Most Interesting Vendor: Cerner — Moving Outside the Hospital's Four Walls

May 29, 2014
Facing several different challenges—including a massive shift towards ambulatory care volume; the ongoing consolidation of the EHR; and above all, the juggernaut-like advance of the Verona, Wis.-based Epic Systems corporation in grabbing the lion’s share of new EHR contracts, Cerner has managed to stay toe-to-toe with Epic.

When Cerner was founded 35 years ago by CEO Neal Patterson and others, its fundamental purpose was to help solve healthcare by making it safer and more efficient. Over the years, the Kansas City, Mo.-based company seems to have succeeded in those areas largely due to its dominance in the global health IT market and its efforts to digitize paper processes by supplying solutions, services, devices and hardware for healthcare organizations. These solutions are licensed by approximately 9,300 facilities globally, including more than 2,650 hospitals; 3,750 physician practices 40,000 physicians; 500 ambulatory facilities, such as laboratories, ambulatory centers, cardiac facilities, radiology clinics and surgery centers; 800 home health facilities; 40 employer sites and 1,600 retail pharmacies, according to Reuters’ profile of the company.

Facing several different challenges—including a massive shift towards ambulatory care volume; the ongoing consolidation of the EHR; and above all, the juggernaut-like advance of the Verona, Wis.-based Epic Systems corporation in grabbing the lion’s share of new EHR contracts, Cerner has managed to stay toe-to-toe with Epic while maintaining a strong position of favorability among patient care organization IT leaders.

In fact, in the “2013 Best in KLAS Software and Services” report, the Orem, Utah-based researcher found Epic and Cerner acute care EHRs to have had the strongest integration story across the continuum of care. “They continue to be the highest-rated and continue to get the most new market share year after year,” said Colin Buckley, director of research strategy at KLAS. Additionally, the company recently reported a first-quarter 2014 revenue of $784.8 million, as well as a 2013 health IT revenue of $2,910,748,000—ranking 2nd in this year’s HCI 100, a list that annually ranks the 100 vendors with the highest revenues derived from health IT products and services earned in the U.S.

At the core of Cerner’s strategy going forward is finding ways to improve the wellbeing of individual people, but also entire populations. By designing leading-edge health information technology, the company aims to offer strategies that empower its customers to know, manage, and engage its populations.  Cerner believes that understanding the needs of groups—and then predicting and coordinating the most effective interventions, will lead to a better healthcare, says Matthew Swindells, senior vice president, population health and global strategy, responsible for leading Cerner’s population health organization. “The goal is to move from reactive sick care to proactive health. This transformational shift toward proactive health management aligns with the vision Cerner was founded on [35 years ago],” Swindells says.

Indeed, Cerner has made population health a significant priority in recent years. The company’s 2013 acquisition of PureWellness, a leading health and wellness company that develops solutions to enable population health, has further positioned Cerner to help organizations manage the health and care of patient populations. What’s more, Cerner’s population health suite of solutions is built around HealtheIntent, a new data platform that is EHR agnostic, and aggregates and normalizes data from any source. To create a longitudinal record for each patient or “member,” HealtheIntent coordinates data across the continuum of care through digitization, predictive analytics and real-time decision support. The platform sits above the venue of care and links together all of those venues to provide an integrated view of a community of care, enabling the user to get a longitudinal view of what’s happening to a patient at any point in time, explains Swindells. 

Matthew Swindells

“It’s really important to have a fantastic EHR in the hospital, but transforming healthcare is more than just being fantastic in the hospital—it’s about linking up all of those venues of care in real time and being able to drive actions in the right place,” he says. “So if the protocol for managing a patient, who just had a heart attack, is to talk about rehabilitation and his or her lifestyle going forward, we want to be able to take that across multiple venues for that patient to receive the right care wherever he or she may be.”

As such, Swindells feels that the future of healthcare needs to be one where the individual is at the center of healthcare, rather than the hospital. And a big part of that, he adds, is getting technology to be more interoperable, because health systems are now saying to vendors, “Either you interoperate with what we have, or we will replace you.” To that end, last year, at the Healthcare Information and Management Systems Society (HIMSS) annual conference, Cerner and other leading health IT vendors announced the launch of the CommonWell Health Alliance, an organization that combines the health and IT knowledge of organizations to create a seamless data environment through common platforms in order to liberate health data from clinical and financial silos.

But still, Swindells feels that health IT suppliers have done far too much whining when it comes to government mandates and regulations. “The government is heavily invested in health IT through meaningful use, so they need to push faster and harder. Some are saying that we’re going too fast, but the government has invested so much, they have a right to push us and they have a right to insist on things like data being shared and interoperability,” he says. “And I think the healthcare IT industry will either respond or get out.”

A Cultural Shift

The key to this new type of care management, Swindells says, is to step away from just the hospital sector, and instead look at how to transform the health of a population, lower the risk of a population, lower the use of hospitals, and ultimately get better health at a lower cost. Swindells says that was a challenging transition for Cerner, whose standing has long been within the hospital segment. “Yes, that has been our reputation, but our vision has always been wider than that, and now you’re talking about home care and other forms of extended care,” he says. “The reforms in the American healthcare system—particularly with accountable care organizations (ACOs) and the shifting of risk to health systems—reinforce the objectives that health systems have together with the vision that Cerner has.”

That shift from reactive care to preventive care is one that seems to be a taxing one for both vendors and providers across the health IT industry, as the payment model is partly in fee-for-service and partly in the new risk-based contracts. So any big health system has to manage both models simultaneously, making it a very complex dynamic as you move from one to another, Swindells says. “In that respect, we’re trying to bring the expertise that we brought from the hospital sector to ‘close the loop’—identifying the risk, treating the risk, and managing improvement right out into the community. For the person that had a heart attack, how do we make sure he or she is weighing himself or herself every day and that the IT is tracking that weight? Who is chasing them if they’re not?  That’s what closing the loop means, and it’s a whole new way to thinking about healthcare.”

One such integrated health system that needs to manage the care of more than 500,000 patients—the Chicago-based Advocate Health Care, who collaborated with Cerner in 2012—has deployed a population health strategy that integrates all of Advocate’s data silos, including administrative and electronic health information. This data will then be used to create predictive models for patient outcomes before they occur—leading to early interventions. The health system/vendor partnership works because the organizations have aligned visions to drive towards something richer to promote wellness across the care continuum, says Rishi Sikka, M.D., senior vice president of clinical transformation for Advocate.

Sikka says there were three parts to the strategic partnership that would help further population health, starting with building a data platform to create true longitudinal patient histories. Sikka notes that a total of 50 to 60 data feeds are coming in, both internal and external, from a variety of different EHR vendors. While that work is largely complete, Sikka says the next part revolves around developing analytics and predictive models. And the last part to the health system’s population health strategy is implementation, as Advocate has a team of industrial engineers who look at workflow, process, and design.

Rishi Sikka, M.D

Undoubtedly, Advocate’s population health strategy has helped bring Cerner’s population health management solutions to market. “It wasn’t always smooth sailing,” Sikka admits, referring to bringing two different organizations together with very different cultures. “The melding and the synergy that has occurred have been tremendous, and that’s because of the alignment of our direction,” he says. “We spent a lot of time asking the ‘why’ question. Why are Advocate and Cerner both here doing this? And the reason is centered around health and wellness—it was just so aligned.  “Now we have tapped into it, and have provided direction, energy and leadership to bring different organizations together to generate real solutions, results and impacts.”

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