Epic + Oracle Health headed into 2024

Hospitals and health systems continue to invest in EHR platforms as the technology becomes more sophisticated for more coordinated care.

Two of the largest companies by market share, Epic and Oracle Health, are taking different paths to growth. What happens next?

Epic Systems
The last 12 months have been huge for Epic, with major health systems announcing full transitions to Epic EHR. Among the largest systems making the switch include Salt Lake City-based Intermountain Health, Cleveland-based University Hospitals, and New York City-based Northwell Health.

University Hospitals said it will pay $400 million for the full transition, set to go live next year, and Pittsburgh-based UPMC is transferring 6 million patient records as it consolidates from 9 EHRs into one. Broward Health in Fort Lauderdale is spending $250 million on its Epic transition, set to complete next year.

Epic has also been busy striking partnerships, working with Microsoft to integrate generative AI into its EHRs. In May, the partners began working together to integrate the technology and make In Basket available. Clinicians can use In Basket to draft responses to patients asynchronously.

Epic is also working with Nuance Communications, a Microsoft company, to develop a Nuance Dragon Ambient eXperience Express solution for Epic EHR users. The DAX Express will integrate with Epic workflows so clinicians can manage administrative workloads and have the time to expand access to patient care.

In August, Epic also decided to integrate new AI clinical documentation capabilities into its platform through Abridge, a generative AI company. The program, known as "Partnerships and Pals" to reduce administrative documentation for clinicians, saving an average of two hours per day.

But perhaps the most interesting updates from the last year has been acceleration toward interoperability. In December, its subsidiary Epic Nexus, was named one of the first qualified health information network designation recipients, facilitating secure information exchange through the Trusted Exchange Framework and Common Agreement. There are also 489 hospitals who are Epic customers, ready to join.

What's next for the company? More interoperability and partnerships.

"This single on-ramp toward universal interoperability will help clinicians connect to each other and better serve patients, regardless of their electronic health record vendor," said Matt Doyle, software developer at Epic. "We hope this public-private partnership will spur providers who have previously not participated in nationwide interoperability to join this initiative.

The company will likely continue enhancing its patient experience as well. In early December, Epic partnered with Qualtrics to integrate patient experience data into the EHR for a more personalized experience.

There could be more partnerships as well, but don't expect any mergers or acquisitions. Judy Faulkner, Epic's founder, has been steadfast in her stance against acquiring companies and technology, She says it's easier for the company to acquire skills and talent to build new capabilities than integrating acquired companies into the existing platform.

Oracle Health
Oracle is taking a different approach with Cerner after acquiring the company in 2022. Cerner has gained some hospital customers while it lost others as health systems merged and transitioned to a new platform. But Larry Ellison, chief technology officer of Oracle, isn't worried.

"We have products for the entire healthcare ecosystem, which is a much larger footprint than Cerner ever had," said Mr. Ellison, during a Dec. 11 earnings call. "We are going after a much larger market than Cerner was. So, we expect Cerner to be a growth story."

The Cerner Millennium suite is transitioning onto the Oracle Cloud infrastructure to bring new features and capabilities to customers next year. It's also focused on bringing in new projects for public health and offerings for pharmaceutical companies.

A large project originating from the Cerner HealtheIntent platform, known as the Health Data Intelligence Platform, is expected to be completed next year and offer a public health management solution convenient for all areas of the healthcare system. The platform is being sold in Australia and Europe, and U.S. states to provide a national view of healthcare data that was missing during the COVID-19 pandemic.

"It is fully [software-as-a-service], and it is available right now," Mr. Ellison said in the call. "Some of the Cerner pieces are coming online. Other Cerner pieces are moving more gradually, but they're all going into OCI, and they're all very quickly moving from a license basis to a subscription basis."

Safra Catz, CEO of Oracle, said during the call that Cerner will be a negative one to two basis points for the fiscal year, but then will be "a gross story."

Cerner, now referred to as Oracle Health, has expanded to include a telecommunications module to summarize consultations between physicians and patients. The module can also write physicians' notes automatically.

"For the first time, we've done it. We now have our large language model generating the summary without a scribe that the doctor can edit in a couple of minutes," Mr. Ellison said. "It actually succeeded in doing one of the very hardest tasks we assigned it."

Oracle has also made progress with the VA EHR install. The process was temporarily halted in April due to persistent problems with the system. The VA announced plans to renew the installation in the summer of 2024.

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