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Oracle's Larry Ellison shares fears of bankrupting Western civilization with healthcare

But the solution may need more than a really big database

Comment During the keynote of Oracle's annual sales jamboree in Las Vegas, founder and CTO Larry Ellison took the opportunity to offer some profound insight into the state of healthcare in the US and Europe.

"If we're not careful… we're gonna bankrupt Western civilization unless we find a more efficient way of providing healthcare to everybody," he told onlookers who had turned up to attend a computer conference.

To be fair, he had just spent 45 minutes espousing the virtues of Oracle's cloud and autonomous database, but the permanently bronzed island-dweller eventually shifted to his favorite topic: healthcare.

To unpick his claim about the impending crisis in "Western civilization," it's helpful to point out that there is nothing new here. Healthcare is increasingly unaffordable, and that's a good thing.

I started out as a healthcare and medical reporter for The British Medical Association in 1996. The ABC of healthcare economics is that as new treatments and technologies become available to doctors and nurses, people live longer and in the end require more treatment.

Take coronary artery bypass surgery. Not only did its introduction in the 1960s create a cost in term of a new treatment option, but it also meant many coronary artery disease patients survived into later life, when they would require more treatment, maybe for CAD, maybe cancer of something else. And there were more treatments available for those things. It's a snowball effect in terms of cost, but for healthcare it's a good thing.

We've heard Ellison wax lyrical about healthcare before. In an unhinged report about his work with former US president Donald Trump on the COVID-19 response and his long-term vision for healthcare, Ellison talked about his acquisition of his Hawaiian island, Lanai, on which he has spent least half a billion dollars turning it into a "laboratory for health and wellness powered by data."

The attitude provokes a suspicion that Ellison's obsession with health is personal. To misquote Woody Allen, he wants to become immortal, not through his work but through not dying.

Whatever the reason, Oracle acquired Cerner – a specialist developer of electronic health records systems used throughout the world – for $28.3 billion in June. And then it walked straight into a public relations bloodbath.

First, news broke in July that computer errors following the go-live of a new Oracle Cerner electronic health records system harmed nearly 150 patients at a Washington hospital, as revealed during a hearing in the US.

Four days after Mann-Grandstaff VA Medical Center in Spokane switched over to its new Cerner software, staff became aware of an "unknown queue" problem which had the potential to cause harm to patients, a US Senate Committee on Veterans' Affairs heard.

Obviously, the problems predate Oracle's ownership of Cerner, which won the 10-year, $10 billion contract with the Department for Veterans' Affairs (VA) in 2018. Oracle also promised to fix the issues.

But that was less than reassuring to customers. Earlier this month, the VA announced it is delaying pending deployments of the Oracle Cerner electronic health records (EHR) system until June 2023 because of ongoing problems.

"Right now, the Oracle Cerner electronic health record system is not delivering for Veterans or VA healthcare providers – and we are holding Oracle Cerner and ourselves accountable to get this right," said Deputy Secretary of Veterans Affairs Donald Remy in a statement.

Cerner has had problems in the UK too. In October, Royal Free London NHS Foundation Trust staff were told not to use the system due to a technical issue affecting Cerner.

The Register has seen screenshots of alerts saying the incident was unplanned and caused the application to run slowly and crash. Another error message said the problem was an "invalid database configuration" and that the "configuration file could not be found."

It's been a rude introduction to the intricacies of healthcare informatics for Oracle. Ellison's idea that affordable healthcare is doomed unless we use technology to improve efficiency is compelling, but heinously difficult to put into practice.

One of the pillars of Ellison's claims is doctors' access to electronic health records. "Doctors can't treat you if you have an accident in Montana or London. Doctors can't get your health records," he said in his keynote.

He then repeated his commitment to taking "all electronic health records and consolidate them into a single national database."

In a presentation in June, the CTO had complained that records for individual patients were stored by hospitals and physicians, and not replicated or shared between providers.

"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," he said.

This has been tried before and Oracle should know. Cerner was one of the suppliers to the National Programme for IT, a disastrous £10 billion ($11.2 billion) UK effort to create unified electronic health records on a regional basis.

Dating back to 2003, the programme, which was at times estimated to cost £12 billion ($13.4 billion), was stopped early in 2011 and "did not deliver key benefits" despite the Department for Health and Social Care spending an estimated £9.8 billion ($10.9 billion), the National Audit Office (NAO) said. The public spending watchdog conceded some national digital services were delivered successfully and are still in use.

In 2011, the NAO said [PDF]: "Progress in delivering care records systems varies dramatically between regions. There has been more progress in London in some health settings, although no GP practices are now receiving a system through the Programme and the number of systems in acute hospital settings has halved."

The reasons for the failure were disputed between the Department for Health and Social Care and the suppliers, one of which, Fujitsu, ended up in court with the government and won its case.

What makes a central database of health records, accessible to all health professionals, so difficult is the problem of defining what should be in the records in the first place. Different health professionals need different information for different reasons. How and when they access that information depends on the processes run in the organization. Processes are defined locally in the UK's NHS although there is national oversight and funding. Funding, oversight, and providers are even more fragmented in the $808 billion United States healthcare market.

Larry Ellison may want to create a central health records database for the United States, but given that he's 78 years old, he'd be very lucky to see the end of the project.

Although maybe there's something on that Hawaiian island we don't know about. ®

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