On the heels of Oracle’s $28.4 billion acquisition of Cerner Corporation, the second largest EHR supplier in the US, board chair and CTO Larry Ellison announced his vision of a national health records database. During their recent virtual press conference, The Future of Healthcare, Ellison said, “We are building a system where all American citizens’ health records not only exist at the hospital level, but they also are in a unified national health records database.”
This was of course news that made us all take notice. But as the dust is settling what does the rest of the industry think about this? We reached out to see just what the buzz is.
Oracle’s vision for building a national health records database faces several major challenges, including enterprise barriers to data sharing; identifying and linking patient data in the absence of a national patient identifier; making information usable for clinicians given the wide variation and format of clinical data code sets; and assuring stakeholders that aggregated patient medical information will be appropriately safeguarded and remain confidential.
Carole Tremonti, RN MBA, Vice President of Clinical Strategy, Ronin
Oracle’s national health record database will finally supply critical information to clinical teams that is needed when patients seek care outside their usual doctor’s office and also begin to reduce wasteful re-testing and re-scanning. Additionally, this large pool of aggregated information will enable public health insights at a level of accuracy and quality not previously possible. Most importantly, it will inform a patient’s clinical course using historical data to predict disease trends and outcomes in the form of safe artificial intelligence-based clinical decision support systems.
The health data silos that exist today create barriers within each patient’s continuum of care. A national health records database would go a long way in advancing the U.S. healthcare system; however, it is not enough to simply provide access to records through a single source. True growth will be realized when data is liberated from healthcare’s unstructured states within a national database and leveraged vastly across healthcare to drive innovation, reduce administrative burden, and provide transparency throughout the healthcare industry.
With the Cerner deal now closed, Oracle chair and CTO Larry Ellison’s aspirational vision for a national electronic health record system will require the participation of other major EMRs as well organizations such as Truveta, which is made up of health system members that deliver 16% of clinical care in the United States. If Oracle can make this goal a reality, artificial intelligence initiatives could accelerate quickly using anonymized health data from the national database to expand their data lakes. While there are challenges, data-sharing is the future of healthcare and will drive technology innovation, better treatments and improved patient and clinician satisfaction.
A truly complete, national database of health records would be a serious boon to interoperability, but not necessarily a panacea. Privacy is clearly a relevant concern, but often overlooked are the potential costs if the repository is run for profit and the generally under-addressed problem of data made unusable by duplication and other ‘cleanliness’ issues such as differing compendia and vocabularies used during data entry. Overcoming these issues would result in a national repository being actually, rather than theoretically, impactful.
A national database has huge potential to streamline care across providers, offering a complete picture about the patient. But today, even within a single health system, the coordination of care is broken because the delivery of healthcare is in silos. What’s missing is a new approach that combines not only the map of the patient’s care across all providers, but also the GPS to better navigate and orchestrate care.
The best way to increase patient safety is to make sure accurate and complete patient records are available to clinicians when they need them. For that reason alone, a national health records database would be incredibly valuable. When clinicians can securely access quality patient data, they can be more proactive in treating patients and are better able to practice precision medicine.
The concept of national medical records is not new and has been attempted for many years without a lot of success. The primary reason has been the lack of interest by EHR providers to work with each other as they are more interested in attracting the market around their own data sets. There are other issues, such as ethical priorities set forth by government for EHRs, which include: Privacy and confidentiality, security breaches, system implementation and data inaccuracies. These make it more difficult to nationalize or have a consistent set of data that can be shared across the EHR platforms. However, there is a silver lining here and it is due to the COVID-19 pandemic. At the beginning of the pandemic, a group of researchers funded by the US National Institutes of Health (NIH) realized that many questions about COVID-19 would be impossible to answer without having access to combined patient records from different institutions. They developed the National COVID Cohort Collaborative (N3C), which collects medical records from millions of patients around the country, cleans them, and then grants access to groups studying how COVID affects human health. However, this is still far from the concept that Oracle is pitching here. We applaud this effort, and also realize this is a lofty goal with numerous obstacles along the way.
The need for a unified national health record database has never been greater. What we know is that when we improve data sharing and provider and patient access, we will increase efficiency, reduce costs, and most importantly, improve patient safety and delivery of care. The progression of EHR performance and Patient Identity Integrity illustrate the evolution in access to patient information. While interoperability barriers, technology limitations, and privacy and data security issues remain, we are moving closer to overcoming these challenges every day.
This is exciting news! As a vendor responsible for archiving data from countless clinical platforms, I can appreciate the gravity of this announcement. Data aggregation is never a simple task, but the reality of a single national health record database is now closer than ever with Oracle’s acquisition of Cerner. If successful, all patient data would exist in a single repository. This would certainly simplify the complex web of health information networks currently in existence. I’ll certainly continue to follow all developments as it relates to this space as archived data will invariably be part of the equation.
It’s a bold statement for sure, and no surprise coming from Larry Ellison. It’s not a novel one though. Many others, including Microsoft and Google, attempted nearly 20 years ago and without success to create similar solutions, albeit more from a patient centric perspective. The environment today from a clinical IT perspective is far different than a decade ago in that virtually all patient clinical records are digitized, as a result of Meaningful Use, the Center of Medicare and Medicaid (CMS’s) electronic health record (EHR) incentive programs. While Oracle and Larry Ellison have a much better opportunity than those that have tried before to realize the vision of a unified health database, strong headwinds exist from public policy, patient privacy considerations, and competitive pressures.