A unified digital health record system for American patients has long been considered the "holy grail" for the healthcare industry. And, like the medieval legend, it's been a quest embarked on by countless health IT leaders and industry groups over decades.
Oracle Chairman Larry Ellison's vision to use the power of Cerner to build a national health records database is a lofty ambition, and it's an aspiration that will take an unprecedented level of collaboration to execute, health IT execs told Fierce Healthcare.
Ellison's announcement last week, on the heels of its $28 billion deal to pick up the electronic health record company, was met by a healthy dose of skepticism by interoperability experts who have been striving for years to build technical "roadways" to make it easier to access and share health data.
"The concept is not new, and the barriers still remain," Patrick Murta, a health IT leader and chief platform architect at digital health company BehaVR, told Fierce Healthcare. "Saying that you're going to build a national database and bringing that to fruition is a different story. This particular model is going to face the same barriers that have been there for many years and there's no easy path to overcome those barriers quickly."
Murta is a former co-chief architect for the Office of the National Coordinator for Health IT's FHIR at Scale Taskforce (FAST), an effort to accelerate the adoption of the Fast Healthcare Interoperability Resource (FHIR) standard for application programming interfaces to improve data sharing. FHIR serves as the core data standard to allow patients to access medical records on their smartphones.
There are immense and long-standing barriers to sharing health information with the same ease that consumers can share their financial information using banking apps. These hurdles include a lack of coordination among different facilities and health systems and inconsistent technical standards resulting in EHR systems that can't "talk to each other." Along with technical challenges, there are also operational and business roadblocks, such as divergent policies related to privacy that govern how electronic health information is exchanged or used.
There are significant data security issues, and the industry has to contend with different approaches to gaining consent from patients to share information.
"The purchase of Cerner by Oracle represents further consolidation within the healthcare IT industry, but the challenge includes knitting together data from multiple ambulatory and hospital-based governmental and commercial systems that are currently not interoperable," said Rich Parker, M.D., chief medical officer at Arcadia, a healthcare data and software company. "Though I applaud the goal, I believe we are a long distance away from achieving a truly practical and unified EHR for the American public."
"Having a database of all the medical records in the U.S. will be a translation exercise beyond any ever undertaken, more than the books scanning of Google," Nathan Ray, partner, healthcare and life sciences at consulting firm West Monroe, told Fierce Healthcare.
"Additionally, it is nearly impossible to have a system that holds all medical records in the U.S. in real-time, at any given time. It will be difficult to ensure all providers have the same level of maturity or even consent to providing the data," Ray said.
Combining the power of Oracle and Cerner, a company that has about 25% of the healthcare provider market, Ellison said the software giant plans to build a national health record database that would pull data from thousands of hospital-centric EHRs.
The concept of the national health records database, which would hold anonymized data, Ellison said, is to help doctors and clinicians have faster access to patient records when providing care. Anonymized health data in that national database could also be used to build artificial intelligence models to help diagnose diseases such as cancer, he said.
Can Oracle succeed where other tech giants failed?
The purchase of Cerner, which marks Oracle's biggest acquisition, gives the database giant a stronger foothold in healthcare and strategically positions the company as a major player in the healthcare "cloud wars."
"It does present an interesting opportunity for Oracle to really jump in with both feet and get on par with some of the other large vendors who have had pretty successful commercial offerings here for the last year or two," said Matt Ripkey, director of strategic partnerships at Redox, an EHR integration company that provides a platform for payers, providers and products to connect to health records systems and other healthcare data sources.
"The acquisition of Center by Oracle automatically places them at a more important seat at the table as far as big tech players in healthcare data and in healthcare data exchange," Ripkey said.
There are many examples of how big tech has failed in healthcare, including Microsoft's attempt to create a personal health record system, called HealthVault, that shut down in 2019. Google Health’s personal health information service was introduced in 2008 and ended three years later because of low user adoption.
But some industry stakeholders expressed guarded optimism that Oracle, with its massive database technology, combined with established healthcare player Cerner could make headway in tackling interoperability problems.
"This isn’t the first time big tech has come in to 'fix healthcare'; however, the scale at which Cerner already operates is exciting," said Justin Norden, M.D., partner, GSR Ventures, a venture firm investing in early-stage digital health companies.
"If Oracle could pull something off like this with a national health database, it could be a huge step forward to advance real-world evidence and clinical research," Norden said.
But unifying national patient records involves more than just connecting all of the Cerner sites together, Ripkey said, noting that there are already efforts underway to create a more unified database of health records, such Epic's Cosmos. Epic build a de-identified patient database combining the company's EHR data of over 122 million patients.
There are also plug-and-play networks like CommonWell and Carequality that enable healthcare providers to access patient data.
New federal regulations, which went into effect in April 2021, now require health IT vendors, providers and health information exchanges to enable patients to access and download their health records with third-party apps.
But there still remains the major challenge of getting the "Epics and Cerners talking to each other," interoperability experts say.
"We need to get the small remote outpatient facilities that are running a smaller EHR communicating with the Cerner system or the Epic system at the large health system up the road," Ripkey said. "Oracle is talking about trying to open things up and make things more connected, but there's a long way to go. A lot of it has to do with business relationships between borderline competitive entities getting together and being able to share data to facilitate better patient experiences."
"The merger of Oracle and Cerner will provide a lot of excitement and investment around the idea of data management and analytics overall, and EMR data in particular, but the 'man on Mars' commitment of 'all medical records' ignores the real and valuable data issues and frankly immense work ahead of the industry to deliver value while aggregating and enhancing historical clinical data," West Monroe's Ray said.
Tech companies set their sights on healthcare
Beyond Oracle's lofty ambitions, some in the industry applauded the potential for Oracle to bring innovation and emerging technologies into healthcare.
"Opening the Cerner platform and making it easier for companies to integrate and build on top of it is something Oracle knows how to do. Expect more app-store thinking from them moving forward," Ashish Shah, CEO of Dina, which provides an AI-powered care coordination platform and network for home-centered care.
"Regarding an anonymized national database, this is something Oracle is perfectly positioned to do, and likely will unlock new value to researchers, the pharma industry and others who are looking to advance breakthrough therapies in the market. This is not unlike what Epic is planning with Cosmos. Overall, Cerner's acquisition is a good thing for healthcare—a big tech player will help accelerate the modernization of healthcare in almost every aspect," Shah said.
Big software and tech giants continue to make a push into healthcare with megadeals like Microsoft's $19.7 billion bid for Nuance and two private equity firms picking up Cerner competitor Athenahealth in a $17 billion deal.
These moves speak to big tech's desire to fundamentally disrupt healthcare and the technology that enables it, said Laura Kreofsky, vice president of strategy for Pivot Point Consulting, a healthcare IT services firm.
"Oracle has already promised bold moves—a national health records database, EHR voice assistant capabilities and advanced AI. At the same time, Oracle will need to address the headwinds facing Cerner—ongoing challenges with the VA deployment, the migration of revenue cycle platforms, and market share," Kreofsky said. "Overall, the next few years will be a fascinating study in how an industry adapts; will it remain anchored in incremental progress or are we ready for seismic shifts?"