September 29, 2022

Software giant Oracle set a challenging goal of creating a national electronic health record Thursday following the close of its $28 billion Cerner acquisition, while also setting some more realistic goals for improving the Cerner Millennium electronic health record.

With its Cerner acquisition, Oracle chairman and CTO Larry Ellison said during Oracle’s healthcare strategy announcement that the company plans to solve the electronic health record (EHR) fragmentation problem by “putting a unified national health records database on top of all of these thousands of separate hospital databases.” EHRs are digital patient data records that can include information such as allergies, medications, and lab and test results.

Ellison said EHRs today are “hospital-centric” rather than “patient-centric,” meaning each hospital buys its own EHR and operates its own information system, creating a network of isolated databases. Healthcare systems have struggled with interoperability issues, or the ability to exchange patient data between different EHRs, for years.

“Together, Cerner and Oracle have all the technology required to build a revolutionary new health management information system in the cloud,” Ellison said. “That system will deliver much better information to healthcare professionals. Better information will fundamentally transform healthcare.”

Gartner analyst Gregg Pessin said Oracle has a long road and a lot of obstacles to creating a national EHR system.

“The reality is there are a lot of barriers for that to come to reality in the United States,” he said.

Oracle faces a challenging task

Data interoperability and integration between EHRs remain some of the most significant challenges facing creation of something like a national EHR, Pessin said.

Pessin said some may argue that Oracle could rely on the Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) data standard with application programming interface specifications to facilitate their goal. The HL7 FHIR standard defines how electronic health information sharing can occur between different EHRs and includes specifications for an API for healthcare data exchange.

To get to that vision that Larry Ellison has, it’s going to require a maturation of the FHIR API beyond where it is today.
Gregg PessinAnalyst, Gartner

However, Pessin said the HL7 FHIR API still functions at a basic level and has a long way to go before it can accomplish a goal such as communicating between a national EHR and separate EHRs.

“To get to that vision that Larry Ellison has, it’s going to require a maturation of the FHIR API beyond where it is today,” he said.

A national EHR also faces legislative hurdles, Pessin said.

If Oracle serves as the host for the national EHR, holding the data of millions of patients, Pessin said it becomes a component of critical infrastructure and would likely evolve into a federal issue for protecting that data.

During the health strategy announcement, Ellison said the national database will protect patient data through anonymization, giving patients control over who accesses their information. Pessin said that would likely require creation of an information consent process as well as national patient identifiers, which don’t currently exist.

“That takes Congressional action for that to happen,” he said.

While Oracle may face significant challenges with its national EHR goal, Pessin said the goals Ellison set for improving the Cerner Millennium EHR including adding voice user interface, integrating a telemedicine module, and using targeted AI for disease management are more realistic and feasible short-term.

Makenzie Holland is a news writer covering big tech and federal regulation. Prior to joining TechTarget, she was a general reporter for the Wilmington StarNews and a crime and education reporter at the Wabash Plain Dealer.