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Project Northstar

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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dbelgard

(@dbelgard)

Posts: 6

Active Member

Topic starter

Project Northstar? I was able to see a small portion of the webinar today, total replacement of CPS? Thoughts on it?

Posted : June 8, 2016 11:11 am

Lee

(@lee-cooper)

Posts: 348

Reputable Member

Eventually, I would say the answer is yes. It will take time to do it, of course. GE's plan is to roll out components in segments with the initial item being a new orders workflow. It is important to note that all components will continue to work within the existing framework of CPS and C-EMR, replacing as they go.

Posted : June 8, 2016 12:12 pm

dcarpenter

(@dcarpenter)

Posts: 323

Reputable Member

GE is trying to stress the point that Northstar will not replace CPS, but it does seem like it will eventually have replaced all of the major components of the system by the time it is all rolled out. I think the main point they are making is that Northstar will be a modular rollout to prepare CPS and EMR to join the GE healthcloud framework.

On the plus side, the first module we are getting is to change how Orders work, so...YAY! ^-^

Posted : June 8, 2016 1:13 pm

swestfisher

(@swestfisher)

Posts: 132

Estimable Member

Yesterday's presentation was all buzz words and "pie in the sky in the sweet by and by". It was very useful to see GE's vision of the future, and they may have acquired the proper leadership to make it happen - time will tell. We will know more when the OS requirement is not PowerPoint.

From a workflow perspective it will be interesting to see how the clinician will enter information during the encounter on the tablet, I doubt point-n-click will be sufficient. Most (but not all) of our current crop are computer adverse so the likely hood of having the chart complete by checkout is remote at best. This may not be an issue at your site and as retirements loom, will eventually be a non-issue for us as well.

The above paragraphs do look rather negative, but I am actually excited to see the vision that GE presented and I feel that they are moving in the right direction. I will have more confidence in their ability to deliver once I can get my hands on something. I believe the next couple of presentations will have more meat in them so that expectations can be more appropriately set.

Steve

Posted : June 9, 2016 2:04 am

Adam Daniel

(@adaniel)

Posts: 524

Prominent Member

I wonder if this entails an entire MEL overhaul. Would be nice to know when it gets closer, so custom form user can begin to adjust.

Posted : June 9, 2016 4:10 am

gibsonmi

(@gibsonmi)

Posts: 827

Prominent Member

I would expect a slow transition away from MEL entirely to HTML5 and javascript. Right now if you develop html forms you still need MEL underneath to get and write data but I would bet that over time they start using web services to accomplish that.

Posted : June 9, 2016 5:23 am

Lee

(@lee-cooper)

Posts: 348

Reputable Member

We are uncertain as to the future of MEL, current forms architecture, or even HTML 5 at this time. With regard to JS, there was mention of a transition away from vanilla JS to Angular JS along with mention of HL7 FHIR interfacing. This suggests that all that we know today will eventually be sunset and replaced with more scalable approaches. To be clear, this is a best guess based on vague statements made to date. I am not certain that GE has even determined what the final approach will be for documenting a visit at this time.

I would suspect that, given the vast variety of content that exists currently, this will be close to if not the last component included in the revamped package, if for nothing else, the current need to better understand documentation requirements for the next series of alphabet soup requirements. I suspect that will drive the framework far more than existing technologies in use today.

Posted : June 9, 2016 6:27 am

Adam Daniel

(@adaniel)

Posts: 524

Prominent Member

That would make sense and would bridge the gap of HTML forms and the EMR. I can't speak from experience but writing HTML then making it write to MEL seems cumbersome.

Posted : June 9, 2016 8:33 am

tnc

(@tnc)

Posts: 517

Honorable Member

I have some concerns about cloud based offerings as I live and work in a place where hurricanes and tornadoes are prevalent. Our clinic is attached to a hospital with UPS and generator power but there have been times where the internet is down, although rare. Hurricane Andrew back in the 90s knocked out power in the Miami are for 3-4 weeks in some areas. There have been major backbone outages in Atlanta which have affected us in the past 5 years with no storms. A SLA is cost prohibitive. We have instead invested in a good hurricane/tornado proof infrastructure which eventually we won't be able to use to keep us running.

So we have to do this because that is the way GE has decided to go. I will need to explain to our providers that this is not optional and that there may be disruptions. Our up time has been very good because we have control over it. I already have some concerns with GE being the cloud provider here given some challenges I have had with sales and support.

I have thought about this for a while and have a Pro/Con list

Pros-

It is supposed to save money. We would only save money if we no longer had to pay for licensing (SQL, Windows, VMWare), SAN/Blade hardware, After hours support for upgrades, kb updates, ICD updates. If we could move our entire infrastructure into the cloud we might save money but not as a piecemeal approach

IT staff reduction (possibly)

licensing? Will we finally be able to get away from learning the foreign language that is licensing? It is usually when we receive one of those large bills when we have to decode the item names and quantities to be sure we are good.

Cons-

Lower expectations-If I don't do this then it will certainly come back to burn IT. We will have no control over ISP outages, or GE cloud outages.

Limited or changes in work flows. Nuance Dragon is an example as they are going "cloud only" too. This will limit some things our docs do now with respect to templates. Some of our providers tried the cloud version but did not like the limitations.

Inability to shop for the cloud provider with a good reputation (in the case of GE). This cloud will be bleeding edge instead of something with a history. Will that be good or bad?

Backups-How will this part work? I am certain the GE legal will continue to leave the responsibility on us to backup OUR data. How do we do that? Would it be possible to pull a 100GB backup down overnight? In a day? a Week?

GE closures for storms in TX and holidays. I don't do it if I can avoid it but I have worked holidays in the past. Storms in TX will now affect me in FL {possibly}? Unless they are willing to give me access to the servers, lol

Speed-The biggest complaint I hear from cloud customers (Exchange 365, Cloudcare, others) is speed or lack thereof. I hope GE's offering will not be like that.

Cloud Experience so far:

RTE plug-in. At the beginning of every month, this GE provided cloud service is horrible and our help desk explodes. I don't bother calling support on this because there is nothing they can do. Remember, lower your expectations.

GE Licensing server down for maintenance on certain weekends.- This has not affected me but it could have. This may be irrelevant in a cloud situation -it should be.

Index Logic-We tried this but it just didn't''t fit our work flow and we couldn't really adjust our work flows to make it work. The pdf documents leave our site where we have massive computing power which we could leverage for OCR, it goes to a cloud facility in TX, then comes back maybe in 5 minutes, an hour or overnight. The employees get to keep checking with no control over it. All for just to do something which we can do here on site? It made no sense.

Tiger Text-They always blame their outages on AWS. While true it doesn't help when it is down.

This is not cloud hater rant; there are some good things about clouds which we do use. We have a piece of our backup strategy in the cloud (Amazon Glacier). It wouldn't be a fast recovery though, so it is only archived data. If we miss a window then it is no problem to catch up. I am considering the cloud for our mail server too, but that is down the road.

Consideration to switch vendors over this will probably also disappoint as everyone seems to think this "one size fits all" solution is good for everyone. If you went to another vendor there is no guarantee that they will remain cloud free. It is certainly good for the bottom lines of the vendors.

The lower your expectations are, the happier you'll be.

Mike Zavolas
Tallahassee Neurological Clinic

P.S. GE, if you are listening...PLEASE use a standards based model for the client end so we can FINALLY use OSX clients, linux, Chrome OS or Windows (Mozilla, Chrome or even IE if you really want to) Staying with the proprietary MS model is killing us, especially if you require a MS client to get to the cloud. If we could cut costs on the client end it will help. Jboss can handle it but you have to demand a higher standard from your developers!

Posted : June 10, 2016 4:51 am

Lee

(@lee-cooper)

Posts: 348

Reputable Member

Two interesting articles that tie into your concerns:

http://www.wsj.com/articles/SB10001424052702304908304579566662320279406

http://blogs.cisco.com/perspectives/iot-from-cloud-to-fog-computing

Will be interesting to see if GE follows suit and keeps a 'local client' of some sort to provide needed muscle to manage the data streams. Given the descriptions thus far, it certainly sounds like it. 🙂

Posted : June 10, 2016 5:58 am

burnsh

(@burnsh)

Posts: 155

Estimable Member

I was at C-LIVE and participated in the Customer Advisory Group meeting - I am on the optimistic side at this point and agree with some of the comments above, which imply that there's really no other choice than to move toward the cloud (or the fog). At the very least, it seems like GE is making a pro-active decision rather than a reactive one.

Posted : June 14, 2016 8:38 am

tnc

(@tnc)

Posts: 517

Honorable Member

Cloud technology is nothing new; the 'cloud' is just someone elses computer/server which you are accessing remotely. That remote resource is only as good as what the provider maintains. We have to trust GE based on past history and their word that everything will be great.

There are many links in the chain between the customer and the cloud. A chain is only as good as the weakest link. I would not want to be a patient with an operable brain tumor but a good prognosis potential who can't be scheduled for surgery because some link in the chain is preventing CPS from running. As the IT guy employed to be sure that stuff is running, my hands will be tied if something is wrong on some cloud somewhere.

I am trying to be optimistic but as a technical person I have to look at the details so that we can rewrite policies and plan the appropriate infrastructure. I am already backed into supporting other cloud services here at the clinic. I do know how to fix a certain recurring problem but can't get past the helpdesk to talk to a tech person. I do not have access to their servers to fix the recurring printing problem without their help so we just tell our users to reboot and -hope- that they get on a different server with this particular cloud service. This has been going on for 9 years so far with no improvement....but they are in the cloud so I guess everything is good.

Posted : June 15, 2016 9:08 am

virtualHITman

(@virtualhitman)

Posts: 319

Reputable Member

WARNING - MAN ON A SOAPBOX AHEAD

I didn't want to respond to this forum post just yet because I am waiting to hear GE's final presentation in July (it's supposed to be more technical and less PR fluff); but I'm having a weak moment and need to blow off some steam. Anyone developing custom content for their medical practice as an employee or as a consultant should be extremely interested in how this whole Northstar project plays out. All I will say at this point (okay I lied, I'll say a lot more) is that I hope GE taps into the creativity and talent of this community and the third party entities that are delivering meaningful solutions today. GE appears to be saying the right things, but actions speak louder so I am suspending my skepticism for the moment. In my estimation, innovative third party entities and experienced IT departments are far more agile at delivering solutions that positively impact physicians and end users; mainly because they can focus on the needs of specific specialties and functional workflows and channel their expertise towards solving a particular problem. GE has stated that they recognize you can't be all things to all people but their recent announcements are filled with platitudes and lack substance. I hate to sound so jaded but I've heard the same language from most of the other large EMR companies. In my opinion, GE would do well to focus on the database infrastructure and the interoperability components (i.e. workflow and rules engines; not to mention some thoroughly documented APIs) and then create the governance framework and tools necessary for third party entities and medical practices to develop solutions around this infrastructure. I have heard language (words such as "highly configurable") that would indicate they might be exploring this kind of strategy (long term), but at this point, nothing has convinced me they will actually deliver anything of substance. Centricity's greatest strength (it's relative openness compared to other EMRs) is also its greatest weakness when you consider the inevitable transition from fee-for-service to value-based payment systems. Capturing the right data at the right time in a fashion that facilitates and promotes best practices is not a new concept but it will require the intellectual capital of those at the "tip of the spear" as one of our doctors put it; and that includes providers, nurses, admin staff, and IT. I am not opposed to "the cloud" per se as it has many advantages, but many organizations look to their internal IT departments to deliver usability and interoperability, so designing for the cloud is a dangerous proposition when you consider all of the nuances involved from one organization to the next. I understand the need for greater control of the data, but if it is at the expense of customization and product extensibility, then no thank you. There are far more questions than answers at this point and the lack of specificity on how they will transition all of their clients (many of whom have invested a great deal of time and effort into customizations and interfaces) to the Northstar solution unnerves me; particularly when so many other root issues have gone unaddressed (ref. unsigned clinical list change issue). I am generally an optimistic person, but I believe that if GE were truly interested in partnering with end users on the next generation version of their product, they would figure out a way to solicit input from the community and provide regular feedback to those willing to invest their time into making the product better for everyone. Sorry GE, working with a select few of your high profile practices is not enough to convince me. Sometimes the most innovative and creative thinking comes from the smallest of medical practices. I hope I am wrong, but what I have seen (and not seen) thus far leads me to believe that GE might be saying what we want to hear in an effort to veil the possibility that they want to control everything for the sake of cashing in big on "pop health" opportunities (it would be too soon if I never heard that expression from another salesperson :)). Time will tell.

Posted : June 28, 2016 9:00 am

virtualHITman

(@virtualhitman)

Posts: 319

Reputable Member

You are spot on with your comments. Completely agree! As Han Solo once said, "I've got a bad feeling about this."

Posted : June 28, 2016 10:29 am

aaltotsky

(@aaltotsky)

Posts: 129

Estimable Member

gibsonmi: ... Right now if you develop html forms you still need MEL underneath to get and write data...

Not necessary. The $mdObject ( https://github.com/mdObject/GECentricity) wrapped all MEL call. So you could produce an HTML/JS/CSS form with zero MEL in it.

Posted : June 28, 2016 12:58 pm

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