A couple weeks ago, Oracle’s acquisition of Cerner closed and Oracle held an event to announce the vision for the The Future of Healthcare. Much has been written about Larry Ellison’s vision of what he called a “National EHR Database.” I wanted to give it a few weeks to sit before I commented, but it’s certainly worthy of comment.
First, it’s worth noting that Larry Ellison’s main job as co-founder and executive chairman of Oracle is to set the vision for the company and that includes setting the vision for what he wants Oracle to accomplish with the acquisition of Cerner. Leaders’ visions at large corporations of what they’d like to accomplish don’t necessarily have to match reality. Many notably share a vision they know can’t be achieved in order to “inspire” their employees to go beyond what they thought was possible. In some cases, this can work really well and what seemed impossible becomes possible.
To be clear, I’m not sure if this was Ellison’s goal with a “National EHR Database” or not. It’s quite possible that this is a vision of how he thinks healthcare should work or how he was told how it should work and that’s the vision he shared. If we’re honest with ourselves, his vision is one where patients would benefit in many ways. The question that most are asking though is whether this vision is grounded in any sort of reality and whether it ignores the complexities of healthcare that make this impossible to achieve.
What’s clear is that Ellison laid out a vision where Oracle had a National EHR database that had a longitudinal record for every patient. That’s his goal and what he wants his team at Oracle (including Cerner) to achieve. It will be fun to follow up with this in a year or two and see what he and the Oracle think about this vision.
The big challenge most people make is can this really happen. Can Oracle really create a full longitudinal record of all patients? To simplify the question, is Epic going to give Oracle Cerner access to all their health records? I think we all know the answer to that and FHIR and all these other standards won’t get us there either. To complicate the question, what about the hundreds and thousands of other points of care with thousands of different software. Plus, this is growing every day as patients start getting retail healthcare in person or virtually. I’ve long believed that a full longitudinal record for a patient is impossible. Ellison saying that they want to do it doesn’t change my mind. I’d like it too, but that doesn’t mean it’s possible.
As Brendan Keeler on Twitter noted, the top end of what’s possible for this effort is Epic’s Cosmos (ie. a lot of data, but not all the data). I think he’s right. Oracle Cerner could definitely create an Epic Cosmos type of product, but it’s hard for me to imagine a road to them having a full longitudinal health record for patients.
The other thing that I found intriguing was Ellison’s comments about who would benefit from this single database of all our health records. First was patients. He gave the example of going to the ER and the ER doctor having access to your full records. Most of us agree that access to your full record would be a good thing and improve care. Ellison did highlight that all of this would be done with absolute data privacy and would require the patient to validate that they want the data shared with the ER doctor. I won’t dive into all the ways this is going to be hard to implement, but let’s just start with the unconscious patient in the ER. Needless to say, that there are a lot of challenges associated with the patient getting the doctor access to the records. You can imagine plenty of doctors treating the patient without the information because of these complexities.
The second group to benefit from this National EHR Database was public health. Ellison highlighted how public health didn’t have a way to look across the health of a population. This new database would allow them to do this. Of course, he highlighted the privacy area here by saying that the data would be anonymized. I think plenty of hackers have proven that creating truly “anonymized” records is hard and possibly impossible given the nature of health data. Although, it seems like the law so far has been ok with a kind of “best effort” approach to anonymized health data.
From a public health perspective, it begs the question of whether you need all the health records like Ellison envisions. The answer is you would love to have every record, but you don’t have to have every record to get value. Maybe that’s how Ellison looks at it for patients as well. Most of the information is better than what we have today even if it’s not all the information. However, no leader would say that we’re trying to get most of your data. That’s not inspiring.
What Ellison didn’t include in his talk was how much pharma and life sciences would love this National EHR Database. I’m not surprised it wasn’t there since it’s not great PR to say that we’re selling your anonymized data to pharma and life sciences, but you have to think this is part of the Oracle vision of how they’re going to get a return on the billions they spent on Cerner. Plus, they already have relationships with pretty much all the major pharma and life sciences companies who use their other products. Cerner was pursuing this path prior to the acquisition too and no doubt Oracle will accelerate this effort in big ways.
What was most surprising to me about the event was how after Ellison spoke it was largely a presentation of Oracle’s work in healthcare with little tie in to the Cerner acquisition. Much of it was pharma and life sciences work and some public health efforts like the V-Safe product that Oracle did and you may have participated if you got a COVID vaccine. On the one hand it makes sense since the event wasn’t specifically a press conference for the Cerner acquisition but was billed as Oracle’s look at The Future of Healthcare. That said, it wasn’t clear to me how many of these Oracle healthcare efforts really tied into the acquisition of Cerner.
One thing that did come through clearly was the opportunity for Oracle’s ERP and Cerner’s EHR to be integrated. No doubt there are some big opportunities for things like supply chain and HR where a tighter integration of the two would provide a lot of value to users. I think Ellison slightly overstated Oracle’s position in the healthcare ERP market, but they are a big player and a tight integration with Cerner could provide a lot of value. Ironically though, many of the big names that use Oracle ERP are on Epic. Will Epic want to play nicely? Will Oracle play nicely with Epic when it comes to integrating the Oracle ERP with Epic or will they want that as a reason for organizations to move to Cerner? That would be a bad mistake for Oracle in my view, but time will tell what they do.
What do you think of Larry Ellison’s vision for Oracle Cerner and the Future of Healthcare. How about a National EHR Database created by Oracle Cerner? Let us know your thoughts in the comments and on social media with @hcittoday. You can watch the full event video embedded below as well.
