One “Unified Health Record System” To Rule Them All? – I Think Not

“It’s Deja Vu All Over Again”

Yogi Berra, Baseball Legend and Philosopher
Image Credit:

Oracle’s chairman Larry Ellison outlined a bold vision last week for the database giant to use the combined tech power of Oracle and Cerner to make access to medical records more seamless. Days after closing its $28.3 billion acquisition of electronic health record company Cerner, Ellison said Oracle plans to build a national health record database to pull data from thousands of hospital-centric EHRs.

“We’re going to solve this problem by putting a unified national health records database on top of all of these thousands of separate hospital databases. So we’re building a system where the health records all American citizens’ health records not only exist at the hospital level but also are in a unified national health records database.”

Larry Ellison, Chairman and CTO, Oracle

Oracle also plans to modernize Cerner’s Millennium EHR platform with updated features such as a voice interface, more telehealth capabilities, and disease-specific AI models, Ellison said. He also highlighted a partnership between health tech company Ronin, a clinical decision support solution, and MD Anderson to create a disease-specific AI model that monitors cancer patients as they work through their treatments. (Sound familiar, IBM?)

Needless to say, Ellison’s bold vision was met with a healthy dose of skepticism by interoperability experts who have been striving for years to build technical “roadways” to make it easier to access and share health data.

“The concept is not new, and the barriers still remain. Saying that you’re going to build a national database and bringing that to fruition is a different story. This particular model is going to face the same barriers that have been there for many years and there’s no easy path to overcome those barriers quickly.”

Patrick Murta, Chief Platform Architect, BehaVR to Fierce Healthcare

Let’s get real here – This isn’t the first time big tech has come in to ‘fix healthcare.’ (I’ve written on this topic before) Big software and tech giants continue to push into healthcare with megadeals like Microsoft’s $19.7 billion bid for Nuance and two private equity firms picking up Cerner competitor Athenahealth in a $17 billion deal. But the health care landscape is littered with failed attempts to create “the mother of all EHRs” over the years, including Microsoft’s attempt to create a personal health record system, HealthVault, that shut down in 2019. Google Health’s personal health information service was introduced in 2008 and ended three years later because of low user adoption. How about IBM’s attempts with Watson Health? Or GE’s attempt with Edison? All of these were announced with great fanfare, and all failed despite the backing of big companies who were willing to spend billions in funding to ensure success.

Unifying national patient records involves more than just connecting all of the Cerner sites. There are already efforts underway to create a more unified database of health records, such as Epic’s Cosmos. a de-identified patient database combining the company’s EHR data of over 122 million patients. There are also plug-and-play networks like CommonWell and Carequality that enable healthcare providers to access patient data. You also have consortia like Truveta, which brings together health systems from around the country to aggregate their EHR data into a massive database for research.

Ellison’s “moonshot” commitment to ‘all medical records’ ignores the actual and valuable data issues and, frankly, immense work ahead of the industry to deliver value while aggregating and enhancing historical clinical data. It is nearly impossible to have a system that holds all medical records in the U.S. in real-time, at any given time. And, it won’t be easy to ensure all providers have the same level of maturity or even consent to providing the data. The extensive database also raises security questions. Throughout the presentation, Mr. Ellison noted patients would still have the “key” to their health records, which are anonymized until patients give providers access. How will that work exactly? What Ellison did not say was who would pay for its national electronic health records database.

And how would this effort tie into the Federal Government’s framework for nationwide data exchange called the Trusted Exchange Framework and Common Agreement (TEFCA)? TEFCA aims to eliminate individual legal agreements between health information networks, health plans, providers, and other entities by instituting one common agreement that qualified networks and their participants sign onto, paring back the administrative burden. The framework standardizes the operational side of data exchange while raising the privacy and security bar for entities that want to be certified as qualified health information networks (QHINs), groups of organizations that agree to the same data-sharing infrastructure. It’s composed of two parts: the Trusted Exchange Framework, which describes a set of principles for data-sharing across health information networks, and the Common Agreement, a legal contract signed by QHINs. TEFCA is entirely voluntary and will succeed or fail wholly depending on industry buy-in — historically, not a good prospect for a piece of health IT regulation — though experts note the competitive advantages to joining TEFCA could be a significant motivator.

Update 6/17/2022: On Thursday Epic announced that it will join the Trusted Exchange Framework and Common Agreement, and that when the application process opens later this year it will apply to connect to TEFCA as an inaugural Qualified Health Information Network.

Moonshot announcements like Mr. Ellison’s make for great press and usually a bump in the stock price. But, as with most issues in healthcare, there’s a chasm between identifying the problem and being able to fix it. And to stay with the Lord of the Rings theme of the title of this post, I’m betting there’s someone in Verona, Wisconsin, ready to say:

GIF Credit:

2 thoughts on “One “Unified Health Record System” To Rule Them All? – I Think Not

  1. While I applaud any vendor’s attempt at solving the riddle of unifying patient electronic medical records, I seriously doubt that this dream will come true with the Cerner approach. The giant in the AMC space is, of course, Epic, What would motivate Epic to easily share information with its competitor?

    I think back on the early days of medical imaging and DICOM. It took YEARS to come up with a standard with which simple images could be reliably shared among vendors in a meaningful way. And this took a joint co-operation between government entities and competitive medical imaging companies. I know because I was there. And still even then, companies were hiding the best data in “shadow groups” of the protocol.

    We need to think through the eyes of the patient. What “we the patient” want is a complete view of all our records in one place. We don’t want multiple patient portals. We don’t want to log on multiple times to multiple different systems to see our PCP results, our lab results, our cardiac results, our prescriptions, our dental records, etc etc. And I have to believe that is what our clinical caregivers want as well. A complete view of “We the patient”.

    And this will not happen until “We the patient” demand it and everyone in this business sits at the same table and makes it happen.


Leave a Reply