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.

Opinion by:

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.

E-mail Inga.

News 1/6/11

Allina Hospitals & Clinics endorse Greenway’s PrimeSUITE EHR/PM solutions for affiliated regional providers. Key was Greenway’s ability to interface PrimeSUITE with Allina’s Epic acute care and ambulatory EMR.

The six-provider Cancer Centers of North Carolina–Asheville implements iKnowMed’s oncology-specific EMR. iKnowMed is a division of US Oncology, which is now owned by McKesson.

American Medical Group Association adds four new members to its board of directors.

More doctors are embracing Web-camera visits using services such as Skype. It’s unlikely to replace in-person visits, but providers are increasingly comfortable with the technology as an alternative for short follow-up visits or initial consults with long-distance patients. A big question mark is how patients can and should be billed for video appointments, which tend to be shorter than in-office visits, but longer than e-mail or text interactions. I suspect concierge practices might be the among the early adopters since most of those providers charge patients a flat monthly fee for all visits.

AT&T adds MedApps’ products to its ForHealth portfolio of offerings. AT&T will provide 3G connectivity to the MedApps remote monitoring solution suite and will co-sell MedApps’ remote care monitoring hub and enterprise back-end solutions.

Providers participating in the CentraState Healthcare System (PA) HIE will have an option to use the MobileMD’s EMR Light offering. CentraState is deploying MobileMD products across its medical community and will configure, manage, and support CentraState’s HIE technologies.

MedicalEdge Healthcare Group becomes part of Texas Health Resources in what is thought to be the second largest transaction of its kind. MedicalEdge includes 420 physicians and 2,300 employees. In a side deal, THR also acquires PhysServe, MedicalEdge’s MSO, and plans to sell PhysServe to THR’s joint venture partner, MedSynergies. Despite predictions that the acquisition will improve patient care, you can be assured the primary objective is to increase THR’s healthcare footprint and align physicians for a future ACO.

Other recent deals involving hospitals purchasing practices:

• Mount Nittany Medical Center (PA) absorbs the 51-physician Centre Medical and Surgical Associates
• The Tampa Bay Heart Institute at Northside Hospital acquires the 16-physician Heart and Vascular Institute of Florida South
• Saint Joseph Mercy Health System buys Michigan Heart, a practice with 33 cardiologists and 10 nurse practitioners and physician assistants
• WakeMed Health & Hospitals (NC) adds three practice and a total of 13 physicians.

In doing a bit of Web surfing today, I noticed that HIStalk sponsor Kareo is offering a couple of free webinars this month on how physicians can make medical billing easier and increase profitability. Details here.

I also see Navicure has a free guide for physicians preparing for the 5010 transition. Yikes. The 5010 deadline is officially less than a year away. Navicure is also hosting a webinar January 13th to discuss 2011 reimbursement and the challenges and opportunities for medical practices.

An internal medicine physician completes a review of Motion J3500 tablet, which he was considering for his practice. He seems to know his stuff, having  previously used other Motion devices, as well as the Fujitsu Lifebook, Lenova X61, and HP TouchSmart tm2. His bottom line: the unit is powerful and “has no competition” if you want to use a tablet that can serve as a desktop replacement. However, a fully loaded unit runs over $4,000, is a bit heavy at nearly four pounds, lacks a forward-facing camera, and needs more external control options. In addition, the doctor found he only got 2:45 of use on two fully charged batteries. He concludes by saying he’ll wait for the introduction of other Windows 7 touch screen slates before making a purchase.

E-mail Inga.

News 1/4/11

Day One of registration for EHR incentive money is now over. I wonder if the ONC’s new portal is  bustling, or, if Blumenthal will need to invest a few dollars to better inform providers of the specifics for the attestation process? If you are an Eligible Professional and ready to register, make sure you have on hand your NPI, NPPES user ID and password, and tax ID number if you are reassigning benefits.

Medicity receives modular ONC-ATCB certification for its iNexx platform technology for ambulatory care providers. Aetna, by the way, announces that its $500 million purchase of Medicity is complete.

Sutter Health (CA) patients can access their personal medical records using Epic’s MyChart for the iPhone. The app also allows patients to message their doctors, check lab and test results, view appointments, and receive health reminders.

Happy New Year, by the way. I’ve reinstated a few of my regular resolutions for 2011, such as making time for regular exercise and losing a few pounds. I’ve also decided to step away from the computer a bit more and make time for things like have lunch with friends every once in awhile. I already get up pretty darned early and rarely watch TV, so I don’t exactly know how I am going to “make” this extra time. But what the heck, I’ll give it a whirl for a few weeks.

With the new year, HIStalk Practice is adding some new sponsors. A big welcome to 3M Health Information Systems, which is already a supporter of HIStalk Mobile. The 3M HIS division offers a variety of software and consulting services for clinical documentation and improving financial performance, including computer-assisted coding technology, ambulatory revenue management software, mobile transcription, and an assortment of charting tools. Click on their ad to the left or the link to your right to learn about some of their many offerings. A big thank you to 3M HIS for their support of HIStalk Practice!

Also lending their support to HIStalk Practice: Nuesoft. The great folks at Nuesoft are spreading their Platinum love across by HIStalk and HIStalk Practice, which makes Mr. H and me most appreciative. Some of Nuesoft’s products include NueMD PM and billing software, NueMD EHR, and the Nuetopia medical billing service. In addition, they offer a suite of clinic billing and management products for student health clinics and college health billing services. They are also the creators of the very fun Lady Gaga video that we’ve posted on HIStalkTV. Thanks, Nuesoft, for your support!

If you are not already signed up to receive automatic e-mail updates for HIStalk Practice, the new year is a great time to take care of such housekeeping details. Take two seconds to sign up at the top right hand corner of the page. I promise you will instantly feel the calm that comes with knowing you will never miss a post. It’s also a great time to share your love with our sponsors. Take a moment to click on their ads and see what offerings might make your life more complete, or at least might address some of the pesky HIT problems in your life. And thanks for reading.

CMS launches its new Physician Compare Web page, which provides online tools to help patients locate area health professionals. A later phase of the project will specify which providers participate in e-prescribing and will eventually include quality of care profiles.

Two aspects of last year’s healthcare reform package may be a boon for house call providers. The Independence at Home initiative will launch in 2012 and include incentives for primary care teams providing house calls. There may also be a place for house call providers in emerging ACOs. Proponents believe that incorporating house calls into care programs can increase quality and reduce costs. And here is an interesting statistic: 2.3 million house calls were paid for by Medicare in 2009, up from 1.5 million in 1995.

The use of online appointment scheduling services is growing, with 16% of family doctors now allowing patients to schedule appointments online. As doctors incorporate more technology into their practices, providers are warming up to online tools and realizing the potential to reduce overhead costs and attract new patients. Pricing for online scheduling models vary: ZocDoc charges doctors $250 a month to be listed in an online directory; Health in Reach charges providers only when a doctor gets an appointment.

Neurological Services of Orlando selects Waiting Room Solutions’ EHR and PM system.

We are looking for a few physicians willing to share their insights into the technology in use in their practices. If you are a physician using an ambulatory EMR or some other cool technology, and willing to share your impressions, send me a note.

Ingenious Med wins a 2010 Mobile Star Award in the Healthcare Management category. The category recognizes vendors providing “breakthrough mobile application enhancing quality of care and practice management.”

E-mail Inga.

News 12/28/10

Sign of the times: more physicians look to escape the hassles of non-clinical obligations and improve life balance by leaving private practice. In Chattanooga, TN, one hospital reports it has tripled its number of employed physicians over the last three years, from 40 to 120. A second hospital says it has grown from 10 employed physicians to 25 in the last three years. Meanwhile, WakeMed Health & Hospitals (NC) adds three new practices and 13 physicians to its physician practice division.  |

More tidbits of information on eClinicalWorks’ new 100,000 square foot office space. The site will include workout facilities (including showers), a cafeteria with an on-site chef, and an outdoor volleyball court. Also, plenty of natural lighting and glass conference rooms throughout the building.

Practice Velocity, a developer of VelociDoc urgent care EMR, is named a semi-finalist in Innovative Illinois 2010, which recognizes entrepreneurial and innovation achievement.

JPS Health Network (TX) launches an innovative initiative to increase the number of physicians in rural areas. JPS is asking small communities to pay the salary of new doctor resident. In exchange, the doctor must make a five-year commitment to the community. According to JPS officials, underserved communities are willing to participate because the program improves access to healthcare, which can drive economic growth.

A Cleveland physician submits a guest column to the local paper, complaining about his recent EMR implementation. He claims that after three months, the product has not saved time or money or improved practice efficiency or employee morale. Patients don’t prefer it over paper, but he points out it is a “bonanza” for document-scanning companies. He continues to rant about how EMR “disrupts the doctor-patient relationship” and suggests that EMRs could be the end of medical rapport (he also writes that Obamacare is unconstitutional, so maybe he’s not going to like very many government-sponsored changes to the practice of medicine). He sounds like every vendor’s worst nightmare. I hope he writes  a follow-up report in another six months to let the world know if things have improved.

I’m only semi-working this week, in part because I am in a location with horrible Internet access. Good thing it will likely be a slow week in HIT, unless you are a vendor trying to pad year-end revenue by implementing as many last-minute systems as possible. Or, perhaps a desperate sales type attempting to close a big deal or two. Regardless of whether you are one of the really working folks, a semi-worker type like me, or perhaps just a bored vacationer, I’ll do my best to make sure you get your HIT news fix this week. 

E-mail Inga.

News 12/23/10

From Frosty: “Re: OK REC. Have you seen this, before? It’s the new REC fundraising method: pay to play.” The Oklahoma Foundation for Medical Quality sends an e-mail to certified EHR vendors, giving them the opportunity to post a demo on the REC’s site for a mere $5,000 a year. OFMQHIT will use the site to walk customers through the vendor’s options and drive traffic to the company’s site. OFMQHIT adds that its model is “completely vendor neutral.” I also see on OFMQHIT’s website that organizations can “sponsor” a provider for $700, and earn recognition on the REC’s website. I’ll give them the benefit of the doubt and accept their neutral stance. On the other hand, I hope their technical expertise is superior to their marketing and financial strategies.

Colorado Regional Extension Center (CO-REC) announces its approved list of 14 EHR products.

Practice Fusion commits to donating $1 to Doctors Without Borders for each new healthcare provider signing up for its free EMR. The promotion is part of company’s Care for the Holidays drive and runs through January 15, 2011.

ONC reports that more than 28,000 providers are now signed up with 62 regional extension centers across the country. Each center has a goal of at least 1,000 physicians in its first two years of operations, with a total target of 100,000 for all RECs.

Speaking of ONC, it now lists 137 certified ambulatory EHRs on its website. Mindless trivia for those wishing to impress co-workers at the holiday luncheon: 102 products are designated complete EHRs and 35 modular EHRs. CCHIT is the certifying body for 79 products, Drummond for 53 products, and InfoGard for five.

Researchers at Northwestern Medicine find that the use of a subtle yellow light on the side of doctors’ computers help boost preventive care of chronically ill patients. The light works with the practice’s existing EMR and lights up when a physician opens the chart of a patient with a chronic condition, such as diabetes and cardiovascular disease. The study’s lead author says the system is effective because, unlike some alert systems,  it doesn’t waste doctors’ time and is not intrusive. Northwestern also tied doctors’ interactions with the reminders to their performance reviews (likely contributing to the success of the reminder system). Some of the noted improvements after one year: a six percent increase in heart disease patients receiving cholesterol-lowering medication and a five percent gain in colon cancer screenings.

McKesson wins anti-trust approval to complete its $2.16 billion purchase of US Oncology.

Oregon, West Virginia, and New York are among a handful of states creating electronic databases that include patient directives for life-sustaining treatment. Oregon’s program is different than a typical  living will because the database includes actual medical orders signed by a physician.

With three days to go, I’m happy to report I have completed most of my Christmas shopping, done a bit of baking, and even sent a few holiday cards. If you are still rushing to complete such tasks, best of luck. And best wishes to all for a wonderful holiday!

E-mail Inga (who is on good terms with the guy above)