After years of speculation that Amazon, Apple, Google, IBM or Microsoft might acquire an EHR vendor to gain deeper roots in the health care sector, tech giant Oracle made the bold move by acquiring Cerner for $28.3 billion. This deal that gives rise to the question: Will having big tech in the EHR space finally be a forcing function that drives real innovation in health care?
Before answering, it’s important to recognize the innovation that has already happened in the EHR realm. Since the passage of HITECH in 2009, most EHR companies have developed cloud-based platform options that makes access and upgrades easier for customers. Some have added in analytics functionality or services, equipping patients with access to personal data via portals. Following in the footsteps of technology companies, leading EHR vendors have also established app stores to foster ecosystems of third-party developers with the skills to innovate in ways that the EHR companies themselves lack. Even data sharing and interoperability, though imperfect and with much work remaining, have undergone notable progress.
Despite so much innovation, however, EHR vendors have not widely embraced the technologist’s mantra of “delighting the user.” That mindset is sorely needed in health care as year after year, research studies are published demonstrating the direct connection between EHR usability and burnout. Clinician burnout caused by kludgy software interfaces, interminable logins, generally too many clicks and time spent looking at a screen rather than at patients is so rampant, in fact, that it has all become cliché.
That is precisely where an Oracle-owned Cerner has the opportunity to move more quickly in advancing the software more than traditional EHR players and it has already made bold claims about advancing the user interface. Statements in press releases do not guarantee future success, but in this instance, they illustrate that executives understand the problems and recognize the opportunities those issues present.
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Oracle Chairman and Chief Technology Officer Larry Ellison said in the acquisition announcement that buying Cerner expands the company’s “corporate mission to assume the responsibility to provide our overworked medical professionals with a new generation of easier-to-use digital tools that enable access to information via a hands-free voice interface to secure cloud applications. This new generation of medical information systems promises to lower the administrative workload burdening our medical professionals, improve patient privacy and outcomes, and lower overall health care costs.” Another Oracle executive specifically explained that customers should expect Cerner’s user interface to change.
It’s too soon to know exactly when and what a new interface might look like. What we do know is that delivering against that promise will be challenging beginning with the need for Oracle to catch up to Microsoft, which made a bid to acquire Nuance for $19.7 billion in April 2021 (that deal has not yet closed). Nuance offers voice-enabled, AI-powered ambient clinical intelligence technology that is designed to reduce administrative burden and improve clinician productivity. The difference is that Oracle will now have its own EHR, though Microsoft integrates its health care cloud with EHRs from Epic, Allscripts and, yes, Cerner.
What’s more, developing those cutting-edge technologies is merely the start. Convincing clinicians already skeptical of EHRs and the trust worthiness of artificial intelligence data to use those unproven tools will be another obstacle altogether. Additionally, every merger introduces risks for the companies and their customers and Oracle has a colorful history when it comes to acquisitions. The two most notable in the mid-2000s are the contentious public feud between Oracle founder Larry Ellison and former employee and Siebel founder Tom Siebel that appeared to be designed to kill the latter company, and the even more notorious repartee with PeopleSoft CEO Craig Conway featuring comments about whether Ellison would shoot Conway or his dog given the opportunity and just a single bullet. (Hint: Not the dog.)
The ultimate success of those mergers is a matter of some debate. That said, earlier this year Oracle extended support for PeopleSoft to 2032 and last year the company guaranteed investment in Siebel for at least a decade.
Looking to the future, if Oracle can integrate Cerner into the company and leverage its own engineering expertise to outpace Epic and the other EHR players in developing software that improves clinician productivity, increases patient satisfaction and either saves customers revenue or yields a return, the company has the potential to build compelling products and cloud services that other EHR vendors will have difficulty matching.
The innovation that will spark among Oracle’s competitors in the EHR space will be a boon for all EHR customers — but if Oracle does not deliver on the promises it made in acquiring Cerner, at the very least Cerner clients won’t benefit and at worst its EHR could be relegated to just another enterprise application in the vendor’s large portfolio.
