Is Oracle Health’s Big Vision smacking into the wall of Healthcare Reality? Their business says so.

May 15, 2024 | by

Once again, ‘healthcare transformation’ may be A Bridge Too Far but definitely a Long Slog for Oracle. A highly critical Bloomberg report details the flat and deteriorating business of Oracle Health, the division that includes the former Cerner. Since their much-touted acquisition of Cerner two years ago [TTA 14 June 2022], Oracle has not righted the basic health system EHR business. Revenue and clients have stagnated with high-profile losses, versus the massive gains predicted only two years ago, and Cerner falling further behind the hospital/practice EHR leader, Epic, with a 26% hospital bed share compared to Epic’s 48%. 

  • Bloomberg’s internal sources indicated that sales reached $5.9 billion in 2023, but are projected to slip to $5.6 billion both in 2024 and 2025.
  • In 2023, 12 accounts did not renew and announced they would replace Cerner with Epic. These are major names such as Northwell Health and Boston Children’s Hospital. In 2022, clients with a combined capacity of 4,658 patients were lost, according to KLAS Research. This is despite the fact that EHRs are not moved lightly. The average commitment is 15 years or more since the ramp-up is taxing and costs are astronomical.
  • Common complaints cited by KLAS center around Cerner’s legacy software and the Cerner transition: tracking clinical revenue, tool integration, technical glitches, and uncertainty or worsened service associated with the Oracle takeover.Boston moved to improve data exchange with surrounding hospitals and Northwell for Epic’s set of better integrated tools.

Oracle laid off many involved with customer accounts. The consulting and sales area laid off 3,000 in one year from March 2023 to February 2024, according to Bloomberg. These may have been as early as May 2023. In June 2023, there were reports that the VA’s pause of Cerner Millenium for at least a year coupled with the completion of MHS Genesis triggered 500 to 1,200 additional Federal service area layoffs plus rescinded job offers. The layoff total may be as high as 4,200 on a pre-acquisition employee base of 28,000, with salaries and promotions frozen. On the executive level, Don Johnson, who once was a successor to CEO Larry Ellison, departed from leading Oracle Health and AI. Reportedly, Dr. David Feinberg, who briefly headed Cerner prior to the sale, is now a ‘ceremonial’ chairman of Oracle Health. [TTA 18 May 2023] Dr. Feinberg also joined Aegis Ventures as a senior advisor and is on Humana’s board, which sounds like a winddown of Oracle responsibilities [TTA 11 Jan]. The layoffs and freezes have improved the former Cerner’s operating margin from 22% to 33%, but not as high as Oracle’s 46% margin.

Since the acquisition and chairman Larry Ellison’s Big Vision promises of creating ‘healthcare transformation’ and ‘better information’, Oracle’s challenge with Cerner has been not only to move their legacy systems onto the cloud but also to integrate Cerner systems with Oracle–and Oracle may have underestimated that complexity as well.

  • Oracle has stated that most customers have been moved to Oracle’s cloud, but inside sources have qualified them as Oracle Health’s smallest and least technically complicated. The big systems with their own domains have yet to be touched.
  • Cerner applications had about 8,000 bugs to be fixed.
  • On the people management/integration side, there are substantial differences between ‘legacy’ Cerner and Oracle people, often centering around not understanding the nuances and complexities inherent in healthcare–as well as compensation and working conditions. This Editor, who as a marketer has had to deal peripherally with ‘legacy systems’ (to the point of tears) through acquisitions on the payer side, knows this is common.

Where Oracle has had success with Cerner’s EHR is in international markets less saturated with EHRs or with home-grown systems, winning contracts in Sweden, the UK and Saudi Arabia. As previously noted, they are a supplier for the NHS. Oracle has moved forward on population health software,  modernizing Cerner’s revenue-tracking tool, and planning for an AI-assisted ambient listening voice note system. 

What remains up in the air is if the VA will restart Millenium transitioning from VistA this year. Oracle is pushing to restart it and its revenue stream this summer as projected last year [TTA 18 May 2023]. This counters VA Secretary Denis McDonough’s testimony last month to the House Veterans Affairs Committee that the VA does not intend to resume deploying it until FY 2025, which does not start until October 2024, and use carryover funding. This FY, there are no funds or plans allocated except for Lovell FHCC, which seems to be going well. The contract, already tightened last April with multiple metrics, demanded improvements, oversight, and annual renewals, is running into more Congressional headwinds this year. Three senators on the Senate Veterans’ Affairs Committee called for the VA “to use the opportunity the new contract structure provides to re-review terms and add additional accountability and oversight provisions to protect veterans and taxpayers.” pointing to the OIG report issued in March. The contract is up for renewal this coming Thursday 16 May. NextGov, Becker’s

The final burden on Oracle–only alluded to in the article–is the debt load undertaken to finance the $28 billion Cerner acquisition. A complex set of bridge and term loans were used to finance the buy [TTA 27 Oct 2022]. At the time, Oracle’s $90 billion debt load was one of the largest in tech. While Oracle’s stock value has been buoyed by its investments in AI, in the current environment, this debt load becomes suspect. Yahoo Finance, Quartz

Contact lenses as sight-saving drug delivery system

September 7, 2016 | by

A drug-dispensing contact lens has shown success in effectively lowering eye pressure in monkeys with induced glaucoma. In what is termed a ‘pre-clinical model’, the study found that the medication, latanoprost, usually administered by the patient in conventional eye drops, in the contact lens form had equal or better intraocular pressure reduction. To quote the study’s first author, “We found that a lower-dose contact lens delivered the same amount of pressure reduction as the latanoprost drops, and a higher-dose lens, interestingly enough, had better pressure reduction than the drops in our small study,” said Joseph B. Ciolino, M.D., an ophthalmologist at Massachusetts Eye and Ear and an Assistant Professor of Ophthalmology at Harvard Medical School. The design of the lens does double duty: the periphery contains the thin film of drug-encapsulated polymers that slowly releases the drug; the center of the lens is clear and breathable, thus usable for standard vision correction.

Contact lenses for drug delivery have been for decades intriguing to researchers, but the embedded drug delivery has been too rapid to be effective in most cases; thus the polymers and the design are critical in slowing delivery. (more…)

IBM Watson Health adds 5 partners, 2 solutions

September 10, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/09/pillar.jpg” thumb_width=”150″ /]Breaking News  IBM Watson Health not only cut the ribbon on their new global HQ on Kendall Square in Cambridge, Massachusetts (and on their new General Manager Deborah DeSanzo), they also announced two more data crunching power platforms and five new partners.

  • The IBM Watson Health Cloud for Life Sciences is designed to help life science companies fast track the deployment of a GxP compliant infrastructure and applications while adhering to stringent requirements for hosting, accessing and sharing regulated data.
  • The IBM Watson Care Manager is a population health solution that integrates Watson Health, Apple ResearchKit and Apple HealthKit into a personalized patient engagement program to improve individual health outcomes.

The five new partners are Boston Children’s Hospital (pediatrics), Columbia University (Pathology & Cell Biology and Systems Biology), ICON plc (pharma clinical trial matching–Ireland), Sage Bionetworks (Open Biomedical Research Platform) and Teva Pharmaceuticals (treatments for chronic conditions–Israel). They join CVS Health, Medtronic and Yale University. On opening day, the new headquarters also hosted demonstrations by health ecosystem partners Best Doctors, Modernizing Medicine, Pathway Genomics, Socrates and Welltok. Release (PDF)

Previously in TTA on IBM Watson Health: their big announcement at HIMSS 15 and we do wonder about their work with the VA on clinical reasoning and mental health.

A ‘before the alarm’ approach to the soundtrack of ICU data

April 22, 2014 | by

ICUs–and indeed, any acute care setting–have a soundtrack of boops and beeps that accompany regular telemetry of data from multiple devices. Alarms which indicate emergencies shatter the rhythm, eventually inducing ‘alarm fatigue’. What if ICUs could get a step or two ahead and use the torrent of data to predict a downturn in a patient’s condition and warn clinicians before that alarm goes off? That is the idea behind the system being developed at Boston Children’s Hospital with a local data analytics startup, Etiometry.  The latter’s Risk Analytics model is designed to transform data into clinically actionable information and to predict decompensation–a worsening or emergency status for the patient. For the cardiac intensive unit at BCH, the Stability Index pops up on the vital signs screen. “Doctors choose different parameters to measure, then the Etiometry system renders its risk assessment on a simple numerical scale, with 0 being most stable and 4 the least.” Not the first innovation for Boston Children’s either; with another software provider, they developed a single view of vital signs interface dubbed T3.  Boston Globe, FierceMobileHealthcare