As specialized engineering partners who build modular, interoperability-first clinical systems, we’re tracking this transition closely.
Here’s what EMR platform engineers need to know about how Oracle’s influence is reshaping interoperability strategy,
and what it means for your integration roadmap.

The Tale of Two Architectures

Classic Cerner Interoperability (The Legacy Model)

Cerner’s traditional interoperability approach was built on several foundational pillars:

• CCL (Cerner Command Language): Proprietary scripting for data extraction and manipulation
• MillenniumObjects: Component-based architecture for clinical workflows
• Cerner Open Engine: RESTful APIs layered atop the Millennium platform
• IHE profiles: Standards-based integration for HIE connectivity
• HL7 v2.x interfaces: The workhorse of point-to-point integrations
• CareAware: Medical device integration platform

This ecosystem was mature but fragmented. Organizations often maintained hundreds of custom CCL scripts,
point-to-point interfaces, and bespoke integration patterns. While functional, it created technical debt and vendor lock-in.

Oracle Health’s New Direction (2024-2026)

Oracle’s acquisition brought a fundamentally different philosophy shaped by Oracle’s broader cloud and database DNA:

Cloud-Native Infrastructure

• Oracle Cloud Infrastructure (OCI) as the deployment target
• Kubernetes-orchestrated microservices replacing monolithic components
• Multi-tenant architecture enabling shared services

Standards-First Approach

• FHIR R4 (and R5 preparedness) as the primary API layer
• USCDI v3/v4 compliance built into core data models
• OAuth 2.0 and SMART on FHIR for app authorization

Oracle Technology Stack Integration

• Oracle Integration Cloud (OIC) for enterprise integration patterns
• Oracle API Gateway for unified API management
• Oracle Autonomous Database for performance optimization

Five Strategic Shifts Happening Now

1. From CCL to FHIR: The API Evolution

Oracle is systematically deprecating custom extraction patterns in favor of standardized FHIR APIs.

What this means for engineering teams:

Legacy Pattern (Cerner):
CCL Script → Custom XML → Transformation Engine → Target System

Emerging Pattern (Oracle Health):
FHIR API → Bulk Data Export → Standard Profiles → Target System

2026 Reality: While CCL won’t disappear overnight, Oracle is creating economic incentives to migrate
to FHIR-based patterns. New capabilities will be FHIR-first, and custom CCL development will become a premium service.

Engineering Implications:

• Audit your CCL inventory and identify high-value candidates for FHIR migration
• Build competency in FHIR resource mapping and profiling
• Invest in tooling for FHIR validation and testing (HAPI FHIR, Inferno, etc.)

2. Oracle Integration Cloud as the Integration Hub

Oracle is positioning OIC as the preferred integration middleware, replacing traditional interface engines in many use cases.

OIC Advantages:

• Pre-built adapters for Oracle and third-party applications
• Low-code development environment
• Built-in monitoring and analytics
• Native cloud scalability

OIC Challenges:

• Learning curve for teams experienced with traditional engines (Rhapsody, Cloverleaf, Mirth)
• Cost model differs from perpetual license interface engines
• Requires rethinking integration governance models

3. SMART on FHIR App Ecosystem Expansion

Oracle Health is accelerating its SMART on FHIR app marketplace, similar to Epic’s App Orchard but with Oracle’s enterprise software partnerships.

What’s emerging:

• Embedded SMART apps within Oracle Health workflows
• Standardized launch contexts and data scopes
• Revenue-sharing models for third-party developers

Engineering Opportunity: If you’re building clinical decision support tools, specialty-specific workflows,
or analytics overlays, SMART on FHIR apps provide a modular deployment path that works across multiple
Oracle Health clients without custom integration projects.

Key consideration: App launch performance and session management become critical. Oracle’s cloud architecture
should improve latency, but test rigorously in production-like environments.

4. Bulk Data Export and Da Vinci Profiles

Oracle is investing heavily in asynchronous data patterns, particularly:

• Bulk FHIR Export (Backend Services specification)
• Da Vinci Payer Data Exchange (PDex)
• Da Vinci Coverage Requirements Discovery (CRD)

Why this matters in 2026:

Healthcare’s data gravity is shifting from synchronous queries to asynchronous batch processing for:

• Population health analytics
• Payer data exchange (regulatory requirement)
• Research cohort identification
• AI/ML model training

Engineering Pattern:

Traditional: On-demand API query for patient data (slow at scale)
Modern: Nightly bulk export → Data lake → Analytics workloads

Oracle’s Autonomous Database excels at the “data lake → analytics” piece, creating a natural advantage for organizations in the Oracle ecosystem.

5. Interoperability as Competitive Differentiation

Perhaps the most significant shift: Oracle is positioning interoperability as a product feature, not a services burden.

• Marketing Oracle Health as the “most open” enterprise EMR
• Highlighting FHIR conformance scores
• Bundling interoperability capabilities into base licenses (rather than add-on modules)

Impact on service line strategy: If you’re an Epic or MEDITECH shop evaluating Oracle Health,
interoperability parity is no longer a selection blocker. If you’re building third-party systems,
Oracle Health environments may become easier integration targets than some incumbent platforms.

Practical 2026 Interoperability Roadmap

Based on our engineering work with Cerner/Oracle Health environments, here’s a pragmatic roadmap for platform engineering teams:

Q1–Q2 2025: Assessment and Skill Building

• Inventory all existing Cerner integrations (CCL scripts, APIs, HL7 interfaces)
• Classify by complexity, business criticality, and technical debt level
• Train engineering team on FHIR R4, OIC basics, and SMART on FHIR
• Pilot one low-risk FHIR API integration to build organizational capability

Q3–Q4 2025: Foundation and Standards

• Establish FHIR governance (profiles, extensions, validation processes)
• Deploy API management infrastructure (if using OIC, configure gateways and policies)
• Migrate 2–3 medium-complexity integrations from legacy to FHIR patterns
• Implement bulk data export for analytics use cases
• Document lessons learned and update enterprise architecture standards

Q1–Q2 2026: Scale and Optimization

• Accelerate FHIR migration for remaining high-value integrations
• Sunset redundant or low-value legacy interfaces
• Optimize OIC or hybrid integration architecture based on performance data
• Launch first SMART on FHIR app (internal or vendor)
• Participate in Oracle Health interoperability beta programs

Q3–Q4 2026: Innovation and Differentiation

• Enable advanced use cases (real-time CDS, closed-loop medication administration)
• Implement Da Vinci profiles for payer/provider data exchange
• Build organizational competency in FHIR R5 for future-proofing
• Measure interoperability ROI (reduced integration time, faster app deployment)

The Modular Engineering Advantage

At AST, our philosophy centers on modular, interoperability-first systems—precisely because transitions like Cerner-to-Oracle Health are inevitable in healthcare IT.

Three principles for resilience:

1. Decouple Business Logic from EMR APIs

Build an abstraction layer that translates between your application’s domain model and whatever FHIR profiles Oracle Health exposes.
When Oracle changes APIs (and they will), you modify the adapter, not your application.

Your Clinical App → Domain Model → FHIR Adapter → Oracle Health APIs

2. Favor Standards Over Proprietary Extensions

When Oracle offers both a proprietary API and a standards-based alternative, choose the standard—even if the proprietary version has more features today.
Standards compound over time; proprietary APIs become anchors.

3. Design for Multi-Tenant, Multi-EMR Reality

If you’re building solutions for multiple health systems, assume EMR heterogeneity. Oracle Health is important,
but you’ll also encounter Epic, MEDITECH, athenahealth. Your architecture should accommodate this without exponential complexity.

What Oracle Gets Right (and What’s Still Uncertain)

Oracle’s Strengths in This Transition

• Technical Horsepower: Oracle’s database, cloud, and integration technologies are enterprise-grade. The infrastructure foundation is solid.
• Standards Commitment: Oracle has publicly committed to FHIR and USCDI compliance in ways that create accountability. Their Cures Act compliance has been strong.
• Market Pressure: As a smaller player in EMR market share, Oracle needs interoperability as a competitive weapon. This aligns their incentives with customers.

Remaining Uncertainties

• Migration Complexity: Moving existing Cerner clients to Oracle’s new architecture is a multi-year, complex endeavor. The transition period will be bumpy.
• Pricing Models: How will Oracle price API calls, OIC transactions, and cloud compute? The economics are still evolving and may surprise (positively or negatively).
• Cultural Integration: Cerner’s healthcare-first culture and Oracle’s enterprise software culture are different. How this affects product decisions remains to be seen.
• Market Confidence: Some health systems are hesitant about Oracle’s long-term commitment to healthcare. Oracle must prove staying power.

Preparing for the 2026 Interoperability Landscape

The Cerner-to-Oracle Health transition is redefining interoperability strategy, but the fundamentals remain constant:

• ✅ Standards-based integration reduces long-term risk
• ✅ Modular architecture enables flexibility
• ✅ API-first design accelerates innovation
• ✅ Cloud-native infrastructure improves scalability

For EMR platform engineering teams, 2026 is the year to cement your FHIR competency, rationalize your integration portfolio,
and position your organization for the next decade of healthcare interoperability.

The good news: Oracle’s investment in modern interoperability patterns creates opportunities. The challenge: managing the transition without disrupting clinical operations.

About AST (All Star Tech)

AST is a specialized engineering partner building modular, interoperability-first clinical systems. We help healthcare organizations and health IT vendors
navigate complex EMR integrations, architect FHIR-based solutions, and accelerate time-to-market for clinical applications.

Our EMR Platform Engineering services include:

• FHIR implementation and profile development
• Legacy integration modernization
• SMART on FHIR app development
• Interoperability strategy and roadmap consulting

Interested in discussing your Oracle Health interoperability strategy?
Contact our engineering team for a consultation.