For anyone who watched the fintech revolution unfold between 2010 and 2020, the parallels between what banking looked like before that decade and what healthcare technology looks like right now are striking.
Banking pre-2015 ran on legacy systems that had accumulated decades of feature requests, regulatory patches, and integration debt. The systems were broad, monolithic, and reluctant to change. They served every banking function, which meant they served no specific function particularly well. Building new financial products on top of them required negotiating multi-month vendor relationships, navigating fragmented data architectures, and accepting integration overhead that effectively excluded most innovation.
Then a wave of fintech infrastructure companies emerged. Plaid for bank data. Stripe for payments. Marqeta for card issuing. Galileo for processing. Each took a piece of the monolithic banking stack, rebuilt it with a modern API and developer experience, and exposed it as infrastructure that anyone could build on. The result was a Cambrian explosion of fintech products built on rebuilt infrastructure that finally matched what the market actually needed.
Healthcare technology is in the equivalent place right now, and the equivalent infrastructure layer is starting to emerge. The most visible example of this shift is happening in electronic medical records.
The legacy EHR problem
The dominant EHR systems in healthcare today are the technology equivalent of pre-fintech banking cores. They were designed to handle medicine in general, which means they serve every specialty broadly and none specifically well. The interfaces are heavy. The data models are rigid. The integration paths are limited.
For clinics trying to deliver specialty care, this creates predictable problems. Pediatric developmental specialists end up using free-text notes for things that should be structured data. Cardiology clinics miss medication titration sequences that more specialised software would prompt automatically. Behavioral health practices document patient progress in formats that do not flow into reporting or analytics. The legacy EHR delivers compliance but actively impedes the delivery of high-quality specialty care.
For healthcare technology entrepreneurs trying to build on top of this infrastructure, the problems multiply. Data integration with legacy EHRs is famously difficult. APIs are often partial, undocumented, or non-existent. Developer experience is essentially absent. Building healthcare products that work across multiple EHR systems requires accepting integration overhead that excludes most startup-scale companies.
The pattern is exactly what banking looked like in 2010, and the response is exactly what fintech did to banking infrastructure.
What the new infrastructure layer looks like
The emerging healthcare infrastructure layer is built around a few specific principles drawn directly from the fintech playbook.
Modular, vertically specialised products replace monolithic platforms. Rather than a single EHR trying to serve every medical specialty, modern platforms build pre-configured environments for specific care models. Each environment is optimised for the actual workflows, protocols, and data needs of the specialty it serves.
API-first design replaces closed integration. Modern healthcare platforms expose comprehensive APIs and SDKs, allowing integration with other clinical, administrative, and patient-facing tools. The data flows in and out in standard formats. Building on top of the platform does not require negotiation; it requires documentation reading.
FHIR (Fast Healthcare Interoperability Resources) becomes the standard data layer. Just as fintech standardised around specific data formats and protocols, healthcare is increasingly standardising around FHIR for clinical data interoperability. Platforms built with FHIR APIs as a first-class capability participate in the broader healthcare data ecosystem natively.
Developer experience improves dramatically. The new healthcare platforms publish documentation, offer sandboxes, provide AI-generated demo patients, and treat external developers as customers. The friction that excluded healthcare technology entrepreneurs from building on legacy EHRs is being deliberately removed.
Canvas Medical is one of the clearer examples of a platform built around these principles. The company offers pre-built EMRs customised for specific care models (cardiovascular health, developmental and behavioral pediatrics, chronic care management, therapy and behavioral health, weight management, primary care), with SDK and FHIR API integration as foundational capabilities. The model is recognisable to anyone who has tracked the fintech infrastructure boom: vertically specialised products on top of a unified API-first core.
Why this matters beyond the EHR market
The parallel to fintech is not just stylistic. The downstream effects of better infrastructure tend to compound across the industry that adopts it.
In fintech, modern infrastructure enabled the consumer fintech wave (Robinhood, Chime, Cash App), the embedded finance wave (every consumer app gradually adding financial services), and the specialised B2B fintech wave (vertical SaaS adding financial features). None of these would have been possible at the same pace on legacy banking infrastructure.
In healthcare, modern clinical infrastructure is starting to enable similar second-order effects. New specialty care models become viable when the EHR is built around them. Telehealth-native practices launch faster when the underlying platform supports hybrid care workflows natively. AI-assisted clinical tools integrate cleanly when the data layer is structured and accessible. Population health analytics become possible when clinical data is captured as structured fields rather than free text.
Healthcare entrepreneurs who, ten years ago, would have spent the bulk of their startup capital on EHR integration and compliance can now focus on the clinical and product innovation that actually differentiates them. The infrastructure shift is what makes the rest of the ecosystem possible.
What the timing looks like
The healthcare infrastructure parallel to fintech is currently somewhere around 2015 to 2017 in fintech equivalent timing. The new infrastructure layer is mature enough to be usable. Early adopters are building real products on it. The legacy incumbents are starting to notice. The funding ecosystem is recognising the opportunity. The broader healthcare market has not yet fully shifted, but the direction is clear.
The next five years are likely to see the same kind of acceleration that fintech experienced in the 2017 to 2022 window. New care models will launch on modern infrastructure. Established practices will migrate from legacy EHRs to specialty platforms. AI-assisted clinical tools will proliferate on the new data layer. Healthcare technology entrepreneurship will become significantly more accessible.
This is what happens when an industry’s underlying infrastructure gets rebuilt. The downstream effects take a few years to fully manifest, but they are predictable.
What this means for healthcare technology investors
For anyone tracking healthcare technology as an investment category, the infrastructure shift is one of the more consequential trends to understand. The same dynamics that produced fintech’s largest outcomes are starting to operate in healthcare. The investors and operators who recognised the fintech infrastructure layer early in its development captured disproportionate value as the rest of the ecosystem built on top of it.
The healthcare equivalent of that recognition is happening now. The specialty EMR layer, the FHIR-based interoperability layer, and the API-first clinical infrastructure layer are still in their early phases of mainstream adoption. The companies building this infrastructure are positioned to benefit from the broader wave of healthcare technology innovation that the infrastructure enables.
The takeaway
Healthcare technology is at the same infrastructure inflection point that fintech reached in the mid-2010s. The legacy systems that have dominated for decades are being replaced by modern, vertically specialised, API-first platforms. The downstream effects on healthcare technology innovation, clinical care models, and entrepreneurship are likely to mirror what happened in fintech over the past decade.
For technology and infrastructure observers, the parallels are unusually clean. The patterns that reshaped one industry are now reshaping another, on roughly the same trajectory, driven by roughly the same underlying dynamics. The names of the companies are different. The structural story is recognisable.
Healthcare’s infrastructure layer is catching up. The rest of the ecosystem is about to start building on it. The next decade in healthcare technology is going to look more like the last decade in fintech than most observers realise.
Frequently Asked Questions
What is the parallel between healthcare EMRs and fintech infrastructure? Both industries built on monolithic legacy systems that served every use case broadly and none particularly well. Modern infrastructure layers in both industries rebuilt the core capabilities with API-first design, modular vertical specialisation, and developer-friendly access.
What is a specialty EMR? An electronic medical record system built specifically for the workflows, protocols, and data needs of a particular medical specialty (cardiovascular care, behavioral health, pediatrics, primary care, etc.), as opposed to generic EMRs that try to serve all specialties broadly.
What is FHIR? Fast Healthcare Interoperability Resources. A standard for exchanging healthcare information electronically, increasingly used as the foundation for modern healthcare data integration.
Why is API-first design important for healthcare platforms? Because healthcare innovation depends on integration between systems. Clinical tools, patient-facing applications, analytics platforms, and administrative systems all need to share data cleanly. API-first platforms make this integration possible at the speed modern healthcare innovation requires.
How is the developer experience for modern healthcare platforms different from legacy EHRs? Modern platforms publish documentation, offer sandboxes with AI-generated demo patients, provide SDKs, and treat external developers as customers. Legacy EHRs typically require multi-month integration negotiations and provide partial or undocumented APIs.
What kinds of care models benefit from specialty EMRs? Almost all of them. The clearest benefits show up in specialties with distinctive workflows: cardiology, developmental and behavioral pediatrics, behavioral health, chronic care management, primary care, weight management. Generic care models also benefit but the differentiation is less stark.
How does hybrid care factor in? Modern specialty platforms increasingly support hybrid care workflows natively, combining in-person visits, telemedicine, remote monitoring, and asynchronous patient communication in a single integrated record. Legacy EHRs were built for in-person care and often handle hybrid workflows poorly.
Where does AI fit in the new healthcare infrastructure layer? AI-assisted clinical documentation, voice-to-structured-data tools, pattern recognition for screening, and predictive analytics all become more feasible when the underlying data layer is structured and accessible. The infrastructure shift is what makes AI applications in healthcare practical at scale.