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Opinion >  Guest Opinion

Dr. Shravani Durbhakula: Doubt surrounds Oracle and its ability to fix what Cerner got wrong

July 3, 2022 Updated Tue., July 5, 2022 at 2:01 p.m.

Dr. Shravani Durbhakula

Given Big Tech’s dubious track record in health care, Oracle’s nearly $30 billion acquisition of electronic health records company Cerner is already prone to doubt. Add to that Oracle’s challenging problem inherited from the Department of Veterans Affairs.

The VA’s health administration, which oversees the nation’s largest health care system with 9 million patients, is embroiled in technical problems in its massive data implementation contract with Cerner. Oracle now owns the problem – literally.

This became apparent June 19 in The Spokesman-Review. That’s when an investigative article about problems with Cerner software at Spokane’s Mann-Grandstaff VA Medical Center ran in this newspaper. Those findings have since reverberated in several health care and military-oriented media outlets. A government audit’s preliminary findings, which are subject to revision, document Cerner software putting patients into what amounts to a black hole where appointments, lab work, refilling prescriptions and other routine follow up procedures failed to work. In all, nearly 150 patients were said to be harmed due in large part to Cerner software.

Credit Oracle’s senior leadership for not ducking the issue. Oracle had a number of ways to avoid addressing the media and the resulting accountability. For one, reporter Orion Donovan-Smith obtained a draft report from his own sources on problems implementing Cerner software. As a draft report, a common tactic would be to defer commenting until a final report is released. Yet Oracle Vice President Deborah Hellinger committed the company to making the software work.

Explaining that the database giant’s software engineers were already working on technical and operational changes, she said the goal is to exceed expectations of providers, patients and the VA. Hellinger went on to say Oracle has “a moral obligation to deliver the best technology possible for our nation’s veterans, and we intend to do so.” This statement creates a sense of urgency while inspiring confidence that Oracle is up to the job. Invoking a moral obligation to developing effective technology for the nation’s veterans elevates the mundane debugging of software and resolving help desk tickets into a patriotic duty.

To be sure, Oracle stopped short of pledging to solve specific issues, which pre-dates the company’s acquisition of Cerner. In 2018, the VA signed a $10 billion contract with Cerner to migrate health records from a 1980s-era legacy system. The deployment in 2020 at Mann-Grandstaff is the first part of what is envisioned as a nationwide rollout over 10 years.

The Office of Inspector General has issued a dozen critical reports about the VA’s patient records modernization initiative. Meanwhile, the GAO, the auditing arm of Congress, recommended delaying the deployment of Cerner to other VA facilities until further testing is completed. Such audits invite additional scrutiny. President Biden signed legislation last month that requires the VA to issue quarterly reports on progress with its Cerner electronic health records rollout.

Members of Congress know the political importance of veterans. “For more than a year, Cerner and VA leadership have avoided accountability, withheld key findings and information, and put the lives of our nation’s heroes at risk,” said U.S. Rep. Cathy McMorris Rodgers, reacting to The Spokesman-Review’s coverage.

While it is easy to assign blame to Cerner, the VA or both, Klas Research finds in a recent study that perceptions of electronic health records systems are formed by an organization’s IT leadership, the vendor and medical personnel as end users. Well-known for analyzing health technology, the firm concludes an organization’s IT leadership is the single most important determinant of success in EHR systems. As longtime health IT observers know, implementing large projects often comes down to management and personnel considerations as much as technical ones.

The bottom line is the track record of Big Tech in health care is dubious at best. Amazon, Apple, Google, IBM and Microsoft have either struggled or outright failed at bold new health initiatives. Technology alone is not enough. As Dr. Robert Pearl, a professor at Stanford University who served as CEO of a large medical system notes, despite engineering know how to create powerful tools, patient record data is tricky business. Many of the issues plaguing Cerner and the VA is the migration of data from the old EHR system.

Oracle has an enormous opportunity here to put their words into action. As Oracle founder Larry Ellison said, “Better information will fundamentally transform health care.” He’s right. Focus on veterans’ health care to make medical data work for those who served the country.

Dr. Shravani Durbhakula is an anesthesiologist and pain physician at Johns Hopkins University. Twitter: @ShravaniD_MD

An earlier version of this piece misspelled the name of Dr. Shravani Durbhakula, due to a copy editor’s error.

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