Purpose: Digital platforms are essential for fostering innovation in first-line healthcare. These platforms require openness, allowing external parties to utilize, enhance, or profit from them. Yet, knowledge about barriers to realizing platform openness is lacking. This research investigates the barriers to realizing platform openness in first-line healthcare. Method: This research employed a qualitative exploratory approach. We collected data through thirteen semi-structured interviews with platform experts, application developers, and healthcare practitioners. As a study setting, we focused on Dutch first-line healthcare. We then analyzed the data using thematic analysis. Result: We identify barriers in three main categories that hinder platform openness: technology-related (e.g., redundancy in development work), business-related (e.g., profit-maximizing strategy), and healthcare-related (e.g., reluctance to change). Scientific contribution: We contribute to the platform literature in medical informatics by being among the first to examine openness barriers that hinder platform-based innovation. We thus explain why platform implementations often do not result in substantial improvements in healthcare delivery despite their transformative impact in other industries.

Whereas open digital platforms drive innovation in industries, platforms in primary healthcare are mostly closed. Policy-makers have been looking for ways to open up primary healthcare platforms to stimulate collaboration and innovation and need to do so even more due to the ongoing COVID-19 crisis. Yet, there is not one way of opening up platforms in primary healthcare, just as it is unclear how different ways of openness can lead to more innovation. This paper analyzes the opportunities and challenges in realizing platform openness while examining alternative forms of openness. To answer this, we (1) conceptualize different forms of platform openness (sponsor-provider-platform-user openness), (2) examine how these forms of openness can resolve barriers to innovation, and (3) examine what challenges need to be overcome to realize that form of openness in practice, such as complexity in roles, regulations, and ICT infrastructure. The findings are relevant to structure further research on how platform openness leads to more innovations in healthcare.