Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
A Look at Cerner Ambulatory
Several weeks ago, I expressed surprise at the findings of an Ovum report entitled Selecting an Ambulatory EHR Vendor in the Healthcare Market. Specifically, that Cerner was rated the “most versatile and multi-faceted vendor.”
My comments prompted the folks at Cerner to invite me to view a demo so I could see for myself what Cerner Ambulatory is all about. From a short peek at MGMA, I commented that “compared to other EHRs on display throughout the exhibit hall, Cerner’s patient summary screen looked comparatively ‘busy’ and not particularly pretty.”
I have to commend the Cerner folks for their persistence because they again urged me to take more detailed look at their product. Cerner gave me a one-hour Web demo, with Dr. Gregg Alexander tagging along since he is, after all, a real doctor and has reviewed a number of EMRs in recent weeks for his own selection.
Here are a few impressions, starting with the positives.
- Cerner Ambulatory provides a comprehensive clinical summary screen for each patient. It’s easy to jump to various areas of the chart, including patient demographics. Most areas support hovering to reveal additional details without requiring a user to actually click on a particular field.
- The clinical summary screen is user-customizable.
- The product includes semantic search capabilities. This is helpful if, for example, you want to find every instance of the word diabetes in a chart. This feature isn’t unique to Cerner, but I still think the technology (based on SNOMED, in Cerner’s case) is fascinating and offers lots of potential.
- Cerner says its base application includes 700 pre-loaded templates. Their client base includes about 30 specialties, so I am assuming the templates are fairly broad.
- Overall, with the summary screen as the home base for most patient encounters, a user can perform most functions within a couple of clicks. The product appears to include all the basic functionality you’d expect in any contemporary EMR product.
On the other hand:
I stand by my original statement that the screens aren’t particularly pretty. While the summary screen, for example, provides tons of functionality, it’s lacking in the eye-friendliness category. The colors are bland, the font is small, and there is a whole lot going on.
Should pretty screens really matter? After using the system for a couple of days, wouldn’t a user be able to zero in to exactly the right field, even if a screen is busy?
I say yes — pretty screens matter. Other products (NextGen and SRS come to mind) are able to incorporate nice screens with good functionality, so technically it can be done. As Dr. Alexander noted, you would think developers would pay more attention to product appearance since it’s as easy to do it well as to do it not so well. Why would a doctor find it acceptable to have his or her cell phone screen look better than his or her EMR?
Here is another positive for Cerner. The KLAS scores for the ambulatory product are up 25% from last year. That is a heck of an achievement of any vendor.
The version I saw included this relatively new summary screen with its comprehensive functionality. Apparently functions that once took many, many, many clicks can now be done in a mere click or two. I assume that there is a strong correlation between higher KLAS scores and increased client satisfaction now that they have a better functioning product. Kudos to Cerner for streamlining their app for user efficiency.
The Cerner people are genuinely excited about their product, which from all reports has made great strides in the last couple of years. However, do these enhancements, along with higher KLAS scores, mean that Cerner should now be considered one of the industry’s leading products as Ovum suggests? Or, is the reality simply that Cerner is a whole lot better than it used to be?
I’m not able to make that determination from a one-hour overview. I’d love to hear opinions from others in the industry, especially from those using the product in their practice.
Here is what I can conclude: if you are hunting for a new EMR, Cerner Ambulatory is definitely worth a look, particularly if functionality is a bigger priority than aesthetics.
To round out the commentary on their ambulatory product, we asked Cerner to provide us with an opinion piece from one of their clients. Thanks to Dr. Randy Goldstein for sending us him impressions.
Randy Goldstein, DO, Board Certified Pediatrician with an interest in Sports Medicine at the wellbody at Blue Valley Pediatrics. (www.wellbodykc.com), a Cerner Ambulatory client since 2006.
Background: Located in a suburb of Greater Kansas City, wellbody at Blue Valley Pediatrics is a pediatric clinic with a special interest in sports medicine. The practice opened four years ago with one clinician, one nurse, one administrator, and one x-ray technologist using the Cerner Specialty practice management and EHR clinical solutions of Cerner Ambulatory.
Starting with a dozen patients in November of 2006 and growing to a patient number nearing 3000, wellbody at Blue Valley Pediatrics has utilized Cerner to its fullest. Dr. Goldstein’s Cerner training team helped a “non-computer savvy” staff feel comfortable with the daily process of an EHR in about one week. Cerner tech support is a phone call or email away for answering questions, handling issues, understanding upgrades. And, possibly most importantly, confidence in a large, continually evolving CCHIT company, that is sure to be around as our business grows over the next 10-20 years.
Currently using Cerner Specialty Practice Management and Cerner Ambulatory EHR.
Three things I like about Cerner EHR PowerWorks are:
1. Efficient – The best way to explain my feeling of Cerner’s efficiency (compared to a paper system) is being able to have “Julie Smith’s chart” open by several different people at the same time. The doctor may be using the growth chart in the room with the patient and mother, the nurse might have the same chart open getting a precertification with a specialty lab for a study that is needed, the administrator may also have the chart open discussing the account with the third party insurance company to ensure the lab work is paid for, and the front desk may have the chart open getting a return appointment scheduled. There is not the situation of pulling one chart and having everyone waiting for it, there is no “lost chart” that is misplaced, there is no “dropped chart with papers on the ground,” and there is no office clutter- it’s electronic, always available and always easy to read- in an order that is understood by everyone in the office.
2. Portable – As a physician who travels to sports competitions during different times of the year and visits teams at their practice sites throughout the week, I am often asked questions from parents, coaches and athletes about various topics such as, “Why can’t he participate this weekend?,” “What did that xray look like?,” “Did her mono test turn out positive or can she go to the meet?” With a signed HIPAA form from the parent, I can pull up xrays, lab results and previous documents to show coaches, athletes and parents onsite, at an out of town competition or at a specialist’s office such as an orthopod.
3. Powerful – Cerner works! On a Sunday, while drinking coffee in my kitchen at home, I have refilled an allergy medication for patient #68, finished a document on patient #1974 with ear pain that I saw yesterday but didn’t quite complete the physical exam, looked over and electronically signed labs that came in from Lab Corp on three patients that I saw earlier in the week and replied to a message from my administrator on a question he had from a previous set of charges that needed clarification on patient #120. And I did all of this in 10 minutes, at home, with music on, while drinking a cup of coffee.
An item that, in my opinion, could be improved is a quicker way to see a diagnosis list.
Listed on the “Clinical Summary” page – which is the first page you see when opening a patient chart – is a friendly chart of recent medications ordered, vital signs and document forms used (such as “Pharyngitis form” or “Well-child form”). An improvement would be a list of ICD-9 codes used (billed/charged) in the last five to 10 visits so each clinician seeing the patient could quickly glance back and note why the patient had been visiting the doctor before starting today’s encounter.
An example would be a two year old patient with recurrent ear infections who might benefit from a visit to an ENT. The ear infection diagnosis is “hidden” within the previous three visits, which were for a well-child visit, a rash, and an upper respiratory infection. In order to see the ear infection diagnosis, the physician would need to open each encounter form on the clinical summary and read it (a time consuming effort.) Reviewing the encounters would show that:
· during the well child visit the patient was also diagnosed with an ear infection
· during the rash visit the patient was diagnosed for 1. contact dermatitis and 2. otitis media (again), and,
· during the third visit the patient was diagnosed for 1. acute pharyngitis, 2. wheeze and 3. otitis media (again).
While one previous ear infection being “overlooked” may be no big deal, if three ear infections in a short period of time is not realized, it could be a missed opportunity for a referral, a procedure, or another course of treatment.
In conclusion, I am 90% satisfied with Cerner Ambulatory solutions and the process in our office 90% of the time. That’s pretty good compared to my 30% satisfaction with the paper charting system at my previous clinic, which had inefficiencies with chart pulling and filing and misplaced charts. With paper charts there were too many lost charts, too many people needing to look to see the same chart, and no ability to remotely access patient information.
Unfortunately, the top three things the client lists as liking about Cerner are true of nearly every EHR on the market today. On the flip side, so are the things he lists that “could be better!”
There are few providers that are exposed to multiple systems as they actually see patients, so it’s hard for real users to understand whether the grass is actually greener on the other side of the fence. Those of us who have suffered through a conversion or who work locums know there is a dramatic difference once you get into some of these apps. Some of them look great but the functionality is Fisher-Price after you get your hands on them.
I don’t know if the PowerWorks product that Dr. Goldstein has reviewed is significantly different from Cerner’s PowerChart product. Perhaps it’s more user friendly since it’s apparently intended for office based practices and is less complex than PowerChart. However, our institution has had nothing but problems with Cerner Ambulatory and it’s really quite dreadful on the inpatient side as well. The mPage that is displayed may look reasonable but if you need to drill down to any information that is more specific, you end up back at the underlying clunky Cerner interfaces. The statement that the mPage is user customizable isn’t really correct. You can rearrange the widgets on the page but you can get specific widgets (e.g. medications) to display the way that you want and you can’t select other fields to display that aren’t in the “stock” mPage without investing a great deal of resources in doing the customization. This is not an EMR equivalent of iGoogle!
It is true that the Cerner people seem genuinely excited about their product. However, it’s still not clear to me whether this is because they have been effectively brainwashed or because they are invested in selling extra modules and extra consulting services (which are almost essential to customize the product to a point of semi-usability).
In my view (as a practicing clinician with informatics and engineering training), Cerner’s marketed products (including ambulatory) are poorly designed with clearcut usability problems that have a detrimental effect on clinician productivity and clinical thought processes, with negative effects on patient care as a result. With other software products, I’m used to doing troubleshooting and testing beta versions which is fine for a web browser. But for a product that has an impact on patient lives, releasing a product that has multiple flaws (at a alpha or pre-beta version for Microsoft or Firefox) as a production release should be viewed as unconscionable.
Unfortunately, looks like the Cerner marketing folks got to you – glad you liked their vaporware… I don’t think very many are actually using what they showed you, and even those that are on that version- I don’t think they are using it for more than results review and maybe messaging and some eRx.
I’d be curious what they’d answer if you asked them exactly how many docs are using the software they showed you to do the following
– Do the majority of their Rx as ePrescribing
– and Create the majority of their orders with it
– and Create the majority of their notes online
In other words- who is actually on this version, and of those- how many are using it to fully replace their paper charts.
I expect the real number will be well under 1000…. Or less than a typical EPIC install…
But Cerner will twist the numbers around (like most vendors) so don’t expect a straight answer.
And their “reviewer” was embarrassing… he basically said he liked that he had remote access to a system and that it allowed him to do refills, finish a document (why couldn’t he do it at the time of the visit?), and respond to a message… the basic functionality of any EMR system.
In the interest of full disclosure does Dr. Goldstein’s agreement with Cerner limit the comments he makes? Or does he receive any benefit from Cerner for providing his opinions?
There is no agreement between Dr. Goldstein and Cerner Corporation that limits his commentary. Dr. Goldstein owns his own practice and is not employed by Cerner Corporation.
Dr. Goldstein is a highly valued, long standing client of Cerner Corporation and an advocate of Cerner technology. As a Beta user for the corporation and a strong user, Dr. Goldstein often speaks publicly about his experience with Cerner Corporation and Cerner technology, regularly providing feedback and insight into the impact of Cerner solutions on his work flow and office staff.
As with any client reference relationship in this industry, at times, Cerner may provide advanced technology to Dr. Goldstein at a reduced cost, often times for Beta use. Additionally, Cerner may cover travel expenses if Dr. Goldstein travels for Cerner related speaking engagements.
Don’t get your hopes up for the Cerner Ambulatory screen. Like most of their software, it’s poorly designed and a burden for anyone unlucky enough to be using it in a practice setting. Our ambulatory screen took so long to load (up to 2 minutes) that it was deemed worthless and had to be disabled. The overall Cerner experience is characterized by a terrible user interface, algorithms that are poorly conceived (why use one mouse click when three mouse clicks will do?), and a general lack of responsiveness to customer concerns.
If this Cerner product is one of your options, RUN FOR THE HILLS!
I have to agree with LookBeforeULeap. Switching from Meditech to Cerner was a serious step backwards in the EHR department. The templates lack detail and are far inferior to those provided by Pulsecheck or T-systems. The reality of “the screens don’t look pretty” is that they cause eye strain and their readbility is such that it takes an excessively long time to find anything. The entire system is far less efficient than either of those two mentioned systems and overall has the look and feel of using the Windows 98 file explorer. Aside from McKesson, this may be the worst electronic health record I’ve ever been cursed with using (and I’m predisposed to like these systems in general).
I have used Cerner and Meditech and prefer the usability of Meditech but like the potential upside of Cerner.
I have offered to get involved in the user interface. I have written low grade Mac software for 20 years and other software before then.
I cannot write the backend, However, the users see the front end and I have not been overwhelmed by the Cerner interface.
I wrote my own EHR for my office. It works well for me. I added CPOE and that works well too, but it is not comprehensive.
I do not thing that Cerner has bad products, I just feel that more emphasis on workflow and efficiency would benefit everyone.
The inability to change font size is a good example of the lack of concern for the end user. It may look good on big screens in Kansas, but it is hard for me to read in Florida.
Improvements would benefit Cerner with increased sales and less complaints. Eye candy sells.
I would be very willing to work with Cerner on these issues for our mutual benefit.
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