Fantasy or reality: Oracle’s plans for Cerner

Probably the biggest story in health IT this year and so far this decade has been Oracle’s enormous outlay in buying the world’s largest EMR vendor, Cerner, for 28 billion dollarydoos. Exactly what Oracle hopes to achieve with the acquisition has been a bit of a mystery, beyond the fact that Cerner is a very profitable company, with revenues of $US5.5 billion a year and net earnings of about half a billion.

Cerner also has a huge amount of future earnings on its books, with the enormous US Veterans Affairs EHR project, worth eleventy billion dollars, still rolling out and a footprint in most developed countries that far outstrips its nearest rival in Epic. But beyond the obvious financial benefits, what if anything Oracle hopes to achieve with the purchase has so far remained unclear.

In a briefing on Oracle’s plans following the closing of the deal to buy Cerner last week, Oracle chairman and CTO Larry Ellison outlined a few grand plans, including what he characterised as a “national health record database” for the US, something that has previously been unheard of and still remains a pipe dream today.

Ellison revealed some realistic plans to modernise the Millennium platform through voice commands, telehealth modules and AI – functionality that Cerner has already either implemented, is working on with partners like Nuance or is well on the way to achieving – but the “national health database” idea was the most remarked upon. The fact is that the US can’t even agree on a national patient health identifier let alone a national health database, the latter of which would appear not just to Republican members of Congress as a nasty bit of creeping socialism.

As reported by Fiercehealthcare, Ellison told the briefing that the merger hoped to solve some long-standing problems with interoperability in healthcare. "Your electronic health data is scattered across a dozen or separate databases,” he said. “One for every provider you've ever visited. This patient data fragmentation and EHR fragmentation causes tremendous problems.

“We're going to solve this problem by putting a unified national health records database on top of all of these thousands of separate hospital databases. So we're building a system where the health records all American citizens' health records not only exist at the hospital level but also are in a unified national health records database."

Horror upon horrors! We can just see the firestorm this will kick off, combining many Americans’ suspicion of government interference in healthcare decisions with a bipartisan scepticism towards Big Tech (and everyone is Big Tech these days) and Republican intransigence on anything and everything that would improve people’s lives.

It’s also a bit naive, we’ve got to say. That’s understandable from a non-specific health IT perspective but it’s unforgivable from Cerner. As Becker’s Hospital Review reported just last month, Cerner CEO David Feinberg was boasting that interoperability will no longer be a challenge in five years’ time. We reckon it can be done technically, but it can’t be done politically.

As Fiercehealthcare subsequently reported in a good piece by Heather Landi, there was a great deal of scepticism about Oracle's plan from the health IT industry in the US. Putting hospital records into a national database is only a minor part of the story, as most healthcare is provided out of hospital. It is still the case that joined-up healthcare relies on agreed standards, easy access to technology and clinician workflow and willingness to share information more than anything.

It also all hinges on stakeholder acceptance of sharing of information and how to go about it. And why are we here in ANZ interested in the doings of Oracle and Cerner in the US? Because Cerner is deeply embedded in the hospital systems run by the three largest states in Australia, and is likely to win NSW’s single patient record deal. It’s also in with a chance for Victoria’s. (Speaking of which, we received some pretty diverse reactions to our blog from last week – some readers were aghast at our criticism of the privacy lobby in holding up information sharing progress in Australia while a few others completely agreed – and this is not something that will go away.)

We are heartened nonetheless by the outcomes of the first national cabinet meeting between the new prime minister, the state premiers and territory first ministers today in Canberra. They all seem to be getting along like a house on fire, including a reputed bromance between Dan Andrews and Dom Perrottet (more horrors). Everyone is quite pleased that the feds will continue to co-fund COVID measures until the end of the year, that the 50:50 hospital funding idea is still on the table, and that healthcare is still top of mind, despite its relative lack of prominence during the election campaign.

What we are most pleased with though is the recognition that the crisis in hospitals has its genesis in the long-term neglect of primary care, and that the solution to it all rests there. As long-term cynics, we are wary of getting too excited about promises about improving the health and aged care systems, but we must say this is the most positive that we have been in some years that solutions to the problems besetting our sector are possible. Now to keep them to account.

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