The American health record was not designed with patients in mind. Records are stored by hospital systems, formatted by the EHR vendor each institution uses and largely inaccessible to patients who see multiple providers or cross institutional lines. Larry Ellison, executive chairman and co-founder of Oracle, sees that model as a design failure — and as a problem Oracle set out to fix.
“That record doesn’t belong to the hospital, that record belongs to the patient, and the patient needs a full longitudinal record, regardless of whether it’s in Epic format or in a Cerner format or an Allscripts format,” Mr. Ellison said at the Oracle Health and Life Sciences Summit Sept. 23.
That conviction shaped how Oracle built the next generation of its patient portal. Rather than extending the existing Cerner portal, which stored records hospital by hospital in whichever EHR format produced them, Oracle built from the ground up for multi-EHR, multi-provider access. The result is a platform that consolidates a patient’s full clinical history regardless of how many systems or institutions contributed to it.
“All of your health records are delivered to the patient,” he said. “They’re interested in their health and the better informed the patient can be, I think the better and more likely that patient will be to help manage their own care. But you have to provide them the information, regardless of what EHR the information is coming from, and regardless of where the provider was, at the hospital or clinic. So we built the next generation, which is multi-EHR and multi-hospital, multi-provider.”
The case for patient-held records is more than logistical. Access to a complete longitudinal history allows patients to bring a full picture of their care to every new provider encounter, to monitor results over time and to participate more actively in decisions about what happens next. That engagement is part of what makes the care better.
The same rethinking that produced the multi-EHR portal is also changing how Oracle approaches clinical documentation. The current model puts physicians behind keyboards, manually transcribing clinical conversations into forms, absorbing clerical burden that takes time away from patients and produces records that can miss what was actually said in the room.
“We shouldn’t have doctors sitting behind keyboards typing in and updating their electronic health records,” he said.
The alternative Oracle is developing is AI-driven documentation: ambient listening during clinical consultations, automatic drafting of notes and orders, and rapid physician review rather than physician entry. The capture happens continuously and the physician edits rather than writes from scratch.
“The doctor should be able to read that very quickly in a couple of minutes, okay it, and make whatever amend it, and then it automatically goes into the health record,” Mr. Ellison said.
The multi-provider architecture has implications beyond individual patient encounters. A system in which every hospital, clinic and pharmacy contributes to a shared, interoperable data layer gives health system leaders and public officials a real-time view of what is happening across entire regions, something that was conspicuously absent in the early weeks of the COVID-19 pandemic, when decisions were made without clear visibility into actual hospital capacity.
“You have a much better picture of how many people you vaccinated yesterday, how many empty rooms you have,” he said. “People were worried about running out of supplies and equipment to treat COVID patients. We really didn’t have a good grasp of inventory. Now, having a multi-provider, multi-EHR [platform] you get that state view and national view of the healthcare system.”
