The subject of patient engagement tools, especially patient portals, took up permanent residence in my head last January when my mother, a few months away from achieving octogenarian status, experienced a health event that would change both of our lives. When she came home from the hospital, suddenly she was no longer under 24-7 observation by hospital staff– she and I were on our own.
Later I learned that the hospital has a patient portal app that could help manage some of the our needs (not the personal chauffer for Mom, sadly– that was still me), and it suddenly it clicked—a mobile patient portal app could be a kind of tiny doctor that goes with you everywhere and is accessible at any time! The next thought, immediately, was “Wait, why don’t we all have that now?”
And thus began the rabbit-hole-diving—no, the portal-diving—into the research behind this post.
Patient engagement? Is that the prelude to patient marriage?
If you’re new to the idea of patient engagement in healthcare, let me break it down:
Patient engagement is the strategy of enabling patients to self-manage their healthcare needs, and patient engagement tools are online programs and services for patients to access on their own. This could include anything from tailored messages and reminders about their treatment plans and medications to educational resources to remote monitoring that tracks medication adherence.
(See also patient adherence, patient empowerment, patient autonomy, patient activation, patient experience…the terms have changed a bit over the years)
Patient portals are a patient engagement tool with a legal mandate: they are required by law to provide two services: 1) access to electronic health records (EHRs), and 2) the ability to contact and correspond with the patient’s healthcare providers. However, patient portals may also include a host of other features– and often do, because they are patient engagement tools. And they come in mobile app format, so let the features flow!
Patient engagement has potential to advance patient empowerment, which the WHO defines as “a process through which people gain greater control over decisions and actions affecting their health”—the worthiest of goals, but strangely also very distant.
Discovering why requires taking a nice long walk through the current landscape of patient engagement, stopping off to learn what EHRs even are, what healthcare tech platforms are, what the law says they have to do, and the reality of what they are doing today, before pointing out some promising possibilities sprouting up and looking hopefully into the future.
Your medical records online, no CD-ROM required
An electronic health record (EHR)1 is a digital system for storing patient health data, intended primarily for use by healthcare providers and platforms. EHRs can contain data in the following categories:
- Demographic Information: Name, age, sex, race, ethnicity, and sometimes socioeconomic data like marital status or occupation.
- Medical History: Diagnoses, medications, allergies, immunizations, surgeries, family history, and previous visits.
- Clinical Data: Test results, imaging reports, physician notes, vital signs, and treatment plans.
- Billing and Insurance: Information about coverage, claims, and payment history.
- Social Determinants of Health (SDOH): The non-medical factors that impact health, such as housing status, income, education, etc.
In the context of a healthcare system like a hospital, EHR data is the central nervous system—it gets vital information in front of the people (doctors, nurses, clinicians) who need to make decisions about a patient’s care, informed by that data.
Note: When the word “patient” is used here, that’s you—provided, of course, you’ve ever sought care from a healthcare system. Keep in mind as we’re talking about who accesses EHR data and how it’s used, because that’s your data—your demographic info, your medical history, your clinical data, your billing and insurance information, and your social determinants of health (effectively, your life).
Empower Patients: Giving patients access to their health data is one of the core benefits of system interoperability. Patients are better able to seek second opinions and alternative treatments, download educational materials that can help with disease management, and access their own diagnoses and test results. They no longer need to hunt down records from multiple providers and remember when and where they sought treatment, which medications they’ve been prescribed, and the details of their treatment plans.
Some big EHR vendor
Key to this effort is providing this comprehensive data to patients through easy-to-use applications or web pages that also include an accurate history of the data’s source.
Who gets their grubby hands on them, and why
Health records existed on paper before they were digitized, and once digitized they could be shared between healthcare systems according to the standards set in place by HIPAA, using Health Information Exchanges (HIEs)2 set up by the by the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology– the ASTP/ONC, for those of us who hate pausing to take a breath in the middle of a name.
But patients didn’t get meaningful access to their EHRs until 2014, with the implementation of the appropriately named Meaningful Use Stage 2 of the HITECH (Health Information Technology for Economic and Clinical Health) Act, proposed in 2012.
Imminent clinical information I mentioned above—diagnoses, allergies, test results, and so on—isn’t the entire set of data in an EHR, nor are clinical purposes the only reason that EHR data is accessed. The information shared via HIEs is aggregated from multiple EHRs and providers to facilitate interoperability (which we’ll get to later) and improve care coordination across systems.
Payers (insurance companies, Medicare, Medicaid) access EHR data to assess coverage, process claims, and conduct risk assessments. Public health agencies access EHR data according to health data reporting standards (including international health data reporting standards, which means the WHO, from which the U.S. is withdrawing, but not until January of 2026).
That’s a lot of entities, but a few are especially relevant here:
- EHR tech platforms don’t access EHR data per se—rather, they provide EHRs for use by healthcare organizations. They’re the OG accessors, and they also provide software used to manage that data such as dashboards, reporting modules, payroll, human resources, risk management and compliance, and of course, patient engagement.
- Analytics platforms don’t replace EHR platforms, so much as sit on top of them. An analytics platform integrates with the EHR platform, taking the (de-identified) data in EHRs and aggregating it, drawing insights that apply broadly and inform healthcare systems from a top-down, population-level perspective that would inform those systems at the administrative level. You can think of EHR platforms as handling healthcare in the here and now, whereas analytics platforms look toward the future.
- Government and regulatory bodies that I mentioned above, including the Department Health and Human Services (HHS) division the ONC, which became the ASTP/ONC3 last July, 2024.
But The legislation with the biggest impact on patient engagement came when the ONC was still the ONC– 2016, with the 21st Century Cures Act.
The Cures Act asserted a goal of offering patients access to their electronic health information in a single, longitudinal format that is easy to understand, secure, and may be updated automatically. To support this, the act promoted the adoption of FHIR (Fast Healthcare Interoperability Resources), a modern data exchange standard that enables seamless, real-time sharing of structured health data across different systems, including EHRs, patient apps, and third-party services.
So let’s look at a few of those, already.
Gimme 5
Healthcare platforms vary wildly beyond the distinction I made between EHR and analytics platforms. In all cases, it boils down to how a platform uses EHR data—and in the case of EHR platforms, the extent to which they allow others to use that data (a big part of interoperability, which we’ll get to later).
These differences naturally determine how their patient engagement tools are going to work, so it’s necessary to take a closer look at some specific examples of those tools in the context of the entities that provide them.
For that reason I selected a sampling of five of the vendors selling those tools: a major EHR vendor, a significantly smaller EHR vendor, a platform of patient journey and educational tools, and two very different analytics vendors.
First up, let’s talk about the gorilla in the room, because he’s going to dominate a lot of the discussion that follows.
America’s biggest: Epic Systems
Epic provides a patient portal, MyChart, that links to Epic’s electronic health record (EHR) system. It’s designed for seamless patient-provider communication within the Epic ecosystem, and allows patients to view health records, schedule appointments, message providers, and manage prescriptions It was augmented recently to include telehealth integration, patient-reported outcomes tracking, and AI-driven health insights.
Messaging on Patient Engagement:
Epic markets MyChart as the gold standard in patient engagement, emphasizing its ability to enhance patient-provider communication and streamline access to records. However, its definition of interoperability is largely confined to the Epic ecosystem, making true cross-platform access challenging.
Epic’s patient engagement strategy reinforces data centralization under its platform. Its history of opposing federal interoperability mandates and allegations of information blocking combined with its public-facing support of interoperability sends slightly mixed messages.
The company has been criticized for making data sharing more difficult when external platforms (see the entry below on Particle Health) attempt to access its network.
Counterpoint: Epic’s Safety Net Initiatives
I can’t portray Epic as the all-around Big Bad when they go and do stuff like using SDoH data insights to influence policy change4 and offer Safety Net program5 tools. However, these tools don’t appear to be integrated6 into MyChart- although it does have a feature to get estimates for cost of care and what’s covered by insurance vs. self-pay. It also allows patients to “provide financial information and request assistance with paying your medical bills,” which is vague but sounds promising.
Next up is more of a refined, artisanal EHR platform that isn’t Epic’s biggest fan.7
Cloud-based EHR and practice management platform: AthenaHealth
AthenaHealth targets smaller and mid-sized healthcare providers seeking a more flexible, scalable alternative to Epic.
It’s marketed as a seamless patient experience platform, emphasizing “a connected patient experience across the care journey,” providing scheduling, secure messaging, and telehealth integration, and automated reminders and billing/payment tools to streamline administrative processes.
Messaging on Patient Engagement:
AthenaHealth positions itself as a patient-first EHR vendor, promoting “patient loyalty” as a key benefit of its engagement tools, while warning of “patient consumerism”—indicating concern over patients becoming too independent in their healthcare choices. AthenaHealth advocates for interoperability8 but has been criticized9 for remaining tied to its own system structure. While it has presented itself as more open than Epic, it still operates within its own ecosystem, limiting cross-platform functionality.
Moving on from EHRs, the next stop is a school for patients.
Clinical decision support (CDS) and patient education: Wolters Kluwer
Wolters Kluwer Health is expanding into patient education and engagement through digital tools.
UpToDate10 is a suite of clinical decision support (CDS) tools for providers, with patient education resources tailored to treatment plans and AI-powered patient journey tools that offer personalized treatment explanations by integrating into EHRs.11
Messaging on Patient Engagement:
UpToDate is marketed as a trustworthy, evidence-based resource for both providers and patients. Unlike Epic or AthenaHealth, Wolters Kluwer’s approach to engagement is more about education than direct patient interaction.
Wolters Kluwer emphasizes its role in enhancing shared decision-making by ensuring patients and clinicians have access to the same information. They have also been a strong advocate for patient empowerment. Their messaging emphasizes the need for better tools, education, and data access to facilitate truly patient-centered care.
Counterpoint: Wolters Kluwer’s positioning on patient empowerment varies, depending on whether they’re talking to healthcare systems or sharing the perspective of one doctor12 advocating for patient empowerment.
Their white paper on the “patient empowerment framework”13 includes this curious statement:
There are many aspects to patient empowerment, but in general, understanding of this concept is fragmented. There are not agreed-upon definitions for terms like activation or engagement. And there is no comprehensive understanding of how these various aspects fit together.
So…I guess we can just define these terms however we want? Because UptoDate referencing how “patient empowerment is a critical component to operating profitability in this new world” doesn’t sound so much like patient empowerment to me, as a money-making strategy. Not that turning a profit is a bad thing, but can we have one term that’s about patients, not turning them into products?
I suspect that this first analytics platform won’t have an answer, but nobody’s perfect– especially this one.
Data Aggregation and Patient Analytics: Particle Health
Particle’s engagement tools include data retrieval services that allow providers to query national HIEs, and a Record Locator Service (RLS) that predicts where patients have received care based on historical data.
Messaging on Patient Engagement:
Particle Health promotes its Record Locator Service (RLS)14 as a way to track patient’s movements between healthcare providers, even promising giving clients a notification “when a patient receives a high-value procedure out of network,” so that they can “ensure high-value procedures are scheduled in-network.”
In addition to making the words “patient journey” in its mission statement: “Drive strategic growth with patient journey insights” sound rather ominous, this level of patient tracking sounds like more of a patient stalking tool than just an engagement platform. Interoperability is one thing, but sharing real-time insights into where patients have been just feels like it’s crossing a line.
Counterpoint: Particle does get credit for its challenge to information-blocking on the part of Epic, filing a federal antitrust lawsuit15 alleging that Epic used its dominance in the EHR market to cut off its own customers from being able to request data from Particle, impacting over 420,000 patients—they even created a dashboard16 showing which organizations were involved. I believe the suit is still ongoing, so it’s something to watch.
But for now, maybe there’s an analytics platform less inclined to follow you down dark alleys.
Data and Analytics: Health Catalyst17
Predictive, AI-driven patient engagement platform: UpFront
UpFront’s predictive analytics bring healthcare closer to the ideal of proactive, personalized care.
It uses psychographic segmentation and behavior modeling to influence patient choices:
- AI-driven outreach for scheduling, reminders, and follow-ups
- Segmentation of patients based on psychological and social factors
- Categorizes patients based on real-time risk factors, including SDoH data
- Proactively reaches out to high-risk patients before their conditions worsen
- Adjusts outreach based on a patient’s engagement level, ensuring personalized interaction
- Helps providers optimize follow-ups and interventions based on patient responses and historical data
Messaging on Patient Engagement:
UpFront promotes psychographic segmentation18 as “hyper-personalized patient engagement,” claiming to improve patient follow-through by understanding motivational drivers. It frames its AI-powered approach to increase patient activation and reduce provider workload.
One potential benefit of psychographic segmentation: personalized patient engagement: by understanding patients’ attitudes, values, and lifestyles, healthcare providers can tailor communications and interventions to better align with individual motivations, potentially leading to improved health outcomes.
Counterpoint: There are, however, prominent criticisms of psychographic segmentation, such as:
- Privacy Concerns:19 There are concerns about the ethical implications of collecting and utilizing detailed personal data for segmentation, including potential breaches of patient privacy and the risk of manipulating patient behavior without informed consent.
- Data profiling: Concerns about how patient behaviors are categorized and acted upon. Its focus on steering patients toward “desired actions” can blur the line between engagement and subtle coercion.
- Risk of Overgeneralization:20 Assigning patients to broad psychographic categories may overlook individual nuances, leading to interventions that fail to address specific patient needs or circumstances.
If UpFront wants to be your health coach, Health Catalyst’s other patient engagement app is more about being your personal health assistant.
Automated patient engagement and communication platform: Twistle
Twistle improves adherence by meeting patients where they are—through familiar communication channels.
It takes the manual burden off healthcare providers by sending reminders, check-ins, and education materials to patients, using their EHR data and self-reported responses to adjust engagement over time. Other features:
- Sends automated reminders for medication adherence, upcoming appointments, and follow-up care, that uses multi-channel automated messaging (text, email, phone, app notifications)
- Uses secure messaging to check in with patients post-discharge
- Integrates with wearables and home monitoring devices, pulling in real-time patient data for more personalized outreach
- Uses SDoH data to adjust engagement—patients flagged as high-risk due to economic instability
- Care pathway guidance, helping patients stay on track with their treatment
Messaging on Patient Engagement
Twistle aims to reduce provider workload through automated patient communication and help patients follow their care plans with automated messaging.
A real-world case study21 focuses on Providence Health’s effort to simplify treatment for total joint replacement care, showcasing how Twistle’s automated communication and reminders reduced complications and improved patient adherence to pre- and post-operative care plans. Twistle emphasizes that its platform allows for seamless digital engagement, helping patients stay informed and compliant with their treatment, ultimately leading to better outcomes and cost reductions.
While all of these platforms access and use EHR data, their levels of access to it vary. Interoperability means cooperation, and some kids want to take their ball and go home.
Lack of interoperability: A fancy term for “Why can’t my doctor see my records?”
Information blocking, the art of making data hard to share22
Information blocking in healthcare refers to practices that unreasonably prevent or limit the sharing, access, or use of electronic health information (EHI) among patients, providers, or health systems, often for competitive or financial reasons.
Sharing data between different health systems is what determines how useful patient engagement tools can be. The ability of different healthcare information systems and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner across organizational, regional, and national boundaries ensures that patient information can be shared seamlessly among providers, labs, pharmacies, and other stakeholders to improve care quality, efficiency, and patient outcomes.
The 21st Century Cures Act and HTI-1 Final Rule were supposed to stop hospitals and EHR vendors from blocking access to patient data. But instead of embracing real interoperability, vendors found loopholes, such as:
- Charging high fees for data access, making it financially unfeasible for competitors to build better patient engagement tools
- Requiring custom-built API integrations for every new connection, forcing external developers to spend months negotiating and developing integrations that should be standardized.
- Allowing hospitals to delay lab result releases until after a doctor manually reviews them, even if laws require immediate electronic availability
Internal interoperability works great—within that hospital system. But if a patient moves to another provider? Suddenly, data transfer becomes a bureaucratic mess. For example:
Vendor lock-in/EHR monopoly
Epic, Oracle (Cerner), and Meditech together control 60% of U.S. hospital EHRs. If a hospital uses Epic, it uses MyChart. If it uses Oracle, it’s HealtheLife. If it’s on Meditech, it’s Meditech Expanse.
Interoperability between different EHR systems remains limited, often resulting in hospitals remaining dependent on their existing systems. Contributing factors include:
- Lack of Standardization: The absence of uniform standards across EHR systems leads to inconsistent data formats and communication challenges, hindering seamless data exchange.
- Technical Complexity: The use of multiple incompatible EHR systems creates data silos and causes duplication of patient records, some of which are incomplete or inaccurate.
Patient engagement as a retention tool
To be fair, it’s just a fact that EHRs were developed for providers, not patients. That doesn’t seem quite as weird if you start with the idea that when EHR adoption surged due to HITECH Act incentives (2009-2015), vendors focused on first on helping hospitals meet Meaningful Use requirements (i.e., digitizing patient records and improving provider efficiency).
The primary customers for EHR systems are hospitals, not patients, so vendors designed tools that optimized billing, scheduling, and regulatory compliance rather than patient-facing features. Insofar as they thought about patient portals, they were just minimal add-ons, basic tools.
But here’s where I stop being fair. Next, hospitals began buying third-party engagement tools to supplement clunky EHR portals, signaling that EHR vendors were failing to meet patient expectations. Rather than improve interoperability, EHR vendors responded by building their own engagement tools, and now we have competition– to best serve the needs of hospitals, that is, not patients.
Learning more about EHRs, and EHR providers specifically, caused me to recall that scene in Miracle on 34th street (my mother’s favorite movie) where Kris Kringle (aka Santa Claus) is working at Macy’s, listening to children’s wishes, when a woman asks him where to find a particular item that Macy’s doesn’t carry, distraught because the item will be a Christmas gift for her son. Kris informs her about another, competing store where she can find the gift.
This causes department head, Mr. Shellhammer, to become incensed—until he receives a deluge of letters and phone calls from customers saying how much they appreciate the Macy’s priority of helping customers over direct profit. Mr. Shellhammer immediately instructs all sales assistants to follow Kris’s lead.
But in this case, EHR Macy’s actually makes the gift, and the other stores all make their own versions of the gift, and there’s not a lot Mr. ONC Shellhammer—or Mrs. Healthcare Provider, the customer—can do about it. She can shop at Macy’s or another store, but she has a contract with Macy’s (or something—stick with me here) to buy their gifts, so it’s extremely difficult to go to another store. And her Patient son gets (almost) no say in the matter.
Okay, so it’s not a perfect analogy—we left out the parts that weren’t in the original story, such as the gift expert analysts who go around telling stores how their gifts could work better, but who also make their own gifts.
Analytics platforms: using AI to give your EHR a workout
While EHR vendors continue to dominate patient engagement through their own proprietary tools, analytics platforms are emerging as a workaround, leveraging interoperability and AI to provide a more holistic, patient-centered approach to engagement. These platforms are built to ingest, analyze, and act on patient data across multiple sources, rather than restricting data within a single EHR ecosystem.
Analytics platforms are leveraging AI to go beyond simple patient record management and actively shape engagement strategies based on real-time data, predictive modeling, and personalized interventions. These tools are helping shift patient engagement from a reactive process (waiting for patients to seek care) to a proactive model that anticipates needs and removes barriers to access.
- Breaking Down EHR Silos (Health Catalyst, Arcadia) – AI-driven analytics platforms integrate data from multiple EHRs, insurance claims, HIEs, and even social determinants of health (SDoH) sources to create a comprehensive patient profile that traditional EHR patient portals cannot provide.
- Predictive Modeling for Preventive Care (Arcadia, Health Catalyst) – AI-driven platforms assess millions of data points to identify high-risk patients before they require costly interventions, enabling earlier engagement and better outcomes.
- Automated Patient Navigation and Outreach (UpFront, Twistle by Health Catalyst) – AI-enhanced platforms analyze patient history, social determinants, and engagement patterns to determine the most effective outreach method—whether it’s text reminders, digital education, or community resource referrals.
- AI-Driven Virtual Care Coordination (Wolters Kluwer, IBM Watson Health) – AI can recommend follow-up appointments, coordinate referrals between specialists, and track adherence to care plans without requiring constant human oversight.
- Real-Time Insights for Patient Adherence (Twistle by Health Catalyst, Wellframe) – AI can monitor which patients are engaging with their care plans, flagging those at risk of non-adherence and providing tailored interventions to improve compliance.
- Bias Detection and Personalized Equity Adjustments (Epic SDoH Analytics, Google Health AI) – AI models can analyze how different populations receive care, identifying disparities and ensuring more equitable engagement strategies tailored to historically underserved communities.
Don’t hold back: moving beyond EHR-restricted patient engagement
As analytics platforms continue to expand their capabilities, they challenge the traditional role of EHR vendors in controlling patient engagement. While EHRs will always be necessary for core medical documentation, their ability to drive meaningful, proactive engagement remains limited. Analytics platforms are filling that gap by:
- Enhancing interoperability to create unified, patient-centered data systems.
- Using AI-driven insights to tailor engagement at the individual level.
- Expanding patient access beyond clinical settings, incorporating SDoH and predictive health modeling.
By shifting the focus from reactive EHR-based portals to proactive analytics-driven engagement, these platforms are redefining how and when patients interact with their health data—offering a glimpse at what true patient empowerment could look like.
P.S. Oh yeah, remember that gift from Macy’s?
Turns out that the gift Ms. Healthcare Provider was trying to buy was a biography about the boy, and one that he, himself, was only recently allowed to read.
But read it he did, and the knowledge empowered him to write his own book– an autobiography, this time.
Dear reader– in a stunning twist you never saw coming, that little boy is you.
Biography or autobiography, people are going to keep copying sections of it for different purposes. But it’s still yours.
Get it, Check it, Use it! Easy access to your health records puts you in control of decisions regarding your health and well-being.
The ASTP/ONC
In the end, we must turn away from the abstract and distant disputes between entities who have no idea who we are, and yet handle our personal information daily. It will probably always feel like an invasion of privacy, no matter how many safeguards are in place. Equally, at some point we have to reckon with the fact that we don’t choose the patient engagement tools we use—Mrs. Healthcare Provider does, so that’s why Macy’s caters to her, not us.
But you know what? We do get to look at what we’ve been given and decide that it’s not good enough, and some of those folks are listening. So my next post will be much less structured and much shorter (it had better be!), but much louder. I plan to yell about some things– perhaps you’ll join me?
- https://media.market.us/electronic-health-records-statistics/#:~:text=As%20of%202021%2C%20approximately%2093,of%20meeting%20meaningful%20use%20criteria. ↩︎
- https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-hie ↩︎
- https://www.thinkbrg.com/insights/publications/hss-announces-reorganization-astp-onc/ ↩︎
- https://www.epicshare.org/perspectives/using-sdoh-data-to-achieve-policy-change ↩︎
- https://www.epic.com/software/safety-net/ ↩︎
- https://www.mychart.org/Features ↩︎
- https://www.healthcareitnews.com/news/can-epic-athenhealth-play-nice ↩︎
- https://www.athenahealth.com/resources/blog/interoperability-interoperability-obstacles ↩︎
- https://behavehealth.com/blog/2023/7/4/athenahealth-causes-big-problems-for-behavioral-health-group-practices-and-outpatient-programs ↩︎
- https://www.wolterskluwer.com/en/solutions/uptodate/ ↩︎
- https://www.wolterskluwer.com/en/solutions/uptodate/about/ehr-integration ↩︎
- https://www.wolterskluwer.com/en/expert-insights/why-patient-empowerment-matters ↩︎
- https://www.wolterskluwer.com/en/expert-insights/the-patient-empowerment-framework ↩︎
- https://www.particlehealth.com/particle-navigator ↩︎
- https://www.particlehealth.com/blog/epic-systems-stranglehold-on-u-s-medical-records-harms-patient-care-lawsuit ↩︎
- https://lookerstudio.google.com/u/0/reporting/7e67d31c-67ba-4e53-8963-3e544f7b6360/page/p_uq5np2rznd?s=gJzJtksjC5k ↩︎
- Full disclosure– HC is my former employer, though all comments (and mistakes) here are exclusively mine. ↩︎
- https://upfronthealthcare.com/resources/patient-activation/how-psychographic-segmentation-can-help-transform-healthcare ↩︎
- https://fastercapital.com/topics/ethical-considerations-and-privacy-concerns-in-psychographic-segmentation.html?utm_source=chatgpt.com ↩︎
- https://digitalcommons.du.edu/cgi/viewcontent.cgi?article=2783&context=etd&utm_source=chatgpt.com ↩︎
- https://hcatwebsite.blob.core.windows.net/success-stories/CaseStudy_Providence_Total-Joint-Replacement_Twistle-by-HCAT.pdf ↩︎
- https://techcrunch.com/2012/06/04/mr-obama-tear-down-this-walled-garden/ ↩︎