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> That said, I guess it can be argued that Cerner and NetSuite being on the chopping block can be attributed to AI because now procurement has the choice to eit

> That said, I guess it can be argued that Cerner and NetSuite being on the chopping block can be attributed to AI because now procurement has the choice to either build in-house via an Anthropic or OpenAI SI like Accenture or TCS or they can negotiate better purchasing terms from a best-in-breed product in HRM and ERP like SAP instead. Cerner isn't an EHR, it's an EMR. EHR == Electronic Health Record. Your FitBit data is an Electronic Health Record. EMR == Electronic Medical Record. Your doctor's records, how much blood thinner that nurse is supposed to give grandpa, and whether or not he's a fall risk are things you'd put in an EMR. You can't just vibecode your way to replacing an EMR. Cerner Millennium has a shrinking, but substantial, footprint at healthcare systems across the country and around the globe. There are 25+ years of bugfixes, caveats, architecture, and other pieces of knowledge to be tracked and accounted for, and you must do so, because if you don't, people under the care of doctors could die. It's also worth noting that the DoD uses Millennium for active service members, and I think they also use it for TriCare. American taxpayers are on the hook for dealing with the problems that Oracle's cost cuts will produce.

shigawire 7mo ago
Minor nit - enterprise EMRs brand themselves as EHR because they consider it more encompassing than just medical records. I agree on other points.
alephnerd 7mo ago
> You can't just vibecode your way to replacing an (sic) EMR Absolutely, but you can now demand a market leader like Epic to give you a significantly better discount (eg. 20-30% over the 10% you may have previously been offered). And that is the crux of the "SaaSpocalypse" and why you are seeing targeted layoffs in Oracle specifically for their ERP and EHR products. > It's also worth noting that the DoD uses Millennium for active service members, and I think they also use it for TriCare. American taxpayers are on the hook for dealing with the problems that Oracle's cost cuts will produce Absolutely, but they were already on the hook for that before Cerner became a part of Oracle.
- lenerdenator 7mo ago
  > Absolutely, but you can now demand a market leader like Epic to give you a significantly better discount (eg. 20-30% over the 10% you may have previously been offered). Is this on the grounds that you can do it yourself?
  - alephnerd 7mo ago
    What larger procurement teams are saying is "we would rather pay Accenture+Anthropic $50M for 2 years and if they fail, sign a $75M contract with Epic in 3 years instead of spending $150M for 5 years". Even at the lower ends of the funnel, companies are now extracting significant discounts from market leaders as well as their incumbent vendors becuase they are quote shopping. Oracle isn't in a position to push back because it isn't a market leader in the segments that NetSuite and Cerner compete in, which makes discount even more critical, which means margins management also becomes significantly more critical.
    - twoodfin 7mo ago
      Who in the healthcare space has actually pulled the trigger on Accenture+Anthropic so that BATNA is even remotely credible? Sorry, but that sounds as mythical as Bigfoot.
      - alephnerd 7mo ago
        No one has, but every buyer is using this line across vast swathes of Enterprise SaaS to extract the most competitive quote available from either the dominant player or their existing vendor. It doesn't matter if the customer is serious because the general sentiment across the board amongst procurement teams is that existing quotes are too high, and that they want to maximize discounting where possible. If you are a non-dominant player in a market segment as Oracle is in ERP and EHR, you lack leeway to better manage margins pressures and win in a price war. It is in this vein that mass layoffs like the one Oracle announced occur. Why pay a premium for a tier 2 product when I can buy the tier 1 product on a discount?
    - 7mo ago
mzl 7mo ago
There was an interesting scandal in Sweden where Oracle managed to sell the Millenium system to a regions hospitals even though they did not fulfill the requirements, and then when it inevitably crashed and burned they had to do an emergency rollback to the previous system after just a few days. Here is an article in English: https://www.heise.de/en/news/Scrapping-the-millennium-introduction-of-a-health-record-in-Sweden-fails-10323142.html https://www.heise.de/en/news/Scrapping-the-millennium-introd...

shigawire 7mo ago

Minor nit - enterprise EMRs brand themselves as EHR because they consider it more encompassing than just medical records. I agree on other points.

alephnerd 7mo ago

> You can't just vibecode your way to replacing an (sic) EMR Absolutely, but you can now demand a market leader like Epic to give you a significantly better discount (eg. 20-30% over the 10% you may have previously been offered). And that is the crux of the "SaaSpocalypse" and why you are seeing targeted layoffs in Oracle specifically for their ERP and EHR products. > It's also worth noting that the DoD uses Millennium for active service members, and I think they also use it for TriCare. American taxpayers are on the hook for dealing with the problems that Oracle's cost cuts will produce Absolutely, but they were already on the hook for that before Cerner became a part of Oracle.

lenerdenator 7mo ago
> Absolutely, but you can now demand a market leader like Epic to give you a significantly better discount (eg. 20-30% over the 10% you may have previously been offered). Is this on the grounds that you can do it yourself?
- alephnerd 7mo ago
  What larger procurement teams are saying is "we would rather pay Accenture+Anthropic $50M for 2 years and if they fail, sign a $75M contract with Epic in 3 years instead of spending $150M for 5 years". Even at the lower ends of the funnel, companies are now extracting significant discounts from market leaders as well as their incumbent vendors becuase they are quote shopping. Oracle isn't in a position to push back because it isn't a market leader in the segments that NetSuite and Cerner compete in, which makes discount even more critical, which means margins management also becomes significantly more critical.
  - twoodfin 7mo ago
    Who in the healthcare space has actually pulled the trigger on Accenture+Anthropic so that BATNA is even remotely credible? Sorry, but that sounds as mythical as Bigfoot.
    - alephnerd 7mo ago
      No one has, but every buyer is using this line across vast swathes of Enterprise SaaS to extract the most competitive quote available from either the dominant player or their existing vendor. It doesn't matter if the customer is serious because the general sentiment across the board amongst procurement teams is that existing quotes are too high, and that they want to maximize discounting where possible. If you are a non-dominant player in a market segment as Oracle is in ERP and EHR, you lack leeway to better manage margins pressures and win in a price war. It is in this vein that mass layoffs like the one Oracle announced occur. Why pay a premium for a tier 2 product when I can buy the tier 1 product on a discount?
  - 7mo ago

mzl 7mo ago

There was an interesting scandal in Sweden where Oracle managed to sell the Millenium system to a regions hospitals even though they did not fulfill the requirements, and then when it inevitably crashed and burned they had to do an emergency rollback to the previous system after just a few days. Here is an article in English: https://www.heise.de/en/news/Scrapping-the-millennium-introduction-of-a-health-record-in-Sweden-fails-10323142.html https://www.heise.de/en/news/Scrapping-the-millennium-introd...