Healthcare Will Ruin Western Civilization • The Register

comment During the keynote speech at Oracle’s annual Sales Jamboree in Las Vegas, Founder and CTO Larry Ellison took the opportunity to provide an in-depth look at the state of healthcare in the US and Europe.

“If we’re not careful … we’re going to ruin Western civilization unless we find a more efficient way to provide health care to everyone,” he told viewers who turned up to attend a computer conference.

To be fair, he’d just spent 45 minutes championing the virtues of the cloud and Oracle’s autonomous database, but the permanently tanned islander finally switched to his favorite topic: healthcare.

To counteract his claim about the looming crisis of “Western Civilization,” it helps to point out that there is nothing new here. Healthcare is becoming increasingly unaffordable, and that’s a good thing.

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

Do coronary artery bypass graft surgery. Its introduction in the 1960s not only created a cost in terms of a new treatment option, but also meant that many patients with coronary artery disease survived later in life when they needed further treatment, maybe for CAD, maybe for cancer or something else . And there have been more treatments for these things. It snowballs in terms of cost, but it’s a good thing for healthcare.

We’ve heard Ellison gush about healthcare before. In a rogue report on his work with former US President Donald Trump in responding to COVID-19 and his long-term vision for healthcare, Ellison spoke about acquiring his Hawaiian island of Lanai, for which he has at least half a billion dollars has spent transforming it into a “lab for health and wellness powered by data”.

The attitude raises suspicions 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 medical record systems used around the world — for $28.3 billion in June. And then it went straight into a public relations bloodbath.

First, it was revealed in July that nearly 150 patients at a Washington hospital were harmed by computer errors after Oracle Cerner’s new electronic health record system went live, according to a US hearing.

Four days after Mann-Grandstaff VA Medical Center in Spokane migrated to its new Cerner software, staff became aware of an “unknown queue” issue that could potentially harm patients, a US Senate committee on Veterans Affairs has heard.

Apparently, the problems lie ahead of Oracle’s ownership of Cerner, which won the 10-year, $10 billion deal with the Department for Veterans’ Affairs (VA) in 2018. Oracle also promised to fix the problems.

But that was anything but reassuring for customers. Earlier this month, the VA announced that it will be deferring pending deployments of the Oracle Cerner Electronic Health Records (EHR) system to June 2023 due to ongoing issues.

“Right now, Oracle Cerner’s electronic medical record system is not appropriate for veterans or VA healthcare providers — and we hold Oracle Cerner and ourselves responsible for getting this right,” Assistant Secretary of Veterans Affairs Donald Remy said in a statement.

Cerner also struggled in the UK. In October, staff at the Royal Free London NHS Foundation Trust were told not to use the system due to a technical issue affecting Cerner.

The registry has seen screenshots of alerts stating that the incident was unplanned and caused the application to run slowly and crash. Another error message stated that the problem was an “invalid database configuration” and that the “configuration file could not be found”.

It was a rough introduction to the intricacies of health informatics for Oracle. Ellison’s idea that affordable health care is doomed unless we use technology to improve efficiency is compelling but terribly difficult to put into practice.

One of the pillars of Ellison’s claims is physician access to electronic medical records. “Doctors can’t treat you if you have an accident in Montana or London. Doctors can’t access your medical records,” he said in his keynote.

He then reiterated his commitment to “take over all electronic health records and consolidate them into a single national database.”

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

“We will solve this problem by adding a unified national medical records database to 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 of the National Program for IT, a disastrous £10 billion (US$11.2 billion) British effort to create uniform electronic health records on a regional basis.

Dating from 2003, the scheme, at one time estimated at £12bn ($13.4bn), was shut down in early 2011 and ‘did not deliver any significant benefits’, despite an estimated £9.8bn spent by the Department for Health and Social Care ($10.9 billion), the National Audit Office (NAO) said. The public spending regulator acknowledged that some national digital services have been successfully deployed and are still being used.

In 2011, the NAO said [PDF]: “Progress in the deployment of care record systems varies greatly from region to region. Greater progress has been made in some healthcare settings in London, although no GP practices are currently receiving a system through the program and the number of systems in acute care hospitals has halved.”

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

What makes a central database of health records accessible to all healthcare professionals so difficult is the problem of defining what should be in the records at all. Different healthcare professionals need different information for different reasons. How and when they access this information depends on the processes running in the organization. Processes are defined locally in the UK 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 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 there might be something about this Hawaiian island that we don’t know about. ® Healthcare Will Ruin Western Civilization • The Register

Rick Schindler

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