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HealthEdge® CTO Update: Key Areas of Investment for 2025

Published Date
Author Rob Duffy

In our December IMPACT customer event, we introduced a few key areas of investment at the platform level, and I have some exciting updates to share with you on customer experience, integrations and interoperability, artificial intelligence and automation, and early access Professional Services opportunities.

Customer Experience at HealthEdge®

Quality Center of Excellence

Over the last six months, we’ve been doubling down on quality. For us, that means increasing the levels of automation, deploying a consistent quality platform, enhancing product quality, and reducing the number of bugs making their way into user acceptance testing (UAT) and production environments.

Our Quality Center of Excellence has been focused on:

  • Enhanced product quality
  • Stable release processes
  • Reducing effort spent on UAT
  • Defect free user experiences

What we have done:

  • Launched an operational platform
  • Selected a Test Data Management solution (TDM)
  • Established a consistent automated testing framework & process

Our wins:

What’s next:

  • Roll out the TDM process for tests with real-world and synthetic data
  • Unify our performance testing infrastructure and framework
  • 80% test automation across the board
  • 80% reduction in defect escape by the end of 2025

HealthEdge User Experience Platform

Our vision is to create something like Microsoft Office – where you go from Excel to PowerPoint to Word – but it still feels like a unified experience, with a comfortable familiarity between the products. We have brought on a new user experience (UX) leader who has been driving the enhancement of the user experience platform.

This platform is enabling us to create a consistent, high-performance, accessible, and modern user experience across products, leading to:

  • Increased usability
  • Enhanced productivity
  • Faster time-to-market

What we’ve done:

  • Created a design system to modernize and unify our products
  • Published components for the design system in React
  • Rebuilt an internal application with these components

Our wins:

  • Identified six projects as candidates to adopt our design system in Q2-Q3
  • Set up a Continuous Integration/Continuous Deployment (CI/CD) pipeline to automate testing and publishing of new versions of the components

What’s next:

  • Consistent and adaptable customer experiences and accelerated time-to-market

Integrations & Interoperability

API & Integration Platform

We have been investing heavily in our new API & Integration Platform. We brought on a new leader and have standardized all our integration work into one workstream. This platform is extending our current integration tooling into a highly secure, scalable, and comprehensive solution for cross product and partner integration.

We have been focusing on providing a world-class API & Integration platform, driven by the following:

  • Secure and scalable integrations
  • Compliance and governance
  • Future-proof real-time architecture

What we’ve done:

  • Developed centralized API management and messaging components, with real-time, dynamic messaging
  • Built a data integration platform to support data ingestion needs
  • Built the streaming platform
  • Created FHIR Converter to support electronic prior authorization workflow

Our Wins:

  • Real-time messaging platform: Live with integration between HealthRules Payer and Provider Data Management solutions, on track to be live with integration between HealthRules Payer and GuidingCare solutions in April
  • Centralized API management platform live with integration between HealthRules Payer and HealthEdge Source
  • Live with Salesforce integration for HealthRules Payer customers

What’s next:

  • Creating a “marketplace” of point and click integrations
  • Standardizing solutions for all data ingestion and extraction needs
  • Enhancing FHIR support
  • Building enterprise services like identity and tenant management

Infrastructure Center of Excellence

For the past six months we’ve been working on a plan to move our applications to the public cloud. To do so, we have created an Infrastructure Center of Excellence, which is focused on standardizing our infrastructure, DevOps, and Site Reliability Engineering (SRE) to provide you with high application availability, security, performance, and scalability. Our vision is that when we move to the cloud, we have one enterprise way of doing things and it’s a best-in-class enterprise platform, ensuring our long-term scalability and performance.

We’re focused on:

  • Enhanced scalability
  • Stable releases
  • Less effort spent releasing

What we have done:

  • Established standards for scalability, security, stability, and monitoring
  • Automated routine operations
  • Selected enterprise tools for all cloud operations

Our wins:

  • Started migrating to an enterprise-wide tool for CI/CD to enable stable releases and processes
  • Established enterprise-wide SRE operations for cloud-based products

What’s next:

  • Ensuring long-term scalability, performance, and adaptability

Artificial Intelligence & Automation

AI and automation have been another key investment area. We’re working toward a unified generative AI and foundational model platform that will efficiently and safely deliver AI-powered workflows and tools across our products. We have an exciting roadmap of AI advancements planned.

We’re thinking about AI and using AI tools and agentic infrastructure to automate the last part of the manual work during claims processing. We’re working on leveraging enterprise AI and automation internally to improve our efficiency and in our products to improve your efficiency.

Our AI and automation guiding principles are:

  • Secure, compliant, safe
  • Cross platform opportunities
  • Enhanced support, documentation, and training

What we’ve done:

  • Launched operational platform
  • Prioritized project list for 2025
  • Consistent approach to deliver AI driven solutions

Our Wins:

  • GuidingCare Member AI Summarizer released in April 2025
  • AI Optical Character Recognition (OCR) Fax ingestion solution by July 2025
  • Multiple other projects under design and development

What’s next:

  • Scale AI and drive innovation across products
  • Leverage agentic AI architecture to streamline user workflows for efficiency, accuracy, and speed

Looking Ahead

Data, Business Intelligence, and Reporting

I spoke with a lot of our customers, including CIOs, CTOs, VPs, and technical users. One key theme emerged – data and business reporting are critical, but with so many different systems and pieces of data, consolidating data and getting an enterprise view is difficult.

To help address that, we’re heavily investing in an enterprise-wide data platform to enable business intelligence, analytics, and AI with data aggregated from all products. This will include features like:

  • Pricing contract data from HealthRules Payer & HealthEdge Source in July 2025
  • History, Audit and Monitor mode data from HealthEdge Source available by August 2025
  • Claims history for performance metrics from HealthRules Payer available by Q4 2025
  • GuidingCare and Wellframe reporting data in design phase

Driving to 100% test automation

We are making progress on our goal of 100% test automation, increasing the quality within our platform, and getting to a place where we have zero defect escapes across all our products. This year we intend to achieve 80% test automation. Important updates include:

  • Quality initiatives focused on test automation prioritized across the enterprise
  • Engaged third-party automation specialists to achieve 80% automation goal by the end of 2025
  • All products actively working on automating manual test cases with a focus on commonly used features first
  • TDM will enable running automated tests against de-identified real-world data and synthetic data further enhancing the effectiveness of automated testing

Our Vision for AI Across HealthEdge

Another key area is Artificial Intelligence. Our vision for AI is to accelerate AI-powered innovation in healthcare, ushering in a future that improves cost and care outcomes while enabling members to live their best lives.

We have been investing in agentic platforms, partnered with a third party for their expertise, and have working proofs of concept for how the agentic workflow is going to help us ingest data, move it through the AI-powered workflow, and provide rules or configurations at the other end. Our focus areas include:

  • Intelligent Claims Operations
  • Automate every aspect of claims adjudication with AI, including contract management, adjudication, fraud detection, and improved financial accuracy
  • Proactive & Integrated Care
  • Improving care and cost outcomes while driving care team quality and efficiency through predictive insights, automation and tailored care support
  • Elevated Member & Provider Experience
  • Enabling personalized experiences at scale to meet member and provider needs across intelligent content, workflows and data

Early Access to 3 Professional Services Offerings in 2025

Want to meet with us and work on this together? We’re looking for partners in the following areas to work with our Global Professional Services team:

1. Reporting Data Lake

If you’re a HealthEdge customer and you’re thinking about your data strategy and how you’re going to get reporting and business intelligence across products, we would love to partner with you. Come spend half a day with us to run a design sprint so that we can understand your data landscape and how we might design our data lake to mirror that. It includes:

  • Multiple new and existing report options across HealthRules Payer, HealthEdge Source, HealthEdge Provider Data Management, GuidingCare, and Wellframe
  • Customized report options
  • Consultation on report options
  • Best practice recommendations
  • Run a Design Sprint—half-day to one-day workshop to understand current, necessary, and recommended reporting requirements

2. Test Automation as a Service

Client-side testing is essential for us to ensure the success of our implementations. The current method is inefficient and costly. But there’s a better way – with HealthEdge’s new test automation platform, which leads to better speed, efficiency, quality, and value. By working together, we can substantially and meaningfully improve the amount of automation and testing we have within your environments, and we can do it on our platform with our knowledge and expertise. It includes:

  • User Acceptance Testing and integration from domain experts
  • Faster, reduced risk, and added capacity for other org priorities
  • IP that can be capitalized
  • Run like Design Sprint—half-day to one-day workshop to understand what your team is doing now, current team size, types of testing, and testing of current processes
  • Proposal with testing automation experts and quality assurance

3. Agentic AI Services

Agentic AI is the next generation of robotic process automation. We’d like to work with you to figure out how we can design a system that closes that gap in automation. For example, with a HealthRules Payer claim, when it goes pending, there are a bunch of steps a human must do (open documents, read information, and gather data from multiple systems). We’d like to create an AI-based agentic workflow system that automates those manual tasks based on the information that’s available to it and build it into the product so that your users can do less manual work.

We’re looking for:

  • 10 customers for Q2 visits
  • Robotic optimization on top of HealthRules Payer, GuidingCare, or total health plan
  • Manual tasks that you want to automate
  • Turn these into a platform with agents
  • Currently looking for design partners

These are three exciting offers we have. We’re bringing them to you early because we think they’re meaningful and because we’d like to design them with you to better understand how you can get leverage from them.

Contact your Customer Success Executive to learn more and join us in one of these early access opportunities.

 

About the Author

Robert Duffy is an accomplished technology leader with an extensive background in product development and engineering. Rob previously served as the Chief Product and Technology Officer at Drizly, an Uber Company, where he played a pivotal role in scaling the company’s product and engineering teams post-acquisition. His leadership at Drizly was instrumental in driving innovation within Uber Eats' grocery delivery services, showcasing his ability to merge technology with user-centric solutions. Prior to his tenure at Drizly, Robert held significant positions at industry giants including Salesforce.com, Amazon, and Time Inc. At Salesforce, he excelled as the Vice President of Software Engineering, leading the team responsible for the Lightning Web Stack, which handles billions of API calls per day. With a Bachelor of Science in Computer Science & Engineering from Heriot-Watt University, Rob has consistently delivered top-tier software solutions that address complex business challenges. His leadership style emphasizes collaboration and innovation, making him a respected figure in the technology sector. Passionate about fostering a sense of community, he is leveraging his expertise at HealthEdge to drive the digital transformation of healthcare.

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