Oracle’s vision of creating a national database of patient medical records, while bold, overlooks long-standing industry challenges, health technology experts said.
Larry Ellison, Oracle’s co-founder, chief technology officer and board chair, last week shared an ambitious plan to build a database that contains data from electronic health records systems at hospitals across the U.S. Doctors would be able to access medical data with patients’ permission and public health officials would be given an anonymized view, he said.
The announcement came on the heels of the company closing its $28.4 billion purchase of EHR company Cerner, which Oracle has described as its “anchor asset” as it expands into healthcare.
There’s a healthy dose of skepticism from industry observers who have seen other technology companies move into healthcare and claim they can fix the system, only to shutter projects a few years later.
“I’m a little bit skeptical,” said Paddy Padmanabhan, CEO of Damo Consulting. “I just don’t know if Oracle as an organization understands healthcare well enough to know how challenging this is.”
Lucia Savage, chief privacy and regulatory officer at digital therapeutics company Omada Health and former chief privacy officer at the Health and Human Services Department’s Office of the National Coordinator for Health Information Technology, said the announcement felt reminiscent of industry conversations a decade ago.
“I felt really transported back to 2009,” Savage said. “That being said, I am always up for somebody with Larry Ellison’s connections and the strength of the Oracle brand behind it bringing his recognition of the need to this conversation.”
The U.S. has been working to address healthcare’s lack of interoperability—or software systems’ ability to exchange data with one another—since at least 2009, when then-President Barack Obama signed the Health Information Technology for Economic and Clinical Health Act into law. The measure included incentives for acute-care providers to adopt EHRs.
But while nearly all healthcare facilities have since installed EHR systems, the systems still don’t easily share data with one another because of technical challenges and a lack of incentives. Also, some healthcare providers and EHR companies don’t want to share data with competitors.
There have been efforts to tackle the challenges. Some EHR vendors have programs to share data among hospitals using their software, and there’s local and national health information exchange networks that route data between participating organizations. As of 2019, the most recent data from ONC, only about half of hospitals regularly received outside data through those methods.
Most recently, the federal government tackled the data-sharing challenge by mandating providers exchange records with patients and one another when requested and requiring EHR vendors to make certain interfaces available to customers as part of ONC certification.
Another government initiative, the Trusted Exchange Framework and Common Agreement, sets standards for local and national health information networks to share data with one another. The initial health information networks are expected to start onboarding to the network this year.
An Oracle spokesperson said the company’s national EHR database will be a “standards based system open to all” but declined to answer questions about Oracle’s progress on the project.
With Cerner, Oracle controls 24% of the EHR market among U.S. acute-care hospitals, according to KLAS Research. One-third is controlled by Cerner’s top competitor, Epic Systems, which has its own database of de-identified EHR data, called Cosmos. The remainder of the market comprises EHR companies like Meditech and CPSI.
“How do they actually plan to execute on this vision?” asked John Moore, CEO and founder of market research firm Chilmark Research. “What type of carrots will they use to attract, say, other EHR vendors to potentially participate in this?”
Moore added he’s not convinced a central medical records repository is the answer to healthcare’s interoperability problem. He said he’d prefer to see a federated system, in which healthcare entities and patients can request data from across data sources.
Aaron Miri, chief digital and information officer at Jacksonville, Florida-based Baptist Health, characterized his view of Oracle’s national EHR database as an “optimistic skepticism.”
“We’ve been needing this across the country for decades now,” he said of a national data-sharing system. But “these issues are bigger than Oracle.”
It’s unclear how Oracle will link a patient’s records across care sites, said Miri, who’s also a co-chair of the federal Health Information Technology Advisory Committee that works with ONC.
Healthcare entities tend to match patients to their records using a name, date of birth and other demographic data. But the information isn’t always unique to each patient, and it becomes even more complex when sharing records between hospitals that might format data and match patients to records in different ways.
While an outsider’s perspective can spur insights into new solutions, Omada Health’s Savage cautioned that new entrants need to understand healthcare laws like the Health Insurance Portability and Accountability Act. Oracle will need permission from its provider customers to use identifiable patient data for its own purposes, as well as to de-identify patient data.
“I think that when [Ellison] gets under the hood, he’s going to find a lot more complexity legally, than even technologically,” Savage said.
Healthcare tends to be skeptical of technology companies’ efforts to “disrupt” the industry, given how such moves have played out over the past decade.
Google in 2012 shuttered a personal health record service dubbed Google Health after four years. The company has since relaunched a health arm, also called Google Health. Microsoft, another company pushing into the healthcare industry, primarily through its cloud business, in 2019 closed HealthVault, a separate personal health record service launched in 2007.
IBM this year sold off parts of its once-hyped Watson Health business to a private-equity firm.
“If anyone’s been in this space long enough—you see them come, and you see them go,” Moore said of tech giants.