This time last year, Oracle co-founder and CTO Larry Ellison took to the stage at the vendor’s annual user event in Las Vegas and said that his vision for the company’s acquisition of Cerner is to aggregate healthcare data at a national – or even global – level to improve patient care. Ellison’s plans for national healthcare databases would put patients at the center of the healthcare system, he said.
This year, Ellison built on that vision and described how continuous collection of centralized healthcare data, built on Oracle’s Cloud Data Intelligence Platform, could help to provide personalized care and allow doctors to make better medical decisions. And according to Oracle’s VP of Industries, Mike Sicilia, the company is ready to start deploying national healthcare databases as of next month (October 2023).
Not only that, but Oracle is prepared to build new data centers to help national governments pursue this. Sicilia said:
In October, we’re ready to deploy the national databases for any country that wants to take it. It launches on OCI in sovereign form, meaning the data will never leave the borders of the country that wishes to consume it.
If we have to go and build data centers in the country to do that, we will do that.
It’s a bold strategy, but Oracle appears willing to invest where there is demand. Other conversations with execs have highlighted how it is able to do this cost effectively because Oracle has standardized on its systems, which has allowed for a high degree of automation. This means that building a new data center in any region, according to Oracle, is more cost effective than what might be the case for other cloud hyperscalers.
Sicilia said that whilst Oracle is happy to take a piecemeal approach to the adoption of its healthcare systems, targeting individual buyers, the strategy is at a federal or national level. He added:
I think the federal and national governments are the focus right now. The strategy is that we are going to put a national database in place, but it doesn’t necessarily require any of the contributors to that national database to change any of their systems. The strategy is you’ve got to meet people where they are.
You’re not just going to flip out everybody’s operational systems and everybody’s databases today. It’s a federated strategy, where you come in and we federate what they already have in place today.
We did this for the United States government during COVID-19, where we federated all the vaccine delivery on the supply chain systems into a single database and didn’t change out anything.
I think that strategy worked incredibly well and then over time, the providers probably will change out their operating systems, because as they feed these national systems, which is an automated process, they’ll see some of the new UI, some of the new user experiences, the analytics
Sicilia said that the reason governments may find Oracle’s national healthcare database ambitions appealing is that COVID-19 exposed a lot of weaknesses in the system, where access to real-time data was difficult. The fear of new infectious diseases and the possibility of another pandemic in the future could be a real motivator for a change in how governments think about healthcare delivery, he added.
In addition to this, Oracle’s hope is that because it can take on the entire stack of healthcare delivery, both with Cerner’s electronic healthcare record (EHR) systems, and Oracle’s other backend operational systems, that more demand will flow its way. Sicilia said:
We’re going to solve the whole whole problem with healthcare. The reason that we think others have tried and not been as successful as they could in healthcare, is because they only took on a piece of the problem. They only took on EHR, they only took on billing, they only took on financials, they only took on HCM. We’re going to take the whole thing on.
We have healthcare specific versions for supply chain, for HCM and for ERP, and we’re delivering that as a full stack in concert with our electronic health records.
Sovereignty a priority
Oracle is very aware that to achieve its ambitions it needs to take data sovereignty seriously. Data protection regulations are stringent for many governments, but when it comes to healthcare, patients are also very protective over who has access to their data, where it sits and where it can be moved to.
As noted above, Oracle is taking the view that if it needs to it will build data centers to make this workable for its customers. Sicilia notes that data sovereignty is the biggest barrier to adoption. He says:
When it comes to healthcare information, it doesn’t matter how big or how small the country is, I haven’t met a government yet that’s a fan of saying ‘I’d love to have my healthcare data live in another country’. Even if it’s an ally, even it’s a friendly
What’s been the barrier is that other hyperscalers have been unwilling to invest in building fully sovereign data centers in some countries. What we’re saying is we’ll build it and we’ll be fully sovereign.
Some say ‘we’ll have a datacenter for you, but the DR (disaster recovery) is somewhere else’. If the DR is somewhere else, it’s not sovereign. We’re saying we will build full DR, full data centers in-country, separated by 75 kilometers, or whatever you’re comfortable with, with our full stack on top of that. Otherwise, they’re gonna have to choose an on premise solution, which is far less attractive.
The other barrier to adoption, as Sicilia sees it, is that because there has been a lack of cloud technology available to healthcare providers, change management requires significant work. Buyers will need to get their head around the fact that the software gets updated automatically four times a year, and training will have to adapt to this. He adds:
As a healthcare provider you need to completely rethink the way you train people and you need to move to a more agile, iterative training process.
Oracle will also be aggressive on pricing, it seems. I put it to Sicilia that another barrier to adoption could be that purchasers of EHR and backend systems may come from different teams and have access to different sources of funding – the strategy isn’t always a unified one when it comes to healthcare provision. He said:
You can still have two different buyers, you can still have different experiences, but wouldn’t it be nice to be able to say, we’re gonna keep these on common upgrade cycles, we’re going to keep these on a common subscription and we know exactly how much we’re gonna spend next year?
We can deliver every aspect of what they need and we can give you an all-in price for everything you spend. And generally, it’s saying, how many pounds are you spending on IT today? We can do it for X. Even if you’re running disparate systems, different buyers, different personas.
Another benefit of this all-in approach, according to Oracle, is that cybersecurity could be improved. Sicilia noted that healthcare organizations are a major target for bad actors – which has been evidenced by a number of high profile attacks – and that by ring-fencing everything into a common cloud perimeter, healthcare data could be safer. He said:
Having a single perimeter defense is far better than having a bunch of different perimeters today. Particularly when you get into the smaller community hospitals, rural hospitals, where you just don’t have a lot of sophistication in the IT stack. It’s incredibly expensive to go try to ring fence very old stuff, you’re far better off lifting and shifting it to something like OCI.
Asking the wrong questions
One of the examples Oracle showcased at CloudWorld this year was its voice digital assistant, which can be complemented by generative AI. The idea being that a health practitioner could use their voice and say ‘show me this patient’s x-rays and highlight the problems for me’, and then if the patient consented to the appointment being recorded, generative AI could provide a summary of the session for approval by the doctor.
I put it to Sicilia that a lot of healthcare providers are still struggling with much simpler problems – such as the amount of time it takes to turn on a computer and log on – and that the thought of using generative AI or biometric tools is a long way off. He agreed, but said that it’s Oracle’s job to educate on how quickly the technology is progressing and just considering small efficiency savings is a missed opportunity. He explained:
They’re asking us to go from 10 clicks to seven clicks, to get that 30% efficiency increase. But as we looked at the problem, and we looked at generative AI and voice navigation, I think we can do better. I think we can eliminate clicks altogether.
I think we go from 10 clicks to zero clicks. They’re asking if we could increase the logout timeout to 30 minutes, to cut down the number of times they have to log on in a day. That saves 10 minutes in the day, which is 10 patients.
We’ve come up with a system which says: what if we just use your voice as the biometric identifier? What if we basically use a biometric identifier, your voice, and you never have to log into the system again? And then as long as the patient consents to recording, you have persistent recording, and you’re provided with a summary, all the data is summarized using generative AI, and there’s a draft for the doctor. Then all the doctor has to say is yes or no.
There’s a disbelief…going from 10 clicks to seven clicks three years ago would have been a very logical request – but I think people need to understand the art of the possible. It’s a remarkable moment. My job has always been in technology, since I left university a long time ago, and I’ve never seen a breakthrough as big as this with generative AI.
Generative AI is the single biggest breakthrough in terms of productivity for healthcare workers.
Oracle’s healthcare strategy and its ambitions are incredibly bold and very interesting to hear. For those of us that have been following healthcare technology for years, what they are talking about has been a dream of healthcare providers – but is something that has failed to materialize for a number of reasons. None of them really to do with technology. There are numerous stakeholders involved in healthcare provision, which often have conflicting thoughts on how to deliver what’s needed. There are local needs and requirements, which often don’t fit into national frameworks of a ‘desired endpoint’. And, of course, patients are very, very cautious about centralized healthcare data.
That being said, COVID-19 changed the goalposts a lot and there is a renewed desire in the market to do things differently. Equally, Oracle does seem to be wanting to meet healthcare providers where they are and address the different demands head on. The strategy is there, Oracle is ready to go, and now we will wait and see if it pays off. If Oracle is telling us this time next year it has deployed national healthcare databases for various countries, it will be a clear win for the foundations Ellison and his team have laid down. We will be watching closely.