Health IT

Cerner’s Burke: Health IT vendors should invest more in R&D

Cerner President Zane Burke talks health IT security, interoperability, innovation in EHR development and the fierce rivalry with Epic Systems.

Cerner President Zane Burke

Cerner President Zane Burke

Zane Burke is president of Cerner. He has taken on an expanded role with the electronic health records vendor this year while CEO Neal Patterson is treated for cancer.

Patterson expects to return in January, but in the meantime, Burke is the face of the North Kansas City, Missouri-based company. At last month’s College of Healthcare Information Management Executives (CHIME) Fall CIO Forum in Phoenix, Burke sat down with MedCity News.

The conversation focused on health IT security, interoperability, innovation in EHR development and Cerner’s fierce rivalry with Epic Systems, among other topics.

He also spoke of the company’s contract to, along with partners Leidos and Accenture Federal, revamp the EHR of the Military Health System for at least $4.3 billion. We will have more on that collaboration with the Department of Defense later this week.

Burke was particularly adamant about drawing a comparison with Epic, which is working hard to improve its image within the healthcare industry and among the general public. Without naming names, the Cerner executive suggested that Verona, Wisconsin-based Epic’s focus is in the wrong place.

Here is an edited transcript of the conversation.

MedCity: Cybersecurity has obviously been a major concern in healthcare of late. Why do you suppose attacks are on the rise?

Burke: I often describe healthcare as the biggest house on the block. We’ve got the prettiest paintings and furniture, yet we don’t have a fence or a dog. Not only are we the most desirable place to be, we’re also the most vulnerable because we don’t do the things we tell our kids to do, which is to lock the doors, don’t let strangers in — start with some of the basic things first.

Healthcare in particular has some unique other elements which are suboptimal if you’re a provider. The ability to share information is significantly limited. The penalties are really grossly unfair from a provider perspective. [Any major breach of protected health information, whether by hack or by accident, must be disclosed to the Department of Health and Human Services, and the entity risks a fine on top of recovery costs.]

“There’s nothing from the government today that really provides a framework by which people should be doing business.”

MedCity: At Cerner, what are you doing to make your technology as secure as possible?

Burke: “We have invested a lot in security. We have invested more in research and development than anybody else in the industry. Part of that goes toward security.

There have been big investments around the technical stack [particularly to enable remote hosting and to protect the data center].

MedCity: Does it matter if the data is stored locally or in the cloud? 

Burke: All of us have to think about security. Everything that we learn about every day causes us to think differently about security. I would say it’s the same application, whether you’re in a cloud-hosted model or in a client-hosted model. You’re getting the same application security regardless.

If you’re cloud-hosted, you’re getting technical security as well, so I would tell you it’s a better provision. None of us are immune to this dialogue.

DoD selected us for remote hosting [so Cerner and its partners have to have military-grade security for the cloud-based option]. All the work we do with the DoD gets extended to all our clients. Any work we’re doing with the application layer, that’s a generally available code set, so all our clients will get the benefits of that security work. It’s the same thing on the technology side.

MedCity: You talk a lot about R&D as “untapped territory.” Why do you believe that distinguishes Cerner from your competitors?

Burke: You have an industry that’s saying, ‘Quit giving us all these Meaningful Use requirements because we can’t do innovation. Invest more in R&D. We can’t do more innovation because there’s Meaningful Use dollars.’ We [as vendors] took all the money.

Now, it’s a marketing problem I have, so I’m going to double down and invest more on marketing.’ Fundamentally, yes, there’s a competitive side to me, but there’s also this notion of we have to help our clients innovate out of this. Fundamentally, we are best positioned as the industry to go do that.

I’m investing more in R&D than anybody else, period. I’m going to keep doing that because I think it’s the right thing to do to make Cerner successful in the long term. But if companies don’t go do that, they’re going to hurt their client bases and then they’re going to open it up for somebody else to come in and play in a different world.

You look at what’s going on in our industry, you see others that are investing more in marketing and sales. Think about our core competitor. They’re coming out and saying, ‘I’m going to double down on marketing.’ Now is not the time. Our industry needs more investment in research and development.”

There’s transparency with some competitors because they are public, and there’s not transparency by others who claim some ‘fuzzy math’ kind of stuff. I think it’s a fascinating dialog in the face of things like telemedicine and cybersecurity.

MedCity: I think you are talking about more than just one company in Wisconsin.

I am, but that one company in Wisconsin is pretty good at the fuzzy math. I think the people ought to know what the transparency is. We’re spending less as a percentage of revenue on marketing than at any time in the history of our company. We’re spending more on R&D in absolute dollars and otherwise than we ever have.

MedCity: A lot of fingers have been pointed about the lack of interoperability of health information, and there is plenty of blame to go around without singling out one constituency. What do you say to people who believe that the big vendors are practicing information blocking or that the big vendors don’t want to make their systems better and easier to use for doctors?

Burke: It’s a multifaceted issue. I think it’s very simple and convenient to blame the big, bad vendor for all the challenges around interoperability. It’s multi-tiered.

We do have to get our own house in order, though. What I would say is there’s still work to be done from the vendor community, and it’s going to be evolutionary.

As an industry, we have to go make this right before we can get to where we are on the true high ground for all the other things that need to get accomplished, like providers agreeing to do the work. They’ve got to decide they actually want to open up their systems and share information and really make [medical records] about the person. We have a fundamental belief that each one of us as individuals has a right to get our own electronic health records, wherever they are.

There’s a regulatory environment that needs to evolve, there’s an industry piece that still needs to be worked through, and whether it’s explicit data blocking or whether it’s more of the behind-the-scenes data blocking, we as an industry have to quit competing on that.

Photo: Cerner