The ACA, and earlier initiatives, also spurred the rollout of regional HIEs across parts of the U.S. over the last decade. These are, in essence, watered-down versions of regional EHRs, and depending on the sophistication of the technology deployed and ambition of the HIE scope, do serve, to some extent, in supporting shared access to patient data across organisations.

However, issues relating to interoperability, ability to integrate HIE data back into an provider-specific EHR, depth of information exchange, level of provider participation and information latency have limited the usefulness of these HIEs resulting in them failing to really take hold in large parts of the U.S. Further, health system participation in HIEs has also been patchy with some choosing to only participate in HIEs where other participants are using the same vendor for their EHR or only participating in systems with allied groups.


However, they do offer at least a starting blueprint for greater data sharing, and with next generation HIE deployment on the horizon this could offer a conduit for Oracle Cerner and its national EHR ambitions.

Internationally there are pockets of success in terms of countries adopting a national EHR database whilst still using local instances of an EHR for provider operational use. Examples tend to be in small- or mid-sized economies, with notable success in the Nordics (e.g., Kanta in Finland). However, for every successful model, there are usually two or more failed or stalled models where the system has not succeeded, or fallen significantly short of the original vision (e.g. Australia, New Zealand, and the UK attempt mentioned above).

Why Oracle Cerner?
Even if the barriers to creating a national EHR overlay from a technology, demand, privacy, logistics and integration perspective can be overcome, Oracle Cerner is not the only company that could support deployment from a technology perspective. Many other vendors offer solutions for aggregating multivendor, cross-setting EHR data into a longitudinal record such as those listed earlier.

InterSystems already has some experience doing this at a national level in the U.S. to some extent via its contract to provide the underlying technology (HealthShare) for the eHealth Exchange (effectively a national network of regional HIEs covering 77% of state/regional HIEs, and 75% of hospitals). This is less of a national EHR and more of a national system for exchanging patient data, but nonetheless offers a real-world example of a solution aimed at addressing the siloed nature of EHRs and patient data at a national level.

Business Affairs Homepage