-first answer.
Vince Kuraitis JD/MBA is an unbiased guide with over 35 years’ expertise throughout 150+ healthcare & tech firms. Neil Jennings is Vice President, Consulting at Untangle Health. Vince publishes The Healthcare Platform Blog, the place this submit first appeared. The authors need to thank a number of colleagues for his or her overview and commentary on an earlier draft of this submit: Michael Byczkowski, World Head of Healthcare at SAP; Brendan Keeler, Interoperability Follow Lead at HTD Well being; Sandra Raup, President at Datuit; and Chris Notaro, CEO of Untangle Well being.
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