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More Hubris than Humility

by John Moore | June 14, 2022

Oracle Aims (Too) High with Cerner Acquisition Announcements

By last Thursday, Oracle had closed its much-anticipated acquisition of Cerner. The next day, Oracle hosted a webinar to discuss their vision and intentions for Cerner and more broadly, Oracle in healthcare. The big visionary picture was provided by none other than Larry Ellison himself, while other Oracle reps chimed in on more mundane aspects of this acquisition.

I found those more mundane discussions to have a better grounding in reality.

However, the lion’s share of the event reminded me of a grade B movie on a continual re-run cycle. Once again, a Big Tech firm is coming to the rescue of all the ills that face the healthcare sector today. It is a pronouncement based on Big Tech’s continuing hubris that they can solve any problem that exists in the market. Little in the way of humility is brought to the table; it is simply “We got this, trust us.”

In the grand scheme of things, I have been studying the health IT market for only a brief 15 years. But in those 15 years, I have seen a number of extremely capable tech companies fail in healthcare for biting off more than they can chew. I fear that Oracle is setting itself up for the same.

But it doesn’t have to be that way. There are numerous synergies between Oracle’s existing enterprise software offerings and those of Cerner that can truly reinvigorate Cerner and allow them to compete more effectively going forward. There is also Oracle’s massive, international salesforce that was not discussed, but can certainly contribute to Cerner’s offshore ambitions.

However, Oracle needs to appease investors and promote its cloud offerings with grand, bold visions. This is where the company runs off the tracks.

Reality? What’s that?

Dumbfounded, simply dumbfounded. That is how I felt when Ellison started talking about how Oracle was going to create a public good by aggregating all patient medical records into one national database that Oracle would host. On their cloud, of course, using Oracle servers. Investors were cheering; those in healthcare were shaking their heads.

Yes, we can all agree that there is a need to allow physicians to have access to your longitudinal medical record in an emergency. Such a service would also be quite useful for public health use cases. As the recent pandemic pointed out glaringly, our public health reporting structure is an absolute mess. These are the points Ellison emphasized. He also emphasized that the data would be de-identified identity only to be exposed by the patient.

But what was glossed over is the actual intent of this strategy. That is for Oracle to become the de facto, global, go-to-source for clinical data for life sciences first, payers second and bringing up the rear, providers. As I have written previously, life sciences will pay dearly for such access and I even went so far as to saying, via Twitter, that this was likely Oracle’s ultimate goal when this acquisition was announced.

However, there are three flies in the ointment of this grand vision.

First is culture. Providers are loathe to share their patient data. HHS’s ONC and TEFCA legislation is forcing providers to open up, but it is slow going. Combine providers’ reluctance with that of competing vendors, e.g., is Epic’s Judy just going to say: “Sure, Larry! Go ahead, here are the keys to Epic’s Cosmos”? I don’t think so.

While patients in the U.S. are more sanguine when it comes to privacy than, say, their European counterparts, this is changing as well. I’m not so sure they would be keen on having their personal health information (PHI) owned and managed by a Big Tech firm.

Second is the technology. As a society, we have been working on this issue for well over a decade and still only a modicum of progress. I remember Rob Kolodner at ONC and his grand vision for a National Health Information Exchange (NHIN). That still remains a dream, despite a ton of resources poured into addressing this issue.

There is also the issue of data architecture. Is it best to have all data reside in some massive Oracle cloud database? Maybe a better approach is one that is federated, wherein data is at rest in existing services and only pulled when there is an API service call. My hunch is the latter is a better approach as it addresses some of the cultural barriers above.

Along with technology is simply the issue of how does one gather all of that clinical data, normalize it, and map it to one common ontology? This has been the bane of all HIE and analytic efforts in healthcare to date. Does Oracle have some magic pixie dust that makes this problem simply vanish? If yes, I would love to hear more.

Third is policy. Do we, as a nation, as a society, really want a company that profits on data to have the ability to profit upon our health data, the most personal information in “our possession”?

It is here where I take off my capitalist hat. Such a public good should rest squarely in the hands of a public service/utility with appropriate safeguards that go far beyond the woefully outdated HIPAA guidelines we have today.

Value in the Mundane

This post is getting long, and I like things short. Below are those mundane items mentioned during the webinar that I get most excited about:

  • Fully integrated ERP (Oracle has a range to choose from) and EHR will help healthcare organizations better understand costs of delivered care.
  • Tying asset management capabilities of Oracle with Cerner’s Millennium will provide front line clinical staff with real-time access to asset availability (think ventilators, OR equipment, infusion pumps, etc.).
  • Oracle’s supply chain solutions can assist health systems in managing their inventory.
  • But the big potential win for Cerner clients and future prospects is applying Oracle’s deep chops in FinTech to address Cerner’s most glaring problem child – RCM.

For as long as I’ve known Cerner, basically since I started Chilmark some 15 years ago, RCM has always been its Achilles heel. Hell, I remember sitting down with Cerner executives shortly after the acquisition of Siemen’s health IT business. Within that business was Soarian, which at the time had one of the best RCM solutions to reach the market. These executives asked me point blank: “Should we adopt Soarian as our go-forward RCM?”

“Absolutely adopt Soarian.” I responded.

It didn’t happen. The NIH (not invented here) syndrome ran strong at Cerner under Patterson’s leadership.

Years later, and Cerner is still struggling with RCM. Cerner, prior to Oracle’s announcement claimed they had a new RCM, RevElate, that is scheduled for roll-out this fall. Early reports I have received tell me it is still not where it needs to be to be competitive in the market.

I truly hope Oracle can once and for all address this long-standing RCM issue that has plagued Cerner for years. I have faith that they can.

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