Cerner Versions

[NYEMMED]

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So I have come across jobs all using different names for Cerner:
Cerner millennium
Cerner FirstNet
Cerner launchpoint

Are these all names for the same program or are these all different in some way?

 

[RustedFox]

Great question.
I have no idea.
Lends itself to superhero creation names.

Cerner Galacticus
Cerner Gambit
Cerner Jubilee
Cerner: Sons of the Atom

 

[dchristismi]

Even Cerners with the same name are different. (I've only seen FirstNet) Each hospital system has their own build with their own nuances and pain-in-the-assery.
The general bits are the same, but the ordersets might be different. Heck, even orders between hospitals in the same system will be different due to lab differences and pharmacy weirdness.

So yes, but not?
And I think "Cerner: Insanity War" isn't a bad description...

 

[thegenius]

Cerner: Stick that icicle in your eyeball

 

[NYEMMED]

Cerner: Stick that icicle in your eyeball

Sigh, I wish EPIC didn’t cost so much. More hospitals would buy it then

 

[GonnaBeADoc2222]

The best EMR is the one you're used to

 

[deleted1013752]

The thread is a bit old but wanted to ensure the question was answered. I'm not a physician, I'm a trainer for these applications. A few terms you might see:

• Cerner Millennium: A blanket term used to describe the spectrum of Cerner's clinical applications. It generally refers to applications based on a shared framework, e.g. Cerner Millennium PowerChart, Cerner Millennium FirstNet. Basically Millennium doesn't mean anything and it's just a term Cerner made up to make their products sound integrated/cool.
• Cerner PowerChart: The basic charting application. Tools you access from within PowerChart depend on your system's build and your role/specialty/workflow. This term describes the application when accessed via ambulatory or inpatient sites, as distinct from the following applications.
• Cerner FirstNet: PowerChart in the ED. Cerner LaunchPoint is not a standalone application, but rather a tool accessed via FirstNet. It's the home screen you see when you open FirstNet and replaced the Tracking Board/List/Shell.
• Cerner SurgiNet: PowerChart in the OR. This includes a surgical tracking list and perioperative documentation.
• Cerner SurgiNet Anesthesia Module: Anesthesia's intraop application accessed via PowerChart.
• Cerner Ambulatory: This one is a mixed bag. It's still PowerChart, but when implemented as part of an enterprise system it is the same as what's seen on the inpatient side. Many physicians will have inpatient and ambulatory views, so calling it Cerner Ambulatory is meaningless. However, it can also refer to Cerner ASP (Ambulatory Service Provider), That's when an office or group buys into a shared Cerner platform strictly for ambulatory services. Though the application can be customized, the group generally has less control over build modifications compared to an enterprise system used throughout an organization with a dedicated IT department responsible for build & maintenance. Either way, it's still PowerChart.
• Cerner AppBar: Application Bar. There are easily dozens of Cerner applications, many of which are small or designed for limited uses. These are often accessed via the AppBar. Some roles that might use the AppBar include Radiology and Pathology, but it's not limited to specific roles and how a user accesses the applications depends on build.

So for the OP's question... if a place says Millennium or FirstNet, they could be using the old tracking board but I haven't personally seen that used by physicians since 2015. If they say LaunchPoint, that guarantees they're using an iteration of the latest user interface for ED docs. Sidenote: about three years ago Cerner rolled out LaunchPoint for ED nurses too. The tools are similar.

 

[KGflyboy]

My hospital doesn't use launchpoint for some reason. We must be using very outdated software.

 

[deleted1013752]

We must be using very outdated software.

IMO that has more to do with how aggressively a hospital is pursued by the Cerner sales team than clinical function/need. Tracking Board to LaunchPoint is largely an appearance mod, albeit with smoother access to favorite orders.

 

[KGflyboy]

I feel like the overall interface and features of Firstnet are less user friendly and less efficient than Epic.

Based on my experiences reading this forum and talking to other doctors who have used both EMRs, my opinion is common.

For instance, Epic allows me to update my note from the tracking board using the "ED course" function. I have to click a dozen times in Firstnet to get from the tracking board to the reevaluation section of my note and complete a brief update.

Epic timestamps my reevaluations for me. I'm Firstnet, I have to click several times just to add a timestamp.

Epic automatically pulls in vital signs. In Firstnet I have to manually do it.

Epic pulls in my labs and imaging. I have to manually do it in Epic.

Some of this may be dependent on my hospitals specific Cerner setup, but the list goes on and on. There are so many common sense features that Cerner doesn't have. I keep thinking Cerner will provide an update with some helpful features, but we just keep using the same old Cerner junk even though Epic keeps making their product more and more user friendly.

 

[Groove]

I used to be biased towards Epic, but now...I think I prefer Cerner. Maybe that's because it's all I've been using for 5.5 years. I can crank through some charts with my macro clickedy click combined with dragon. 25 patients last night during 9 hours with NO scribe and left 15 mins early. I'm sure I could develop an equally efficient system with any EMR but I've really gotten used to Cerner at this point... Hell, I can't even remember how to use Epic, it's been so long.

 

[RustedFox]

I used to be biased towards Epic, but now...I think I prefer Cerner. Maybe that's because it's all I've been using for 5.5 years. I can crank through some charts with my macro clickedy click combined with dragon. 25 patients last night during 9 hours with NO scribe and left 15 mins early. I'm sure I could develop an equally efficient system with any EMR but I've really gotten used to Cerner at this point... Hell, I can't even remember how to use Epic, it's been so long.

I'm with you, homey; but the ONE thing that CERNER sorely lacks is the automatic importing of relevant labs/rads/studies. Sure, it takes me less than a minute to do this; but its HUGE when the rubber meets the road. The fact that CERNER decides to list them like this:

Sodium = 136
Potassium = 4.3.
Chloride = 120
Bicarbonate = 23

and not in the "fishbone" fashion is insulting, hard to read, and makes the note stretch on forever.

If we're going to pit CERNER vs. EPIC... then EPIC wins for so many little reasons.

CERNER is far better than say MediTECH (which, is unacceptable in the year 2019, and should be reason enough for HCA to die in a fire), but there's no excuse for omitting functions that should be "Automatic For the People" (with apologies to R.E.M.) Even MediTECH auto-imports the vitals, labs, and rads.

CERNER: You could win the whole war with simple attention to the simple things that make it all better. Are you listening?

 

[RustedFox]

I feel like the overall interface and features of Firstnet are less user friendly and less efficient than Epic.

Based on my experiences reading this forum and talking to other doctors who have used both EMRs, my opinion is common.

For instance, Epic allows me to update my note from the tracking board using the "ED course" function. I have to click a dozen times in Firstnet to get from the tracking board to the reevaluation section of my note and complete a brief update.

Epic timestamps my reevaluations for me. I'm Firstnet, I have to click several times just to add a timestamp.

Epic automatically pulls in vital signs. In Firstnet I have to manually do it.

Epic pulls in my labs and imaging. I have to manually do it in Epic.

Some of this may be dependent on my hospitals specific Cerner setup, but the list goes on and on. There are so many common sense features that Cerner doesn't have. I keep thinking Cerner will provide an update with some helpful features, but we just keep using the same old Cerner junk even though Epic keeps making their product more and more user friendly.

I was scolded at an HCA hospital for pointing out how many "clicks" it took me to sign a MLP chart with MediSUCK.
It was seriously 13+ clicks, PINS, etc.
I'm so glad I don't work there full-time anymore.

ATTENTION: HCA

YOU'RE DOING IT WRONG.

 

[Groove]

I'm with you, homey; but the ONE thing that CERNER sorely lacks is the automatic importing of relevant labs/rads/studies. Sure, it takes me less than a minute to do this; but its HUGE when the rubber meets the road. The fact that CERNER decides to list them like this:

Sodium = 136
Potassium = 4.3.
Chloride = 120
Bicarbonate = 23

and not in the "fishbone" fashion is insulting, hard to read, and makes the note stretch on forever.

If we're going to pit CERNER vs. EPIC... then EPIC wins for so many little reasons.

CERNER is far better than say MediTECH (which, is unacceptable in the year 2019, and should be reason enough for HCA to die in a fire), but there's no excuse for omitting functions that should be "Automatic For the People" (with apologies to R.E.M.)

My brain is moving slow today so when you said "fishbone" labs, I immediately thought of...

I then sat there for a few agonizing seconds with my mouth slightly open and this blank look on my face....but it finally clicked.

Yeah...you know I don't really mind Cerner's format. All I have to do is type ".labs" and it all dumps into my chart. I think we may have discussed this in a previous thread regarding differing Firstnet versions but in mine, we have this *Radiology smart template that I have bound to the smart phrase ".rads" that also dumps all radiology reads into my chart. If it's after hours and we are only receiving wet reads, I just dictate them into the note. The smart templates for labs and rads really speed up my charts. If you didn't have those, I can see where it would def slow you down. It seems like the Radiology smart template SHOULD be a common function and something that IT could add to your production version.

 

[RustedFox]

@Groove

1. typing .labs or .rads doesn't do anything with my CERNER version.
2. IT here is laughable. I actually put them on the phone with my wife (IT gal at MERCK) and she embarrassed them so badly.
3. We did discuss this in a previous thread. You're not wrong, homey. We have 24 hour rads (at a 35K shop, curiously) but no IT support.

Hope that things are cool in your neck of the woods, brah.

 

[deleted1013752]

1. typing .labs or .rads doesn't do anything with my CERNER version.

Sorry to hear that. Cerner can display labs in fishbone format and there's a smart template for it, but those things need to be configured/managed by your IT department or by Cerner if they manage your IT. Do you have any kind of autotext/templates/dot phrases available?

 

[RustedFox]

Sorry to hear that. Cerner can display labs in fishbone format and there's a smart template for it, but those things need to be configured/managed by your IT department or by Cerner if they manage your IT. Do you have any kind of autotext/templates/dot phrases available?

I have my own autotexts and macros and that's it. I exploit them better than anyone else in my department.
I appreciate that you're trying to help. Please understand that.
No venom is directed at you. You came to this place and stuck yourself out there.
Good on yah!

If CERNER wants to unseat EPIC, then there are a few minor workflow and cosmetic things that they can do to make them DOMINANT in the market.

 

[deleted1013752]

I feel like the overall interface and features of Firstnet are less user friendly and less efficient than Epic.

Can't argue there. They're very different companies. When I worked for Banner Health a few years back, an analyst mentioned "Cerner makes an iPhone but we bought a flip phone." My exposure to Epic is limited but in conversations with other consultants it's apparent they keep everything much closer to the vest. For example, for a project to be officially sanctioned by Epic, contractors on the project need to be Epic Certified. Cerner technically offers some certification courses but they are ill-defined and completely optional. Epic is like a novel. Cerner is a choose your adventure book where some people get a really cool story but many end up disinterested or confused.

Are you using PowerNotes or Dynamic Documentation? From the issues you mention, it sounds like PowerNotes. A few things:

• If your system upgrades to LaunchPoint, you can access your documentation with one click to add your reevaluation.
• Timestamps in FirstNet depend on your documentation method, but you should be able to add autotext for quickly adding the time.
• Vitals, labs, and imaging should be incorporated automatically if you're using Dynamic Documentation, which is why I'm guessing PowerNotes.

I can't say which system is better, but it sounds like your hospital isn't using the latest tech. All of the features I mentioned above came out several years ago.

 

[deleted1013752]

I have my own autotexts and macros and that's it. I exploit them better than anyone else in my department.
I appreciate that you're trying to help. Please understand that.
No venom is directed at you. You came to this place and stuck yourself out there.
Good on yah!

If CERNER wants to unseat EPIC, then there are a few minor workflow and cosmetic things that they can do to make them DOMINANT in the market.

I train at least a few hundred people a year. If I took it personally when they didn't like the system, I'd have been out of this job a long time ago!

Glad you use autotext and macros to your advantage. If you're on PowerNotes, you can include autotext phrases in precompleted notes so you don't have to enter them every time. I don't see that feature get much use. Of course not an option with Dyn Doc but there are workarounds.

As for unseating Epic, it seems Cerner has a lot riding on the success of the DoD and VA contracts.

 

[RustedFox]

I train at least a few hundred people a year. If I took it personally when they didn't like the system, I'd have been out of this job a long time ago!

Glad you use autotext and macros to your advantage. If you're on PowerNotes, you can include autotext phrases in precompleted notes so you don't have to enter them every time. I don't see that feature get much use. Of course not an option with Dyn Doc but there are workarounds.

As for unseating Epic, it seems Cerner has a lot riding on the success of the DoD and VA contracts.

I hear you, amigo.
But I don't care who contracts who for what.
At the end of the day... its the product that sinks or swims.
The fact that HCA is married to MediTECH is a cancer.
I seriously don't want to pick up shifts at my "other" job sites because of MediTECH.
If I got an email tomorrow that said that "OtherSite" has nuked MediTECH and gone to CERNER or EPIC, I would jump for joy.

Right now, CERNER is treading water behind EPIC, and if it wants to swim... it needs to become more user-friendly and streamlined.

 

[RustedFox]

- and I do mean it, amigo - no venom is directed at you.

If we can work together to slay the EMR demon, then we should.

Good on yah.

 

[gutonc]

- and I do mean it, amigo - no venom is directed at you.

If we can work together to slay the EMR demon, then we should.

Good on yah.

You're never going to slay the EMR dragon. But you can saddle it up and ride.

 

[RustedFox]

You're never going to slay the EMR dragon. But you can saddle it up and ride.

Yeah, yeah, yeah.
You and I mean the same thing.

Dude. Bring the grey cat back. I love him.
My black cat is all over my keyboard right now.


Foxes are dogs. But we love cats.

 

[thegenius]

Can't argue there. They're very different companies. When I worked for Banner Health a few years back, an analyst mentioned "Cerner makes an iPhone but we bought a flip phone." My exposure to Epic is limited but in conversations with other consultants it's apparent they keep everything much closer to the vest. For example, for a project to be officially sanctioned by Epic, contractors on the project need to be Epic Certified. Cerner technically offers some certification courses but they are ill-defined and completely optional. Epic is like a novel. Cerner is a choose your adventure book where some people get a really cool story but many end up disinterested or confused.

Are you using PowerNotes or Dynamic Documentation? From the issues you mention, it sounds like PowerNotes. A few things:

• If your system upgrades to LaunchPoint, you can access your documentation with one click to add your reevaluation.
• Timestamps in FirstNet depend on your documentation method, but you should be able to add autotext for quickly adding the time.
• Vitals, labs, and imaging should be incorporated automatically if you're using Dynamic Documentation, which is why I'm guessing PowerNotes.

I can't say which system is better, but it sounds like your hospital isn't using the latest tech. All of the features I mentioned above came out several years ago.

So how much would it cost for a hospital to upgrade to the new tech?

I desperately want to find an easier way to do notes. To import rads. To import EKGs.

 

[KGflyboy]

[*]Timestamps in FirstNet depend on your documentation method, but you should be able to add autotext for quickly adding the time.

I use powernote. Never heard of dynamic documentation.

How do I create an autotext to place a timestamp?

I asked our IT people about this, and they said it can't be done. I also asked them how to create an autotext to import radiology reports and was again told it's not possible.

 

[deleted1013752]

So how much would it cost for a hospital to upgrade to the new tech?

I desperately want to find an easier way to do notes. To import rads. To import EKGs.

Sorry, underlings like me aren’t often included in those conversations. But I can tell you it’s highly variable. Number of sites upgrading, the terms of your hospital’s initial contact with Cerner, and what add-on services are included are major factors. Also Cerner never starts a project the way they intend to finish it. It’s like buying a house. You’ll start with the base price... oh you wanted doors on your house? That’s extra. Not every house has doors, but we can sell you some doors.

Also application-specific upgrades are uncommon. Normally a hospital upgrades their code (“takes a package”), and the upgrade will include a collection of changes. Then there’s other costs to consider like devices and integration (e.g. clerk scanning an image of an EKG into the chart vs the readout being natively and instantly available). I’m sure someone on SDN has been involved with those sorts of negotiations but not I, sir, not I.

 

[deleted1013752]

I desperately want to find an easier way to do notes. To import rads. To import EKGs.

Sorry, meant to address this aspect as well. Even if your site doesn't use the latest software, there may be ways to improve your experience. Do you know what level of code your system is running? This is commonly referred to by year, e.g. 2015 code, 2018 code (latest).

I use powernote. Never heard of dynamic documentation.

How do I create an autotext to place a timestamp?

I asked our IT people about this, and they said it can't be done. I also asked them how to create an autotext to import radiology reports and was again told it's not possible.

Dynamic Documentation is an interface designed to guide you through the flow of creating a note that is then stitched together at the end, vs a PowerNote where you open a blank or precompleted note and start clicking. My current client has everyone on Dyn Doc except GI and Anesthesia. OB/GYN uses both. GI uses PowerNote specifically because of its ability to import images from their procedures. Here's a screenshot of building an ED note in Dyn Doc:

And here's the finished product:

Dynamic Documentation aside, autotext and smart templates can be used in PowerNotes. So IT saying it isn't possible means one of three things: (1) they're not motivated to do it for you, (2) they don't know how, (3) it's not possible with your current build.

It's certainly possible. Your IT personnel hopefully have Cerner Connect accounts (sometimes called CernerCare). The site is used to share information on maintaining Cerner's back end, and there's some training stuff on there too. You might have an account but sometimes only hospital employees have it and not contracted groups. This page walks your IT person through creating Smart Templates, but recall that not every Cerner client has the same build.

A lot of smart templates are available as a stock collection from Cerner, and you can check which ones you have. With a note open, get to a free text area and you should see this icon:

In the next window, click Public Phrases and type the thing you want. I typed "time." Results appear and you make your selection. If you type something like "lab" you're going to get a lot of results and some may not work. After clicking a result, a preview appears on the right so you can see how it will appear when you use it. Anything in brackets updates automatically.

And here's how it looks in use:

Remember your system might not support this function.

 

[KGflyboy]

I'm not sure how to find the level of code. When I click "help", then click "about" it says copyright 2014. Maybe that's the code version.

When I click that button to see the public phrases, there are only a total of 19. None of them are helpful or relevent in the ED.

Can I build a smartphrase to make a time stamp myself, or can only the IT people do it?

I'm starting to realize my IT department is either lazy or simply sucks. Combine that with the fact we have a very old Cerner build, and I have a less than stellar charting experience.

 

[deleted1013752]

I'm not sure how to find the level of code. When I click "help", then click "about" it says copyright 2014. Maybe that's the code version.

When I click that button to see the public phrases, there are only a total of 19. None of them are helpful or relevent in the ED.

Can I build a smartphrase to make a time stamp myself, or can only the IT people do it?

I'm starting to realize my IT department is either lazy or simply sucks. Combine that with the fact we have a very old Cerner built, and I have a less than stellar charting experience.

Any chance you have Dragon?

 

[Siggy]

@Groove

1. typing .labs or .rads doesn't do anything with my CERNER version.

Try \Lab (case sensitive). At my hospital that will give you a drop down for all of the labs available to directly input. Unfortunately I don't know how to import all the labs with a single click.

 

[RustedFox]

Try \Lab (case sensitive). At my hospital that will give you a drop down for all of the labs available to directly input. Unfortunately I don't know how to import all the labs with a single click.

No dice.

 

[KGflyboy]

Any chance you have Dragon?

Mmodal

 

[deleted1013752]

When I click that button to see the public phrases, there are only a total of 19. None of them are helpful or relevent in the ED.

Can I build a smartphrase to make a time stamp myself, or can only the IT people do it?

Okay so they haven't made many autotext phrases, but the templates might still be available. Worth checking at least.

Hopefully this area has more than 19 things in it. Granted we're on different systems but where I'm at the public phrases showed 3 results for "time," whereas the data tokens/templates area shows 7, two of which are appropriate in this context. Anyway I made an autotext phrase with the token:

If there are no tokens or templates in that section then you have other options, but none of them are good. You cannot create templates or data tokens without having the supporting code from Cerner and/or the ability to edit the program's back end. You could use software to create custom hotkeys but that requires installing a new program. If you don't have those data tokens I can look into some other ideas.