By Alex Green

Earlier this month Oracle closed its $28.3B acquisition of Cerner, and shortly after Oracle founder and CTO, Larry Ellison, outlined Oracle’s vision for Healthcare IT post-acquisition. The key elements of this vision included:

• Developing a solution for a national EHR database.
• Leveraging this solution, and similar smaller-scale connected EHR initiatives, to provide life science, pharma and other users with a rich environment for research, clinical trials and drug development.
• Leveraging the combined company’s provider customer base across ERP (legacy Oracle) and EHR (legacy Cerner) to drive new products and synergies.
• Expansion of Millennium functionality in telemedicine, disease-specific management tools, RCM, HCM and diagnostics.

The element of the vision that has captured most of the headlines since has been the national EHR plans, with most commentators correctly highlighting the challenges that would be faced with any such initiative. The last 20 years represent a graveyard of examples of similar projects with similar lofty ambitions that were announced with fanfare but were followed years later by failure. I’m from the U.K. and the catastrophe that was the National Program for IT (known here as “the biggest IT failure ever seen”, and which had similar ambitions) is ingrained into the U.K. health industry’s long-term memory as a warning to all.

That said, the key thrust of Ellison’s arguments rings true. For the most part, the U.S. is a web of siloed EHRs that are hospital/provider-centric in terms of the patient record, not patient-centric, and they do not provide the population and clinicians with a longitudinal patient health history. The same is true for most other countries and the time-honoured argument that “if other industries can connect data better, why can’t healthcare?” still resonates.

Why now?
A key question is, has anything changed in terms of healthcare structures and healthcare IT in recent years that makes the viability of a national EHR overlay any more likely?

To some extent, yes, there have been several developments over recent years that have chipped away at some of the barriers.

The Affordable Care Act (ACA), while itself now more than a decade old, has changed healthcare structures and the technology deployed significantly. There is already more integration in the provision of healthcare and the associated IT across the U.S. The rapid rise of IDNs, ACOs and consolidation of healthcare providers has spurred greater IT integration, particularly in relation to patient records at a health system level. While the journey is far from complete (e.g., a huge proportion of EHR installations are still siloed), some of the barriers have come down, with HIE, PHM and data integration tools being offered by companies like Health Catalyst, Innovaccer, InterSystems, Lyniate, AWS, Google, Redox, Epic and Oracle Cerner itself. These already connect EHRs and other associated healthcare IT at regional/health system levels, providing a summary EHR overlay.

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