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Do We Need a National Health Database?

Written: September 2022

David Feinberg, M.D., former head of renowned Geisinger Health in Pennsylvania co-authored ProvenCare: How to Deliver Value-Based Healthcare the Geisinger Way. I found the book very interesting, and it gave me hope our healthcare system could be improved dramatically if it adopted the numerous principles Dr. Feinberg wrote about. In 2015, Dr. Feinberg announced a new app to guarantee patient satisfaction: the Geisinger ProvenExperience.

Once patients have completed their treatment, they can go to the app, enter a code for the condition they had treated, provide feedback, and then decide whether to request a refund. The refund page knows what patients paid and allows partial refund requests on a sliding scale. This was a bold move. The results have been surprising.

In the first year after the rollout of the app, ProvenExperience refunded $320,141. In 2020, Geisinger refunded about $84,000, and the program refunded $40,000 in 2021. This was a surprising trend, given a national drop in patient experience satisfaction measures throughout the pandemic. Rick Evans, Chief Experience Officer and Senior Vice President of NewYork-Presbyterian Hospital said, “For those who aren’t familiar with how patient experience data moves, this is a huge drop.”

Like most hospitals, Geisinger Health saw an increase in the number of complaints surrounding communication issues, access, and hospitality as the pandemic progressed. However, as complaints rose, refunds still decreased. Geisinger believes the commitment to the ProvenExperience program created an acute awareness among staff of the patient experience and drove the system toward constant improvement.

Dr. Feinberg has had an impressive career in healthcare. After being President & CEO at UCLA Health, he went on to be President & CEO at Geisinger. He then became VP of Google Health. In October 2021 he became CEO of Cerner. Cerner Corporation is an American supplier of health information technology services, devices, and hardware. As of February 2018, its products were in use at more than 27,000 facilities around the world. The company had more than 29,000 employees. Dr. Feinberg has been transformative in healthcare, but I believe his biggest challenge lies ahead.

In June 2022, Oracle Corporation completed its purchase of Cerner for approximately $28.3 billion. Oracle’s chairman, Larry Ellison, outlined a bold vision for the database giant to use the combined tech power of Oracle and Cerner to make access to medical records more seamless. Oracle plans to build a national health record database which could pull data from thousands of hospital electronic health records (EHRs).

Ellison was quoted as saying, “Your electronic health data is scattered across a dozen or more separate databases. One for every provider you’ve ever visited. This patient data fragmentation and EHR fragmentation causes tremendous problems.” Healthcare networks are adding more services but there are many providers who are not part of the networks. Examples at the network where I live include podiatry, urology, pain management, and dermatology. A patient may need to go “out of network” to see an expert not part of the network. All these examples have their own EHR, and none of them are interoperable. Getting information from these providers to your family doctor is by fax.

Oracle Cerner envisions all our health records in a unified national health records database. This is easier said than done. There are many technical, security, privacy, clinical, and organizational issues. I can guarantee it will become politicized. The concept is a good one. I believe if providers can have faster access to patient records and better coordinate among providers, they will be able to deliver better patient outcomes.

A national database can also be a huge boost to population health allowing public health officials to develop better public health policy. Over time this will lead to lower cost of healthcare. The key to population health is to have anonymized health data in the national database. An oncologist looking to make a cancer diagnosis can look at millions of cases where patient parameters match his or her patient. Artificial intelligence and machine learning can tailor the diagnosis to the patient. Anecdotal diagnosis is often good but not always.

I agree when Ellison said, “Better information is the key to transforming healthcare.” Dr. Feinberg said, “We’re bringing world-class technology coupled with a deep and long history of understanding how healthcare works. I don’t think anyone’s ever done that.” Feinberg has a good track record. I hope he can continue to deliver as President and CEO of Oracle Cerner.