The announcement this past month that Oracle would acquire Cerner in an all-cash deal for $28.3 billion was colossal. The planned purchase of the electronic health record giant is the biggest yet for the famously acquisitive Oracle, and one of the biggest-ever deals in the health IT space.

In announcing the deal, Larry Ellison, Oracle's cofounder, chairman and CTO, said it would "provide our overworked medical professionals with a new generation of easier-to-use digital tools that enable access to information via a hands-free voice interface to secure cloud applications."

The company pledged "zero unplanned downtime in the medical environment" for Cerner customers, and Mike Sicilia, Oracle's executive VP of vertical industries, said its "Autonomous Database, low-code development tools, and Voice Digital Assistant user interface [will enable] us to rapidly modernize Cerner's systems and move them to our Gen2 Cloud."

Cerner CEO Dr. David Feinberg, meanwhile, said joining with Oracle would offer "an unprecedented opportunity to accelerate our work modernizing electronic health records, improving the caregiver experience and enabling more connected, high-quality and efficient patient care."

So, what do health system CIOs and industry analysts have to say about this big deal – and its big promises for IT professionals, clinicians and patients? We asked some of them.

First reactions

"Those of us in healthcare information technology have been living this dynamic world of mergers and acquisitions over the past five or so years," said Tressa Springmann, chief information and digital officer at Baltimore-based LifeBridge Health, a Cerner customer. "I don't know any peers untouched by this."

As for the Oracle-Cerner deal specifically, Springmann said she was "surprised perhaps about the specific timing, but not the announcement itself." 

"Those of us in healthcare information technology have been living this dynamic world of mergers and acquisitions over the past five or so years. I don't know any peers untouched by this."

Tressa Springmann, LifeBridge Health

She added: "I do believe major disruptions are needed to make the changes our industry requires."

Other Cerner clients said they simply wanted to make sure that their EHRs would continue to work well for them and their providers.

"My initial reaction was of high interest as we have built a strong partnership with Cerner and want to ensure that continues with Oracle," said Jeri Koester, CIO at Marshfield Clinic Health System, which comprises nine hospitals – plus Marshfield Children's Hospital inside the flagship hospital – and more than 60 healthcare centers across Wisconsin. 

And the U.S. Veterans Affairs Administration, which has been doing an enormous amount of work with Cerner  – not all of it proceeding as smoothly as hoped – on its EHR modernization effort, issued a simple statement expecting an ongoing good relationship.

"While it is not VA practice to comment on the business decisions of our vendors, we do not expect Oracle's acquisition of Cerner to impact VA's electronic health record modernization process," a spokesperson told Healthcare IT News.

Coray Tate, vice president of core solutions and interoperability at KLAS Enterprises, said he was not surprised by the deal – nor was he surprised that many Cerner customers were soon wondering what it might mean for them.

"There have been rumors floating around for several years about someone buying Cerner," he said. "Oracle's name was often mentioned as a possibility."

"Almost immediately" after the deal was announced, said Tate, "we had Cerner customers contacting us wanting to know what their peers were saying."

"Any time you have an acquisition, it puts customers in a state of limbo," he reasoned. "They have all seen acquisitions that have had a negative impact on independent companies. There is always some degree of both hope and concern."

One thing Cerner customers can rest easy about, at least in the near term, is company leadership. According to a Jan. 15 filing with the Securities and Exchange Commission, David Feinberg, along with Jerome Labat, Cerner's chief technology officer, will stay onboard for at least one year following the acquisition.

What Big Tech can bring to the table

Physicians and nurses have long complained about EHR usability – that the systems are not user-friendly and take up far too much of their time every day. 

On the flipside, EHRs now are being asked to do more and more – for instance, incorporating more advanced and granular data, such as genomics, for precision medicine. And that means even more challenges for IT leaders and clinicians to cope with.

Can a Big Tech company like Oracle solve these problems?

Tate speaks bluntly: "Big Tech in general does not have a great track record in the healthcare setting, so Oracle has a lot of things to prove."

"Big Tech in general does not have a great track record in the healthcare setting, so Oracle has a lot of things to prove."

Coray Tate, KLAS

That said, "They definitely have resources that can be brought to bear," he pointed out.

"It has been a challenge for Big Tech to give healthcare the focus it requires, when it is just part of what they do," said Tate. "We have seen healthcare best served by mission-driven companies that want to make a difference first and let the money follow that."

Koester said she believes there's an opportunity with Oracle to accelerate modernizing the EHR into a health platform – with more automation, artificial intelligence and machine learning – bringing in domain expertise from other industries.

For her part, Springmann takes a different view.

"I think I'd rather reframe this and, perhaps, ask more specifically how this move might better enable Cerner to adapt their EHR and fortify their support and implementation structures quickly, as we are seeing the healthcare delivery system change," she said.

"These types of transactions do have the potential to more quickly change a culture, accelerate resources, and make available technical research and development that might not otherwise have had the funding nor focus to mature as quickly," said Springmann.

Can Oracle make EHRs 'delight the user'?

Top healthcare CIOs and other health IT professionals have been asking for years when EHR makers will do one big thing with their technologies: "delight the user."

After all, a decade-plus of well-designed smartphones, websites and other consumer technologies has shifted expectations for what's possible. Can Oracle and Cerner develop an EHR that's enjoyable, even "delightful," to operate?

"Clearly, today, this has not yet been achieved with EHRs," Springmann observed. "Further, our incremental progress to the goal has shown success but not within the timeframe needed. Yes, a daunting task, but not one that I believe is achievable without taking some bold moves."

Cerner has communicated a focus on optimization around the EHR user experience and revenue cycle, Koester noted. 

"Cerner has communicated a focus on optimization around the EHR and revenue cycle. Carrying forward this idea of easing the physician burden to Oracle will serve them well."

Jeri Koester, Marshfield Clinic Health System

Much has been made, for example, of Oracle's promise to bring its voice-enabled AI tools to the Cerner EHR, potentially helping streamline clinical workflows.

"Carrying forward this idea of easing the physician burden to Oracle will serve them well," said Koester.

But the goal of "delighting" the end-user may not be the most pressing concern for this merger – and, at any rate, it's bigger than just Oracle and Cerner.

"Oracle first will have to prove they are all in for healthcare," said Tate. "After that, it will take a lot of work and collaboration. We are learning from the Arch Collaborative that delighting users is a three-pronged approach."

He said this approach requires:

• Great technology delivered well – the software vendor cannot just drop the software off. It must have a recipe for successful implementation and adoption. Otherwise, the results are all over the place. As EHRs stand today, they need to make a technology jump to be smarter and more actively involved in bringing the right things to clinicians.

• Great collaboration at the healthcare organization – it is up to the IT team at the healthcare organization to make the software work and the process workable.

• Real investment by clinicians – they just have to be invested.

"We all want EHRs to be like smartphones, but that is not a good analogy," Tate said. 

"Healthcare is so complicated and EHRs have so many demands on them from government requirements to driving effective billing," he explained. "The reality is they are not just built for physicians. Physicians can have a good experience with an EHR today, but they have to be involved in mastering the EHR to get there."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.