Cerner Millennium

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'Bold text'Bold text''''Bold text'Cerner is a supplier of health information technology (HIT) solutions.

Introduction

Cerner was founded in 1979 by its current CEO Neal Patterson, Vice Chairman Cliff Illig, and Vice President Paul Gorup while they were a part of the Knowledge & Content Team at Arthur Andersen.[1] The vision of these three founders was to create a patient-centered system that would serve as an alternative to paper processes or financially oriented systems. The company has been automating one-fifth of U.S. health care for more than 30 years now. Cerner was initially known as a laboratory information system (LIS) developer, and its first product, PathNet, was installed in 1984. Besides automating general lab processes, PathNet encompassed microbiology, anatomic pathology and blood bank information. Cerner was commercially successful early on. It was profitable in its second year following the introduction of PathNet, which was well received by the industry. Incorporated in 1980, Cerner was the market leader in LIS and by 1986 it had 30 client placements. Growth continued with 70 clients in 1987, reaching 250 installations by 1990. While competitors focused on narrower domain, best of breed systems, Cerner's architecture allowed for integration across domains and it rolled out MedNet, RadNet and PharmNet beginning in 1987. Cerner added more modules in the 1990s with SurgiNet, MRNet for records management and Open Management Foundation.[1]

The company is headquartered in Kansas City, MO. It is one of the largest employers in Kansas City and employs over 14,000 associates worldwide.[2] Further, Cerner rated number 22 in 2014 and number 13 in 2013 on Forbes magazine list of World's most Innovative companies.

Locations

Cerner is headquartered in Kansas City, Mo. Cerner's world headquarters (WHQ) campus is across the street from North Kansas City Hospital, Cerner's second hospital client. In 2005, Cerner acquired the Riverport Campus complex on the site of what was formerly the Sam's Town Casino above the Missouri River in North Kansas City, Missouri. In 2006 it also acquired the former Marion Laboratories complex in southeast Kansas City, Missouri, renaming the campus the Innovation Campus. In 2013, the company opened the first building in a new campus development located in Kansas City, Kan. The company calls this the Continuous Campus. In early 2014, the company announced that it had begun a $4.3 billion campus construction project on the site of the former Bannister Mall in south Kansas City near the Innovation Campus.

Cerner maintains a handful of additional offices in the United States, as well as offices in the UK, Australia, UAE, Saudi Arabia, Egypt, Germany, France and several other countries outside the United States.

Clinical Applications of Cerner

Cerner's Vision has 4 pillars:

"1. Automate the Care Process to Eliminate Paper

2. Connect the Person by Providing Virtual Personal Health Systems

3. Structure, Store and Study the Evidence to Create New Knowledge

4. Close the Loop by Implementing Evidence-Based Care" [3]


As a result, the founders created Cerner Millennium, the industry's first person-centric integrated architecture. Cerner Millennium is a partnership of Cerner and HP. The architecture of Millennium allows caregivers and supporting providers the ability to view results, problems, diagnosis, medications, and other pertinent information in real-time as well as share clinical and management data across multiple disciplines and facilities. This architecture has been referred to as Health Network Architecture (HNA), providing 12 major system applications operating by this means, fitting into 4 interrelated groups [1]. In a continued effort to reduce waste and friction in healthcare, Cerner has developed many solutions including employee health, life sciences, medical devices, clinical trial management, and biosurveillance. In 2012, Cerner announced the launch of Millennium + which combines the enterprise platform with the secure Cerner Cloud (http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/, 2012).

In 2012, Cerner launched Millennium+, which uses the Cerner Cloud to provide a user experience that is “fast, smart and easy”, enabling caregivers to have personalized, intuitive and moment relevant clinical work flows via desktop, tablet or smartphone with minimal orientation to begin usage. [4] As a part of the initial launch of the Millennium+ platform, PowerChart+ Touch was released the same year. With a total revenue $2.8B including $391M globally (Cerner Corporation 2013 Annual Report), organizations ranging from single-doctor practices to hospitals to corporations to local, regional, national and global government agencies and organizations use Cerner solutions. As of 2012, Cerner works with more than 9,300 facilities worldwide, including 2,650 hospitals, 3,750 physician practices and 500 ambulatory clinics [5]. Associates span 7,300 worldwide with business in Argentina, Aruba, Canada, Cayman Islands, Chile, Puerto Rico, Saudi Arabia, Singapore, Spain and the United Arab Emirates.[6]

In a press release on August 5, 2014, Cerner Corporation announced that they would be acquiring Siemens Health Services for $1.3 billion. This acquisition will allow Cerner to provide health IT to 20,000 associates in more than 30 countries and 18,000 client facilities, greatly expanding their global presence.[7] This deal will increase Cerner's annual revenue form about 3 billion last year to more than 4.5 billion on annual revenue this year.

Based on 2014 estimates, Cerner and Siemens Health Services have combined totals of more than:

20,000 associates in more than 30 countries
18,000 client facilities, including some of the largest health care organizations in their respective countries
$4.5 billion of annual revenue
$650 million of annual R&D investment

Cerner's use of Oracle's Database Technology

The partnership between Cerner and Oracle helps to provide a number benefits to Cerner customers such as industry-leading scalability and reliability in both clustered and single system configurations; high performance; fault tolerance; heavy online processing loads; and the ability to handle a large number of users (http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014). Cerner Millennium applications use an Oracle database and provide a common data model to enable data sharing between applications and to eliminate redundant data, while maximizing reliability and performance. This implementation runs on a variety of networks, processors and operating systems, including Windows XP Professional and any Internet browser.[8] All Millennium installs take advantage of the full Oracle database stack (9iEE, RAC, and the Management Packs). Oracle’s Real Application Clustering (RAC) enables both reliability and scalability by allowing the addition of servers to the host cluster. Cerner also uses Oracle’s Tuning Pack, Diagnostic Pack, and Change Management Pack to help protect the integrity, confidentiality, and availability of its Millennium healthcare data. Oracle’s EAL 4 (Evaluation Assurance Level 4) rating also attests to its robust security. Additionally, Cerner's Remote Hosting Facility uses the full Oracle database stack (9iEE, RAC, and the Management Packs) as well and in an exclusive manner (http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014)

[Certification Commission for Health Information Technology (CCHIT)][1] performs rigorous inspection of EHR's integrated functionality, interoperability, security and is intended to serve health care providers looking for maximum assurance that a product will meet their complex needs. These listed products have CCHIT Certification but have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the American Recovery and Reinvestment Act of 2009 (ARRA):

1) Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)

2) Cerner Millennium PowerChart 2007 (Expired January 22, 2011)

3) Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)

4) Cerner Millennium PowerChart/PowerWorks EMR 2007.19 (Expired April 22, 2011).2

Millennium Objects®

Clients can create custom applications on the Cerner Millennium architecture with MillenniumObjects®. MillenniumObjects® utilizes Java and XML services for Application Programming Interfaces (API) development by client developers. MillenniumObjects® can be used to create custom applications and additional features on existing processes. This allows the user to create a unique application tailored to their specific needs using data already present within Cerner Millennium. Third-party extensions are available to create new workflows.[9]


1 St. John Sepsis Agent

Sepsis affects 750,000 patients per year in the United States alone reports a blog at Cerner’s website. It also states, nearly $17 billion annual healthcare expenditures in the U.S. goes to health problems associated with sepsis. Retrieved from, http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/ However, studies show sepsis can be handled better if it is diagnosed in the first six hours after contracting germs. In order to make this detection as early as possible, Cerner now has come with a solution. St. John Sepsis Agent, created in co-operation with Methodist health care in Memphis, Tennessee speeds up early detection and diagnosis of sepsis. How the system works? It gathers information from different sources such as: physician practices, ambulances, emergency department ,lab results and patient electronic health record’s vital signs.The integrated system analyzes all the informations gathered from the above sources which includes Glucose level, Respiratory rate, Temperature, Heat rate, and Lab results. An alert fires when the system finds three out of range criteria. Then the agent sends a message to the hospital’s clinical team which reviews the data and begins the appropriate treatment. In addition to the alert, there are enhancements that complement St John’s Sepsis Agent. One of such is The Millennium Light house. This program includes sepsis management power plan with orders for intravenous fluid, diagnostic tests and an empiric therapy advisor. This advisor guide clinicians to a variety of treatment option based on the source of infection.The agent offering also includes Significant Events mpage component which provides up front view of the patient’s most recent lab results, vital signs and significant treatment event. Retrieved from, https://www.youtube.com/watch?v=_-P6DZos9UU Finally, to follow up cases of sepsis, Cerner offers the Sepsis Confirmation Power form which is designed to use by organization’s quality officers during case review and quality reporting. Reports show using the St. John Sepsis Agent can improve healthcare organizations in the following ways: 24 percent reduction in in-hospital patient mortality rate. 21 percent reduction in length of stay. $5,882 medical savings per treated patient. Retrieved from, http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/

2 Acute care Electronic Medical Record

According to reports Cerner’s EMR delivers a comprehensive set of capabilities to healthcare providers..The EMR is built with Cerner Millennium® architecture that is unified, measurable and patient oriented. It is an enterprise-wide, multi-facility, longitudinal EMR. The design included a built-in expert medical knowledge which increases productivity in healthcare delivery. Further, the EMR integrates laboratory, radiology and pharmacy data into a single enterprise clinical data repository which helps caregivers reduce the risk of medical error and improve overall care quality. On top of that, the report states that it provides a secure real-time access to patient results and other clinical information whenever and wherever it is needed. Retrieved from, http://www.cerner.com/solutions/ Hospitals_and_Health_Systems/Acute_Care_EMR/

3 Cerner Laboratory solution

According to Cerner, their PathNet® laboratory information system delivers to clinicians a comprehensive and fully integrated technology that covers both the managerial and the operational sides of the laboratory. The system operates on the unified Cerner Millennium® architecture. As a result, information links seamlessly with the patient's electronic medical record. PathNet serves the needs of different sections under pathology departments umbrella such as Blood Science, Microbiology, Cellular Pathology and Blood Transfusion functions. The technology has a capability to store, retrieved and disseminated patient specific information to and from health care system. Aside from that, the system is continually updated based on national standards and guidelines. Reports enumerates the different kinds of benefits PathNet® laboratory information system provides. Some are: it has a capability to process large quantities of specimens efficiently with minimal error possible. It integrates lab results with patent's EMR which allows the availability of full patient records on the EMR. Finally it ensures the rapid availability of patent results to care providers. Retrieved from http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/

4 Device Connectivity

Medical devices contain critical health information reports a Cerner’s website, However, it can be a challenge to get that information into the care giver’s hand. As a result Cerner come up with medical device connectivity solution which alleviate this challenge. The company implemented the CareAware iBus, a core component of the CareAware connectivity architecture which acts as a USB for health care devices. In doing so, the solution connects medical devices with EMR enabling two-way communication between the two systems. This solution improves care by allowing care providers to focus on patients rather than paper work and data entry associated with it. Retrieved form http://www.cerner.com/solutions/health_care_devices/

5 Integrating medical calculators into the EHR

Medical calculators integrated in EHR are invaluable assists for care providers, reports a Cerner website. In order to address this need, a group of physicians at Cerner started to work on integrated medical calculator solutions. In order, to accomplish that they partnered with MedCalc300. As a result, this new solution provides all Cerner clients access to more than 600 calculators, clinical criteria and decision trees. To name one example of such clinical calculator is Apgar score for determining the well being of a new born. Retrieved form, http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033




References

  1. www.fundinguniverse.com/company-histories/cerner-corporation-history
  2. Reference: https://www.cerner.com/About_Cerner/Community_Impact/
  3. “Cerner Annual Report 2001” (March 2002) https://www.cerner.com/uploadedFiles/2001_Annual_Report.pdf
  4. Reference: http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/
  5. "Cerner EMR Solutions - An Overview". (May, 2012) Excite Health Partners
  6. "Cerner Corporation" (September, 2013) New York Times Business Day
  7. “Cerner to Acquire Siemens Health Services for $1.3 Billion” (August, 2014) Cerner News Release [[2]]
  8. Reference: http://h20338.www2.hp.com/enterprise/us/en/partners/cerner-millennium.html
  9. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/?LangType=3081
  10. http://www.cerner.com/blog/himss12_the_next_new_millennium_plus/
  11. http://www.forbes.com/companies/cerner/
  12. http://www.forbes.com/sites/matthewherper/2014/08/05/cerner-to-buy-siemens-health-it-business-for-1-3-billion/
  13. http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/
  14. http://www.cerner.com/solutions/ Hospitals_and_Health_Systems/Acute_Care_EMR/
  15. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/
  16. http://www.cerner.com/solutions/health_care_devices/
  17. http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033