Great question on system performance

Question by email:

Just had a patient who is Director of IS at (a local hospital). They use the same Cerner CIS system there as we do both in the hospital and in the outpatient clinics (all across the country in 22 states, etc.) with their main “server” in Tennessee. He said to me “is it always that slow”? There were lots of half second to one second pauses etc. I said "yes, (no different than is has been for years)." He said, “they would have me by the … if the system were that slow at (my hospital).

What could possibly be the issue with our product?

Answer:

At Baystate, we "host" Cerner on our own servers whereas the aforementioned hospital system likely uses what is called an ASP version, or application service provider, such that their Cerner products are web-based. Furthermore, the perceived lack of snappy responsiveness is not only because we use our own local servers, but, as a system, we use the Cerner product that allows us to customize its various tools to our needs. These require more time and juice to operate. Customization is neither offered nor available with the ASP version of the Cerner EMR.

As tough as it might seem in its current state, we, as a physician group, would not be happy if we had to use Cerner contents "out-of-the-box". In addition to our customized PowerNotes, there are other fixed designs that would have you scratching your head as to whether there had been enough clinical input during development.

Another likely factor is that this other system is not able to do nearly as much as we do at BH with our EMR. While the rest of the country is struggling to come to terms with the reality of HIT (health information technology), Baystate is in the 99th percentile with regard to EMR adoption and expansion. We are excelling at CPOE, electronic documentation, data storage and retrieval, and the list goes on.