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Oracle, Cerner and the Unified Medical Record

Oracle, Cerner and the Unified Medical Record
05 July 2022

And yet another Goliath is stumbling to take the hill. The assumption is that size and heft matters in finding a solution to the scattered medical records problem.  I cannot help but recall all of Goliath’s disadvantages as theorized in Malcolm Gladwell’s work.  If size is what matters, Epic holds 40% of the medical records in the USA today.  A small bunch of EHR systems make up the rest.  Why did they not succeed? The concentration of EHR systems in an ever-shrinking minority of antiquated technologies has not advanced the solution thus far.  Concentration has just made the walls between them stronger.    

People continue to ask why the medical systems can’t be like the banking systems where they have achieved interoperability of banking information both nationally and internationally.  A major threat brandished at Russia in the recent crisis was a ban from SWIFT. As an explanation, interbank communication protocols allow a user to consolidate information from several banking institutions.

In the finance sector we have seen the rise of a few major banks who holds all the banking information of the entire country.  They also have become too big to fail. Deep pockets like Oracle are attempting to apply the playbook of the financial industry to the healthcare industry.  As Yoda would ask, “Akin to banking, are they?” At least this “padawan” thinks the answer to that question is in the negative.  There are two major differences that will reject the application of the financial playbook.

Interoperability has not yet been fully achieved. The first stop of a new medical record is usually at the offices of a PCP/HCP.  The medical records of only those patients who require hospitalization is transferred to the hospitals which means that the systems like EPIC and Cerner which service these hospitals still do not have access to the last mile.  They have been trying to make inroads into the PCP/HCPs through a combination of acquisitions and new product introductions.  

That leads us to point number two: motive. Why do you think all these entities are seeking the “holy grail” of a unified medical record?  Money derived from data, of course! Whoever cracks the code becomes the next trillion-dollar company.  The aforementioned consolidation of medical systems is not going to be good for the consumer. There are far too many examples to even start listing them. 

In this pursuit of money by owning and using the medical records of consumers/patients these big players are leaving the real owners of medical records out in the cold.  There is no incentive for the patient/individual who are the owners of that data to participate.  Most EHR systems still claim ownership of medical data. At other times the PCP/HCP claims that ownership. When data is being used by these systems there is no monitory benefit to the real owners.  At least in banks they pay you an interest when they use your money.   

Unless and until the ownership right of the medical record by the individual is granted, protected, and effectively executed there is no incentive for them to participate in this grand effort.  Some progress is made in this direction by startups who are effectively tokenizing medical records using block chain and related technologies.  They also make sure that if anyone uses those medical records for profit the owner of the medical records gets the lion’s share of that profit. 

Oracle, Epic, Athenahealth and the rest can buy up everything in their path but will still miss their goal if foundational changes to interoperability and ownership are not implemented. All they would have done is to buy a 50-year-old obsolete systems with obsolete data.

At blueEHR we have always stood by data ownership rights of the individual.  We have always made sure that there is never a barrier to the retrieval of data.  We have open APIs that enables customers to download data in real-time either to store away or use in a Data warehouse.  Not all of the systems out there are following this road in spite of legislation and meaningful use certification requirements.  To make the Unified medical record a reality there must be 1) a legal recognition of the ownership of data and, 2) expedite the implementation of interoperability.  What will that do?  When owners of data are paid for their records, it becomes valuable to them which motivates them to act to collect and store a complete medical record from all sources.  The strict mandate and implementation of interoperability will empower the individual’s motivation by allowing the free flow of records among systems to gather a more accurate version of their medical data.  In other words, the movement to a unified medical record is through the empowerment of the actual owners of those records.