Product Profile
Product name
PowerChart Ambulatory - EMR
EHR Certification
Meaningful Use – Stage 1 (ONC-ATCB Certified 2011/2012)
History of development and product ownership
Company developed.
Was the product known by any other names in the past three years?
Yes
PowerWorks EMR, PowerChart Office
Year that a fully functional version of this EHR product was first implemented in a medical practice in the US
1994 for client hosted model, 2006 for ASP model
Number of full time equivalent (FTE) staff fully dedicated to this product
Product development: 1,655
Sales: 710
Implementation: 2,573
Support and maintenance: 1,645
Typical size of practice in which this EHR has been implemented
1–3 physicians
4–10 physicians
11–25 physicians
>25 physicians
Typical setting in which this EHR system is used
Academic Medical Center (AMC)/Medical School
Community Health Center/Clinic
Multispecialty Clinic
Private Ambulatory Care Office
What specialties does this EHR support?
Adolescent Medicine
Allergy and Immunology
Cardiology - Invasive/Interventional
Cardiology - Non Invasive
Dermatology
Endocrinology/Diabetes/Metabolism
Gastroenterology
General Internal Medicine
General Practice/Family Practice
Geriatrics
Hematology
Infectious Disease
Nephrology
Neurology
OB/Gyn & Women's Health
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Pain Management
Pediatrics
Physical/Rehabilitation Medicine
Psychiatry
Pulmonary Medicine
Rheumatology
Sleep Medicine
Sports Medicine
Surgery - General
Surgery - Other
Surgery - Vascular
Urology
Clinical - Other
Areas of the United States in which this EHR product is sold
North East
Mid Alantic
South
Midwest
South West
West
Hardware / Network
Operating system platform(s) supported
Does the company resell any hardware?
Yes, Cerner sells hardware. Warranties are those of the manufacturer.
Preferred list of 3rd party hardware suppliers
No.
Preferred list of 3rd party IT Support vendors?
No, Support is handled by Cerner.
Does the product work over a wireless (WIFI) network?
Yes
The EMR can be accessed from any high-speed internet connection. Wireless offerings from Cerner are based on Citrix, which is encrypted. We recommend Secure Sockets Layer (SSL) and Transport Layer Security (TLS) for all Web connections.
VARs - Value Added Resellers
Do you use value added resellers to sell and distribute this EHR?
Yes
To a limited degree.
Can customers purchase your product directly from your company or only from your VAR’s
Yes
Customers can purchase directly through Cerner or from a VAR. VARS are not limited to practice size; they primarily sell within a defined geographic location.
Can customers who have purchased your product through a VAR contact your company for support?
Yes
Support remains with Cerner. However, in some instances, the VAR chooses to handle Tier 1 support.
Application Service Provider
Do you offer an ASP version of your EHR product?
Yes
We offer ASP, Remote Hosted and Client Hosted models.
Can you use Dragon or MS voice tools on your ASP solution?
Yes
Dragon Naturally Speaking version 10 or higher.
Company policy regarding data ownership for the ASP EHR
For both data models, clients own their own data. For the ASP model, in the event of contract termination, Cerner will return or destroy all information received from, or created or received by Cerner on behalf of the client as per our standard contract.
Location of data hosting centers
Two locations in Kansas City, MO and one location in Minneapolis, MN.
Software & Database
What programming language were used to develop the application?
Cerner's Ambulatory EHR was developed using Visual Basic, Visual C+, C, Korn shell scripting (for AIX), and JAVA. Cerner uses its own proprietary query language called Cerner Command Language (CCL) for queries and reporting. CCL is ISO certified.
Do you provide a test version of your EHR product for training and quality assurance(QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment)
Yes
While clients will not have access to a separate training environment, they can practice in the development environment prior to go-live.
Are 3rd party applications required to use your EHR?
Yes
Citrix.
Do you use standard terminologies, e.g., SNOMED-CT, LOINC, ICD9, ICD10 in your program?
Yes, Cerner Ambulatory EHR provides clients with a comprehensive library of templates that incorporate standard nomenclature, including ICD-9, CPT-4, SNOMED CT, and HCPCS.
Expected date to be in compliance with ICD10 coding
2012.
Expected date to be in compliance with SNOMED-CT
Current (2011).
Interfaces / Interoperability
Does this product have existing lab interfaces with Quest? If Yes, please explain whether the interfaces are uni or bi-directional.
Yes
Bi-directional.
If Yes to the previous question, are the interfaces bundled or provided at additional cost? Please explain.
Yes
Additional cost however typically picked up by the lab.
If the lab company picks up the costs, will the practice be charged maintenance and support fees? If Yes, please explain.
No
When picked up by the lab, the practice is not charged ongoing support or maintenance.
Does this product have existing lab interfaces with Labcorp? If Yes,
Yes
Bi-directional.
If Yes to the previous question, are the interfaces bundled or provided at additional cost? Please explain.
Yes
Additional cost however typically picked up by the lab.
If the lab company picks up the costs, will the practice be charged maintenance and support fees? If Yes, please explain.
No
When picked up by the lab, the practice is not charged ongoing support or maintenance.
Does the company offer an integrated EHR/PM system? (i.e. a combined EHR/PM system)
Yes
[If yes to the previous question] Does your system used a single shared database (not interfaced) for the EHR/PM system?
Yes
The system uses a single shared database.
Can your product be interfaced with a different PM system if the practice chooses to do so?
Yes
If they are HL7-compliant. Interfaces implemented for specific clients are determined by the mix of Cerner and non-Cerner systems, as well as the type of data that needs to be exchanged among these systems with regard to directional flow of the data.
List of Practice Management systems with which you have existing interfaces
Cerner has developed over 5,000 interfaces. The following list highlights a small sampling of the interfaces that we have built to third party solutions: GE Centricity, Intergy (Sage), McKesson, Misys, and NextGen.
If you do not have an interface with a particular PM system, are you willing to develop a custom interface?
Yes
Further discussion would be needed around interface details, scope and pricing.
If an interfaced PM system is used, does your EHR product transfer billing and coding data captured during the encounter to the PM system? If yes, is this a one-step or multi-step process?
Yes
This is done via a real-time billing interface that captures CPT4 codes and ICD9 codes.
Does the EHR use an interface engine?
Yes
Interfaces use Cerner's internal open interface engine. However, Cerner has also interfaced to commercial interface engines with our other solutions.
Implementation and training
Tools and/or services offered to clients in order to achieve meaningful use of their EHR?
Users can pull reports to see detailed meaningful use criteria being met/not met, down to the provider level. Cerner can also assist with this process if needed. In addition, clients receive access to a private web collaboration tool, known as uCern. Ongoing education on meaningful use standards, ways to improve provider adoption, and broad industry topics can be distributed through uCern, Cerner's online networking portal for clients.
Tools and/or services offered to clients for current workflow analysis and redesign when using an EHR?
Experienced Cerner team members will work with you to help determine how to best optimize workflow. Prior to go-live, Cerner conducts a systems review and design review with you, and establishes internal check points between the sales and installation teams. A pre-implementation walk-through session will be completed by an experienced solution architect to help to define any processes or procedures that would need to be redesigned to take advantage of the new system that is to be implemented.
Do you recommend a graduated implementation or a big-bang implementation (all live at the same time) for your EHR?
Cerner will work with you to determine the best implementation strategy. We typically recommend a staging/sequencing of applications that considers efficient process integration, timely discontinuance of legacy systems, degree of change to manage, drives speed to value, and aligns well with business imperatives. This can result in an approach with multiple phases in which logical clusters of applications are grouped together and reflect increasing depth and breadth of functionality.
What training mechanisms are used by the EHR Vendor?
On Site
At Corporate Facility
Web Based
Web Based interactive
Other
Is there a minimum amount of training required by your company in order to satisfy the support and maintenance contract that we would sign with you?
Yes
A pre-go live readiness assessment is conducted as part of our standard implementation process, to assess the level of comfort each user has with the system and provide additional training where needed.
Do you provide any guarantees regarding the ability of a practice to meet meaningful use requirements?
Yes
We guarantee that our solution will remain compliant with the evolving Meaningful Use standards. However, Cerner will not assume financial risk for providers not achieving meaningful use. Attaining meaningful use status is dependent upon how each Provider uses provided functionality, which Cerner cannot control.
Does your company provide any guarantees that your EHR product will comply with Stage 2 and Stage 3 meaningful use requirements?
Yes
Cerner is committed to the Stage 2 and 3 requirements as they become final; we continue to design and implement our solutions keeping the potential requirements in mind.
Is there a minimum amount of training required by your company in order for our practice to satisfy compliance with meaningful use guarantees?
Yes
We've built our implementation training around the Meaningful Use requirements and thus required workflows. Therefore, it’s a natural part of how we train our clients today.
What services do you offer for post-implementation optimization of the system with respect to training and system customization?
Free training options are available throughout the year. Some courses are offered live, while others can be accessed at any time online. Clients can also access a web collaboration tool, uCern, which facilitates blogs, discussions, documents, Wikis, projects, tasks and groups.
Prescribing
Does your product support ePrescribing? Is there an additional charge for this service or is it included in the overall cost?
Yes
For the ASP model, this is built-in functionality in the EMR and is included in the monthly subscription fee. For client hosted clients, ePrescribing is a separate module purchased with the EMR.
Which formulary does your product use?
Cerner partners with SureScripts.
Does the system allow users to add drugs that may not be in the original database?
Yes
Prescriptions can be free texted, and medications can be free texted in the current or historical medication lists.
How are drug allergies and adverse reactions recorded and integrated into the prescribing module?
We utilize the Multum database for drug allergies and adverse reactions. This is fully integrated into the prescribing module.
When prescribing multiple medications, am I presented with an ability to separately acknowledge or document individual alerts?
Yes
Is there an ability for the physician or practice to modify preset alerts? (e.g. Severe vs. mild or moderate)
Yes
This can be modified in the Allergy Profile.
Is there an ability for the physician to filter the display of alerts?
Yes
Alerts can be filtered according to how they are modified in the patient's profile - for example, severity, date, clinical vs. administrative, etc.
How are episodic and long-term medications tracked in the patient’s record?
Present and historical medications are tracked and displayed in the patient's summary. Providers can easily prescribe based off of either present or historical medications.
Does the system allow users to switch drug interaction checking on or off?
No
Drug-allergy interaction checking cannot be turned off, as this is in the best interest of providing optimal care to the patient. However the level of severity can be modified.
In the medication list, is a user able to sort medications by multiple parameters including date prescribed, diagnostic code, active or discontinued?
Yes
The list can be sorted and filtered in all of these ways and more, for example, by Order Name, Status, Details, Active, Inactive, all Medications 90 back, cancelled/deleted medications, etc.
Templates
What pre-defined templates do you provide?
Definition: A template is a pre-defined structured capability to rapidly record content including information on clinical conditions or vital signs through mechanisms such as menus, predefined fields or checklis
Cerner Ambulatory EHR has over 700 note templates supporting over 50 specialties and subspecialties, including clinical documentation, order sets, and quality measures. Cerner's logic-based decision support solution proactively delivers executable knowledge in the form of alerts that can contain medical content and clinical guidelines along with the ability to select and execute alternative orders with a point-and-click interface. The EMR also provides an E&M coding assistant.
Do you charge additional fees for any of templates?
No
For ASP model Yes, for Client Hosted, clients can purchase hours for additional customized work.
Can clients customize existing templates?
Yes
Limited: For the ASP model, providers can personalize documentation to meet individual workflow requirements. Templates can be configured at a person level through the creation of macros, auto text and the ability to pull in new structures on the fly as needed. Personalization is also available by designating provider 'favorites' for orders, documentation and the clinical summary screen. Yes: For a client hosted model, more customization is possible
Can clients use tools provided through the system to develop their own templates?
Yes
Limited: Please see above for ASP model. Yes: For a client hosted model, more customization is possible with tools and rules engines.
Will your company build custom custom templates to the practices specifications?
Yes
See above. In the ASP model, all clients are on the same domain so that any upgrades, updates are pushed out to all clients at once, so everyone is on the most up-to-date level of code. Yes: With the client hosted model, custom templates can be built.
If a doctor has created a custom template in their EHR, will the templates and custom rules be maintained when new full releases and patches are installed?
Yes
For client hosted clients, where full customization is possible, they will stay intact. This is not applicable for the ASP model.
Support & Maintenance
What is the process for managing questions and service requests?
The Cerner Help Desk is open 24x7x365 to solve mission-critical problems. Clients access Cerner Help Desk Services through several avenues, including an 800 number, e-service, live chat, and email. Remote monitoring and remote diagnostics are available.
Are different tiers of support offered (including pricing information)?
Yes
There are a variety of ways to access our support organization (see above) along with a Standard Operating Procedure for client escalations. Support is built into the cost of the system so no additional cost based on Tier of issue.
What are the options for a client to contact your company for support?
Clients can access Cerner Help Desk Services through several avenues, including an 800 number, e-service, live chat, and email. Remote monitoring and remote diagnostics are available. Clients can track the status of their service requests online.
What level and type(s) of support are provided during go-live?
For each site, Cerner provides:
• Cerner Engagement Leader (main contact)
• EMR Delivery Consultant
• Technical Resource(s)
• Onsite go-live support
Each location provides a staff member for the following roles (1 person may play more than 1 role):
• Executive Sponsor
• Office Manager
• Clinical Champion
• Super User
• Technical Leader
Is a formal users' group, online community forum or other form of social networking community available?
Regional User Groups by geographical area; the annual Cerner Health Conference. Clients can also access a web collaboration tool, uCern, which facilitates blogs, discussions, documents, Wikis, projects, tasks and groups.
What are the standard hours of operation during which support is provided?
The Cerner Help Desk is open 24x7x365 to solve mission-critical problems.
What are the steps for a client to escalate a support request?
See above. Each issue has a designated severity level, determined by the client. Technical support manages and prioritizes escalated issues according to the following guidelines:
1. Immediate Impact. Operational impairment or impact to client cash flow or workflow.
2. High Impact. Problem with system functionality or patient flow disruption without a workaround.
3. Moderate Impact. Problem with a minor process or has a workaround.
4. Minor Impact.
5. Question/Request for information.
Do you use off-shore technical support?
No
Are software upgrades provided as part of the software maintenance contract?
Yes
Under the ASP model, upgrades are included in your monthly subscription and pushed out to all clients automatically. For client hosted clients, upgrades are also part of the contract however it's the client's descretion as to when to take them.
How are customer requests for enhancements and customizations handled?
Clients can request an enhancement via eService and review the progress of the request online. The appropriateness of the requested enhancement is evaluated. User groups and forums also provide clients an opportunity to voice enhancement requests.
How are drug interaction tools updated in your system?
Please refer to the response directly above. Cerner updates Multum content as needed/monthly, which is included in your monthly subscription fees with the ASP model and monthly LSW fee for client hosted clients.
How are patient education materials updated in your system?
Patient education materials are available through ExitCare as part of your monthly bundled fee, or through Krames for an additional fee. These will be updated by Cerner, without need for client intervention. Clients can also include a link in the toolbar to other patient education systems if desired.
How are requests from clients handle for customizations of their system post “go-live”?
ASP model: Any upgrades or updates are pushed out to all clients at once so all on the current level of code. Providers can personalize documentation, templates and "favorites".
Client hosted: This is typically handled via additional service hours.
Is remote monitoring available with the ability to alert clients about system problems?
Yes
The level of Cerner monitoring of the client hardware (PCs and other items) is limited to the client's internet connectivity. Yes: For those clients who are client hosted, there is a service which is an additional fee.
What is your recommended backup strategy?
With the ASP model, Cerner performs backup procedures without user intervention using Oracle's Recovery Manager (RMAN). This can be run at any time without downtime/performance impacts. A full-system backup is performed on a weekly basis, and incremental backups of database files, etc. are performed nightly with no downtime required. For client hosted clients, they determine their own back up strategy.
Do you offer remote backup for a client's system?
Yes
Please refer to the response directly above. Cerner Client data is hosted in Cerner’s data center behind firewalls. The Cerner data center is a 71,000-square foot, dual-fed, redundant data center operation located in a suburb of Kansas City.
When an interface goes down, how is that information recovered?
If the interface connection is dropped, then the HL7 messages queue up until the connection can be re-established. We have capabilities to replay messages if needed.
Reporting Tools
Does your system provide a reporting tool with pre-formatted reports?
Yes
Reports can be pulled from the system itself. All data fields are discrete and can be reported on.
Is your reporting tool able to create the following reports?
1.Generate a list of all patients with a chronic condition (e.g. Diabetes, COPD)
2.Generate a list of all patients with a specific condition who have not been seen within a defined period
3.Generate a list of all patients with a specific condition and lab result who have not been seen within a defined period. (e.g. diabetic patients with a HbA1c=9 not seen in the last 4 months)
4.Generate a list of all patients on a specific drug with an active medical problem
1.Yes
2.Yes
3.Yes
4.Yes
Are these reporting tools bundled with the EHR system or provided as add-ons?
Yes
These reports are built into the EMR and are part of the bundled Meaningful Use package. (Any reports required to meet Meaningful Use will be part of our bundled Meaningful Use offering without additional fees.)
Does your system support PQRI (Physician Quality Reporting Initiative) reporting?
Yes
Order Management Tools
Does your program provide any order management tools?
Yes
Orders functionality is built into the EMR, including lab and radiology orders, future orders, and order sets. Orders automatically populate the assigned clinician's task list. No additional cost (except interface costs where applicable).
Does your program provide any document management tools?
Yes
Documents are scanned into the system, indexed, and stored in the patient's chart. Once the document is scanned, the user simply selects which patient's chart to attach it to, and it can be sorted/indexed. There is no extra charge for this feature.
Does your program provide any other workflow management tools?
Yes
Cerner offers courses on various workflows within a practice. The EMR can be personalized to meet individual workflow requirements. Cerner also conducts go-live assessments, which include a review of the workflow to assess end user satisfaction.
Patient Health Record (Portal)
Do you offer a Patient Health Record that integrates into your system?
Yes
Clients have the option to purchase this separately, but it is bundled as part of our "Meaningful Use" package.
Data Conversion
Do you offer data conversion services from other products to your product?
Yes
As long it is HL7 compliant.
Data conversion is available for:
Billing data
Demographic data
Clinical data
Metadata
What are the data conversion and transfer costs?
For history uploads, this depends on the specific data to be transferred, approximate number of records, and current format of the data. Details will be discussed with your organization during the data migration evaluation. Cerner begins analysis and planning at the beginning of the project. Interfaces will be confirmed and a functional scope will be established during solution design. The scope will be fully defined during the specification meeting.