Cerner | FirstNet Experience

FirstNet is the Emergency Management module from Cerner. As part of the EDIS team, interviewing the vendors was a daunting task in itself. When endeavoring on a huge job as this as you know you have to look at the whole picture, then consider that in your decision.  Keep in mind we were going from paper to EHR, virgins of the EHR world. We went with FirstNet for many reasons and I’d like to share some of those reasons with you as well as some of the not so good things we ran into.  Remember that how you move into this will also make a difference like, Big Bang or not and for us we took two years to prepare. Emergency Management was the first bite of the elephant that we tackled. After having that under our belt and information flowing we went full bang for the rest of the facility. It was a nice transition as then the information that the clinicians needed was there for them from the ED. Our experience with Cerner was relatively a good one. Cerner has a tendency to send new associated to handle roles they have not yet been vetted in. We were all for that, but then didn’t see the support. Cerner hires more clinical personal and that clinical experience. Epic doesn’t seem to care about the clinical aspect as they care about using the young and technical. I’ll save some of that for another review experience I had.

Our objectives included: improved usability, improved patient safety, increased efficiency, having happy Providers, reduce the length of stay, identify bottlenecks and the ever concern of increasing revenue. Cerner helped with a true validation of the design in our own environment and provided testing under actual workflow conditions.

ED Summary – ED Timeline

We knew our real-estate was at a premium, so we strove to reduce the information on the screen and made divisions according to the workflow.

We were able to hover to view and locate information, verses clicks and scrolling. An Alert popping up for significant events and having the ability to hover over them to view the comment or note allows, you to keep moving in your workflow.  At this point, you also had the option to view more information or launch to the nursing documentation from the flagged event. The design followed intuitive workflows that providers and nurses would usually do when treating patients. We did notice a difference when the Cerner associates were clinical or not, or had ED experience. It did make the journey more challenging as well as frustrating.

Reducing scrolling and clicks within Triage Documentation

Overall FirstNet was found to be more rigid in adaptability to our dream wish list, and if flexibility was available it came at a cost like, specialty reports. If your facility is report centric, know that up front going into a relationship with Cerner or any of the top EHRs.

Tracking Board

When you hover over the Alert, you will see that the nursing documentation has been flagged.  The Tracking board was an intensive labor of love for the ED. All the way from selecting the icons to what was important enough to see on the Tracking Board was in the decision making of the EDIS team. The Tracking Board gives you a quick bird’s eye view of the ED including where staff are, what rooms are clean, where the Chaplain is at, where the patient in room 6 is, what test results are back or ordered, showing in what phase a patient is towards discharge, what is coming in and LOS (Length of Service) just to mention a few of the activities visible. You can see other views like the Triage area that give you a quick view of how many patients are waiting, patients needing to be roomed in ED, acuity levels of those waiting, any tests ordered, treatments, etc. If an ambulance is coming in, for example, it can help you manage rooms to make available for that patient, equipment needed, possibly call a code team or have a crash cart waiting when the patient arrives. Patients that come in with a similar name or a name that sounds like another name, FirstNet, italicizes the name, so you make a mental note. Name cells can be colored coded by sex, like blue and pink. The Tracking Board is a vital part of ED management and Cerner is one of the few to bring the workflow to design, to reality in a functional way according to ED workflow.

Due to EDs becoming so competitive in marking services we needed to publish wait times to web pages and outside sources. Cerner provided us the tools so that we were able to meet those goals. Overall some of the additional usability improvements that Cerner has managed to design with a high success; is the quick launch of a note from the tracking List, a suggestion of patient education by recognizing age and gender, discharge components, tracking control integration with IView, publish ED wait times (LOS), layout report enhancements, presenting a real time dashboard, multi-facility tracking and documentation management improvements.

Having said all this, the one complaint with Cerner that we heard was the number of clicks it takes to do the simplest tasks. I think that we need to review some of our expectations of completing tasks to our expectations of the availability, extraction of information to have available at out finger tips, a goal that needs attention even in the availability of requested information.

When you begin to look at the top EHRs remember it is not only the software that you need to look at, but the company and how they will help you meet the facility, State and National goals. Cerner has had complaints of wining and dining till the contract is signed and then disappears. In our research, we heard facilities voice that they felt abandoned because they weren’t as big as other facilities or that they weren’t in the major cities, lacking in their customer care and being customer centric. We not only interviewed the showcase sites that Cerner provided, but we did research to find other facilities using Cerner and interviewed them to facilitate our decision. It was a key decision, as we were just beginning to select solutions for the future of our facility. Reminds me of a sign I saw in Alaska, which stated to choose your rut wisely, for you will be in it for the next 7 miles. Choose your EHR wisely!

Allscripts | ED and Sunrise Emergency

 

I like the simplicity of view and usage of the real-estate for the ED Tracking Board, versus some of the other EHRs out there like FirstNet – Cerner. The real estate doesn’t seem cluttered and more intuitive to me.

ED Tracking Board

Allscripts has a Workflow Management Tool where each step in the                                                           

Workflow is announced visually by color and shape of Icons.

This tool does not stop the flow but instead supports the clinician in the Workflow.

 

This tool displays the name identifying the Document status

Check incomplete documents status

More examples

One of the key areas of optimizations that we uncovered in our review was in the area of revenue. Early on in the full life cycle we made the decision to go with ED Sunrise. In that choice was the promises of increased revenue and help with inconsistent billing due to multiple factors, and aging receivables. Our ED revenue was 30% below budget and needed to see an increase. In 2011, the ED revenue was $600,000 higher than 2012 revenue with 2013 tracking along the same path of 2012. One of the first directions we took was to identify factors that impacted our charge capture, thus revenue. We prioritized the factors and determined levels of impact that we could exert on those factors. Our desired outcome was to increase the ED revenue/charge capture by 30% by the end of 2013.  Allscripts has helped us meet those goals. I have heard all the top EHR vendors claim the same results, and I believe they all can produce the same results as many factors in the past were never addressed and thus hidden. I do like Allscripts for openness to dialog, openness in training as well as clinical support. I do want to add that sometimes simple is not the best way to travel for the end results needed.

I have had many questions and I have found the answers on the Allscripts portal or have been able to ask in one of their groups. I like especially their Meaningful Use Audit Group where all resources are listed including abbreviations, numbers and how to for Allscripts, Legal information, how to request letters from Allscripts and how to manage an audit. Not much can be done if you are chosen, but you as an organization can be proactive if you find yourself in an audit. Knowing things like how long to hang onto files after the conclusion of an EHR incentive Program can cut a lot of adding more stress, when you really don’t need it. Don’t skimp here in the shadows for an ounce of preparation will save you in the end. The time of the audit is not the time to scramble for screenshots of key functionalities. Don’t count on Dave your design/builder to be around forever, things happen and so make sure he is documenting and that he has copies of vital reports/documents.  We had a valued IT person who designed/built everything for us. He was a know it all, the go to of all. No one knew that he didn’t document as he should have till he left. Then the realization of problems grew. A startled revelation of where we were in reality was the start of a nightmare.  Stay on top of your EDIS team and make sure it gets drilled down the ranks to prepare for an audit each step of the way. I can’t say enough that Allscripts makes these tools available to its clients and easy to locate. Hind sight notation is starting from day one to incorporate Meaningful Use (MU) and its requirements. Not all EHRs are the same especially in support of Meaningful Use.

I’d rate Allscripts at 4.8 out of 5 for EHRs.