Cerner unveils ‘smart’ function at SIIM meeting

April 27, 2006

Working smarter is a critical element of improving workflow. At the Society for Computer Applications in Radiology meeting today, Cerner unveiled a work-in-progress that addresses that point head on.

Working smarter is a critical element of improving workflow. At the Society for Imaging Informatics in Medicine (formerly the Society for Computer Applications in Radiology) meeting today, Cerner unveiled a work-in-progress that addresses that point head on.

SmartOrders, due for commercial release by fall, provides feedback to referring physicians on the advisability and likelihood of reimbursement for imaging exams at the time they are ordered.

"We are building intelligence into the system upstream at the time orders are being placed to make sure they are appropriate in the clinical context," said John Hansen, director of engineering and product management. "This will allow the radiology department to leverage resources most effectively and efficiently and to ensure the patient gets what is right."

To date, most of the effort directed at gauging the appropriateness of exams has come later on, after the order has been placed. This may be done manually by radiology staff, who evaluate orders, or by a RIS running algorithms that make these assessments.

Finding errors helps prevent the wrong exam from being done, but correcting errors after they have been passed to the radiology department exacts a price of its own, Hansen said.

"You have to track down the referring physician to change an order, and that adds time to the process," he said. "With SmartOrders, we will get an efficiency gain."

There is an added benefit, according to Hansen. SmartOrders will provide the referring physicians with a higher level of confidence. They will know that the orders they place, if accepted, will be done.

This new function is nearing the end of its development at Cerner, which is integrating content from Medicalis into the Cerner Millennium IT product to achieve this capability. The smart algorithms will begin the certification process this summer.

SmartOrders is the latest result of a concerted effort by Cerner to speed workflow. Last year, the company introduced its "zero click" approach to PACS with a decision engine that drives the diagnostic process by anticipating radiologists' needs. Specifically, when radiologists save their dictation, the IT system launches images for the next study on the work list and reinitializes the dictation function.

"With zero clicks, you are ready to move on to the next study," he said.

The release of SmartOrders later this year will take the idea to a new level, one that assesses the actions of physicians. SmartOrders will be accompanied by other enhancements more in line with the zero clicks idea of simplifying operations. One such work-in-progress described at the SIIM meeting is the development of an open framework for Cerner's workstation. The ConnectIT is designed to provide access to non-Cerner applications from the desktop.

"We are getting a lot of demand from clients with 3D workstations and voice recognition systems who want these applications to launch from the desktop," he said. "With this open framework, they will be able to do that."

Another improvement leverages Cerner's PACS architecture - its so-called multimedia foundation - to bring ECG data into the company's PowerChart electronic medical record. Although not specifically designed for radiology, this new capability, called DICOM ECG, builds on the company's technology for archiving and managing large objects and images. It is an example of how DICOM-based developments can be used to manage information that does not lend itself to the HL7 standard, which typically rules the handling of vital signs and other nonimaging patient data.

Cerner's development of this new facet was done in collaboration with Mortara Instrument, a vendor of ECG monitors. The open architecture instituted by the two companies clears the way for the entire industry.

"Any ECG supplier that supports the DICOM ECG standard will be able to feed its data into PowerChart," Hansen said. "It is a very compelling advancement in architecture."