cerner's interoperability

Cerner’s Interoperability Challenges and the Workflow Solution

Electronic health records (EHR) have become essential to medical care today. These records contain an individual’s medical history. They include clinical and administrative information such as addresses, allergies, and medications, and the digitized data allows healthcare providers to share patient information securely for improved patient care. 

Cerner’s Millennium system is an EHR solution that works with its specialty EHR applications at over 27,000 sites worldwide. Despite being a popular system, Cerner’s interoperability with third-party solutions has been limited by its fee-based implementation model. However, with its 2022 acquisition by Oracle, its ongoing interoperability capabilities have yet to be defined.

Cerner’s Interoperability Challenges

In 2024, the primary challenge for interoperability with Millennium is its integration with Oracle’s Healthcare Center. According to Oracle, the acquisition will leverage Cerner’s clinical capabilities with Oracles’s analytical and automation expertise to build a cloud-based healthcare information system. Since late 2023, Oracle has been gradually migrating Millennium customers to its cloud-based infrastructure by rewriting the Cerner platform for cloud deployment.

Deployment Delays and Rising Uncertainty

When Oracle acquired Cerner, it also acquired a contract to deliver a Cerner-based EHR system for the Department of Defense and Veteran Administration Hospitals. The deployment was paused in 2023 to address implementation concerns, and it is expected to take much of 2024 to correct.

Related: A Quick Guide to EHR Integration for Health Apps

For existing Cerner customers, migrations to the cloud platform may be delayed as more resources are needed to address the troubled project. For third-party developers, the pause may provide opportunities to deliver added functionality to Cerner implementations using existing integration standards.

Integration Standards

Cerner uses the following standards for third-party integration:

  • HL7 FHIR

Although SMART and SMART on FHIR are listed separately, all standards require FHIR. Cerner only supports HL7 FHIR; however, older installations may use HL7 without FHIR. The Oracle Cerner website lists the features available on each release of an interface. 

Cerner Interoperability Options

Access to third-party applications depends on the standard and the application. Users can access applications through drop-downs, ribbons, or through effectively integrated workflows. Each access method requires careful evaluation to ensure compatibility.


The simplest Cerner integrations list applications in a drop-down menu. Each application has a SMART on FHIR button that users must select to access it. Cerner users must be aware of the application or have time to scroll through the list to find an application. The drop-down menu does not display automatically. 

This access method is inconvenient for physicians to access during time-sensitive patient engagements. They must toggle from Cerner’s EHR solution to an external application, provided they’re even aware of its existence and it comes to mind for that specific patient. Application developers must find alternative ways to make Cerner users aware of their solutions if they want to ensure their use.


Ribbons alert Cerner users to recommendations, reference material, or insights. There’s no scrolling through menus to find an application; however, information accessed through ribbons must be manually entered into the EHR. Although users do not have to search for data, they do have to update their charts with the information.

Regardless of their specialty, physicians spend an average of 4.5 hours per day charting, much of that time after hours. Rushing to update EHRs can contribute to errors, missed treatment options, and billing mistakes.

If physicians copy and paste data, they can still miss pertinent information. If they re-enter information, they can introduce typographical errors. These inadvertent errors can introduce misdiagnoses or poor treatment plans in subsequent interactions.


Integrating third-party applications into Cerner workflows improves interoperability, but it also takes more time and resources to achieve. Plus, there’s no guarantee that a fully integrated application will be used if it’s not truly integrated. A 2020 study of 791 EHR third-party applications divided applications into administrative apps, provider support, and patient care. The study then divided the applications into 18 subcategories. 

The researchers found that EHR applications should address well-defined problems rather than developing added features. According to the study, “providers know the holdups in their EHR documentation or clinical workflow, and they need technology to address those specific needs.” The more integrated applications are into workflows, the more useful they will be to anyone working in a healthcare setting.

Effectively integrated applications minimize the need for users to toggle between applications. Pertinent information appears through pop-ups, sidebars, and badges. If data is used, it is automatically written to the EHR, reducing errors and physician burnout while providing improved patient interactions. This is level 4 interoperability, and it’s becoming an essential need for today’s clinicians.

Achieving Level 4 Interoperability

Level 4 interoperability means data is exchanged securely and in real time. It enables true integration into end-user processes and workflows. Having that level of integration makes an application substantially more usable and useful. 

However, achieving that level of interoperability takes time—time for development, testing, and implementation. It requires considering end users who are looking for specific tools to address their needs. Clinicians aren’t looking for the latest and greatest features. They want easy-to-use tools that improve their productivity.

Interoperability that automatically displays context-based information eliminates the need to toggle between applications. A Harvard Business Review study found that people spend 9% of their time toggling between applications across all industries. Moving from one application to another not only increases burnout but also reduces the number of patients a primary care physician can see.

Related: How EMR/EHR Workflow Integrations Are Improving Healthcare

For example, 9% equals approximately five weeks or 25 business days. If physicians in private practice can eliminate their need to toggle between applications,  they could see an additional 300 patients per year, assuming 12 patients per day. With ongoing physician shortages, improved productivity lessens the burden on the healthcare system. 

True Workflow Efficiency

Clinicians need a solution that makes third-party applications accessible, actionable, and automated. One where end users do not have to scroll through drop-downs or toggle to external websites to find information. Instead, the right information is delivered at just the right time—while the clinician is meeting with a patient and making decisions about that patient’s care.

Clinicians undoubtedly benefit greatly from an integrated solution that embeds third-party clinical decision support tools, data analytics, and AI/ML insights directly into their native EHR interface. By eliminating the need to toggle between multiple systems, providers can access actionable intelligence within their established documentation routines—without disrupting their workflow.

Investment Returns Through Bidirectional Interoperability

Healthcare organizations can increase user adoption and return on investment (ROI) for third-party solutions by allowing clinicians to implement recommendations and update patient records without leaving their EHR. Bidirectional data synchronization prevents fragmented information and manual errors, ensuring that insights from external tools are effectively operationalized into actual care delivery processes.

Elevated Care Quality with Real-Time Clinical Guidance

An effective integration solution should surface the latest evidence-based guidelines, treatment pathways, and best practices from leading third-party knowledge bases at the most critical decision points within the clinical workflow. This ensures that providers have immediate access to current medical standards, enabling them to provide the highest quality care based on the most up-to-date information.

With the right platform, interoperability means third-party solutions reach their intended audience without forcing them to move outside their workflow. Seamless accessibility provides actionable data that healthcare providers can use to improve patient outcomes. They can spend more time focused on patients and less time charting.

Make Cerner’s Interoperability Work for Improved Patient Care

Insiteflow offers Cerner workflow interoperability without the need for extended timelines and added resources. Applications can reach end users quickly to become a valuable resource that relieves physician stress and burnout. The platform provides an accessible, actionable, and automated solution that delivers third-party applications to Cerner users for optimal patient outcomes. 

Request a demo to experience our cloud-based platform or contact us to learn how to overcome the 2024 challenges to Cerner interoperability.