http://clinfowiki.org/wiki/api.php?action=feedcontributions&user=Annathehybrid&feedformat=atomClinfowiki - User contributions [en]2024-03-28T22:17:19ZUser contributionsMediaWiki 1.22.4http://clinfowiki.org/wiki/index.php/The_use_of_electronic_medical_records:_communication_patterns_in_outpatient_encountersThe use of electronic medical records: communication patterns in outpatient encounters2015-10-16T01:46:12Z<p>Annathehybrid: Created page with "The is a review of the article, “The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters. The article was written by Makoul, Curry and Tang. ..."</p>
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<div>The is a review of the article, “The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters. The article was written by Makoul, Curry and Tang.<br />
<br />
==Introduction==<br />
<br />
The article summarizes the use of electronic medical records. The purpose of the study was to determine if communication patterns change when physicians use [[EMR|EMR]] as supposed to using paper records of patients. They also wanted to determine do determine if the ordering of particular labs and length of stay increase compared to physicians who use paper records.<br />
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==Methods==<br />
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The study was conducted at the general medical faculty practice of an urban medical center in Chicago. The physicians use the EMR system were using EpicCare for about 18 months. The participants of the study were three physicians who were using EMR system already implemented in their facility. The other three physicians use paper charting. The study also included a wide range of patients to participate in. All the subjects use in the study were male, due to the fact that the women that use the EMR only use the system outside of the examination room. The physicians that participated in the study were told to focus on physician and patient communication.<br />
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==Results==<br />
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The results of the study shows that the physicians that use the EMR were able to checked and clarify information better than the physicians that use the paper charting. When it came to time and how the test were ordered, there was no difference between the physicians that use paper charting and the physicians that use the EMR. The physicians that used the paper charting spent less time with their patients then the physicians that used the EMR system. The study also showed that there was a lack of personal interaction with the physicians that use the EMR. The physicians were often looking at their computer screens to type in data, which let to long periods of silence. The physicians using the paper chart had more personal interaction with their patient. <br />
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==Discussion==<br />
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During the study many different findings were discovered. The Physicians that used the EMRs were more active in clarifying information more efficiently. The EMRs that were being used gave them the proper tools needed to be more effective in their work. It also allow them to complete their tasks. The EMR physicians spend more time looking between the patient and screen, which made them look less sincere. The interaction that the physician has with their patient are very important. The EMRs were effectively when it came to workflow, but the small distractions with computer screen and recording information divides the attention of the physician. The information gathered in this study can be used to learn how to minimize these distractions.<br />
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==Comments==<br />
Having access to patient medical records at the face to face encounter is needed to make sure that patient concerns can be answered in real time. This access to medical records is also need to reduce the reliance from memory during the encounter. Paper and electronic medical records both have their benefits, in paper world it was easy to start a note and record important parts of history and physical exam findings during the interview, whereas depending upon the EMR it may not be that easy in the EMR, but all relevant information is at fingertips. Each facility may have to design their exam/encounter rooms in a way that minimizes these distractions.<br />
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== Related Article Reviews ==<br />
[[Heuristic evaluation of eNote: an electronic notes system]]<br />
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==References==<br />
<references/><br />
Makoul, G., Curry, R., & Tang, P. (2001). The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters. Journal of the American Medical Informatics Association, 8(6), 610-615. http://www.ncbi.nlm.nih.gov/pubmed/11687567<br />
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[[Category:Reviews]]<br />
[[Category:Usability]]<br />
[[Category:Technologies]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Main_Page/The_Use_of_Electronic_Medical_Records:_Communication_Patterns_in_Outpatient_EncountersMain Page/The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters2015-10-16T01:46:04Z<p>Annathehybrid: Redirected page to The use of electronic medical records: communication patterns in outpatient encounters</p>
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<div>#REDIRECT [[The use of electronic medical records: communication patterns in outpatient encounters]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Main_Page/The_Use_of_Electronic_Medical_Records:_Communication_Patterns_in_Outpatient_EncountersMain Page/The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters2015-10-16T01:45:33Z<p>Annathehybrid: Replaced content with "REDIRECT The use of electronic medical records: communication patterns in outpatient encounters"</p>
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<div>REDIRECT [[The use of electronic medical records: communication patterns in outpatient encounters]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Design,_Implementation_and_Evaluation_of_an_Architecture_based_on_the_CDA_R2_Document_Repository_to_Provide_Support_to_the_Contingency_PlanDesign, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan2015-10-12T17:23:59Z<p>Annathehybrid: Annathehybrid moved page Design, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan. to [[Design, Implementation and Evaluation of an Architecture based on the CDA R2 ...</p>
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<div>== Introduction ==<br />
[[Contingency planning for electronic health record-based care continuity: a survey of recommended practices|Contingency plan]] is necessary to ensure safe and smooth workflow of [[EMR|EHRs]] during downtimes. An effective contingency plan should be part of the health care organization and able to address the causes and consequences of EHR unavailability, triggering process and preparations that can minimize the frequency and impact of such events while ensuring care continuity. The authors of this study illustrate the design, implementation and evaluate a contingency plan at the lab scale that uses the [[Clinical Document Architecture (CDA)|Clinical Document Architecture (CDA)]] Release 2 (R2) document repository to support continuity of care during downtime. <ref name="2015 Campos">Campos, 2015. Design, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan. http://www.ncbi.nlm.nih.gov/pubmed/26262033 </ref><br />
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== Methods ==<br />
The contingency plan proposed in this study utilizes the redundancy generated by the document repository. The authors conduct a laboratory function study and classify the EHR downtime into two main groups:<br />
1) Level 1 is the application downtime, which refers only to problems such as deployment of new version or server issues that is related to EHRs, otherwise the rest of the computing infrastructure operation is normal. <br />
2) Level 2 is the total impact, which refers to situations when database server is affected. For example, natural disasters, database upgrade or maintenance, network outages and data center problems affecting the server farm or storage. <br />
Planned contingency tests (about 20 level 2) were run on different days at randomized times.<br />
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== Results ==<br />
In order to tackle level 1 contingency, the authors developed a CDA navigator, which has some of the elements of CDS as its indexes, which is used to generate a tree that can be accessed based on patient information. From the tree root (any patient of interest), time line for inpatient can be navigated and the caregiver can access all the data from the specified date. This application is deployed on a different server from the EHR, and with a different and redundant database. During EHR contingency the document based EHR can be retrieved. <br />
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In designing a plan to overcome level 2 contingency two pieces of information, present medication list and proper labeling for laboratory samples, were identified as necessities to provide continued care. Based on this, an application was developed to access the document repository every 30 minutes. The computers running this application were dedicated only for downtime use and connected to a local printer and uninterrupted power supply. These computers have a specific local disk space to a folder tree organized by department and inpatient location. Several computers run this application redundantly at specific locations.<br />
<br />
During this study, there were both planned and unplanned downtimes from a minimum of one hour to a maximum of 25.01 hours, during which the facility was able to access patient medications and print prescriptions (in some occasions more than thousand print outs were taken) and these printed prescriptions were erroneous in only < 2% of cases.<br />
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== Conclusions ==<br />
In unexpected EHR downtime the proposed contingency plan works well at the lab scale. The limitation of this contingency plan is that the back up occurs every 30 minutes instead of continuous real time. <br />
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== Comments ==<br />
This is the first study that proposes and tests a contingency plan for EHRs at the lab scale. However, the robustness of this method has to be further tested in other large and small organizations. Additional costs incurred for this contingency plan may make its implementation difficult, which may arise a need for more affordable alternatives.<br />
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== Related Articles ==<br />
<br />
[[Contingency planning for electronic health record-based care continuity: a survey of recommended practices|contingency plan]]<br />
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== References ==<br />
<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: EMR]]<br />
[[Category: HI5313-2015-FALL]]<br />
[[Category: EHR]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Design,_Implementation_and_Evaluation_of_an_Architecture_based_on_the_CDA_R2_Document_Repository_to_Provide_Support_to_the_Contingency_Plan.Design, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan.2015-10-12T17:23:59Z<p>Annathehybrid: Annathehybrid moved page Design, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan. to [[Design, Implementation and Evaluation of an Architecture based on the CDA R2 ...</p>
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<div>#REDIRECT [[Design, Implementation and Evaluation of an Architecture based on the CDA R2 Document Repository to Provide Support to the Contingency Plan]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/An_early_look_at_rates_of_uninsured_safety_net_clinic_visits_after_the_Affordable_Care_ActAn early look at rates of uninsured safety net clinic visits after the Affordable Care Act2015-10-12T17:22:15Z<p>Annathehybrid: Annathehybrid moved page An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. to An early look at rates of uninsured safety net clinic visits after the Affordable Care Act</p>
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<div>==Introduction==<br />
The Affordable Care Act (ACA) of 2010 <ref name=“ACA”> http://www.hhs.gov/healthcare/about-the-law/index.html</ref>was enacted to expand healthcare coverage (including Medicaid expansion) to the uninsured, which was estimated to be 47 million Americans in 2012. As of January 1, 2014, 25 states and the District of Columbia have expanded their Medicaid programs which studies show will allow 13 to 22 million individuals to gain Medicaid coverage. <ref name=“Angier 2015”>Angier 2015. An Early Look at Rates of Uninsured Safety Net Clinic Visits After the Affordable Care Act http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC4291259/</ref><br />
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==Methods== <br />
The authors did a comparison for the rates of uninsured safety net clinics between states that expanded Medicaid under the ACA and states that did not. The authors used data from adult visits to 156 Community Health Centers with [[Community EHR Models|OCHIN]] practice-based research network and shared electronic health records. <br />
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==Results==<br />
The authors found that Community Health Centers located in states that participated in the Medicaid expansion decreased their rate of uninsured visits by 40% and increased their Medicaid-covered visits by 36%. Community Health Centers that did not participate in the Medicaid expansion showed a 16% decrease in the rate of uninsured visits and no-change in Medicaid-covered visits. <br />
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==Discussion==<br />
This was the first study that used electronic health record data from Community Health Centers to measure and compare coverage rates. However, the data only was only gathered from nine states and is not necessarily representative of all states that chose to expand or not expand Medicaid. <br />
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==Conclusion==<br />
The study found that states who expanded Medicaid coverage decreased uninsured visits and increased Medicaid-covered visits. The states that chose not to expand Medicaid coverage saw no change in Medicaid-covered visits and only a 16% decrease in uninsured visits suggesting that the ACA expansion of Medicaid coverage may have contributed to the number of uninsured visits. <br />
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===Comments===<br />
This was an interesting article about the first use of electronic health records data to compare Community Health Centers in nine states. I’d be interested to see this study conducted on larger scale with more states included and possibly more individuals. The study used data from 333,655 nonpregnant adult patients and their 1,276,298 visits to Community Health Centers. I believe if this study were expanded and more inclusive, we would get a better picture of whether Medicaid expansion was a success. Furthermore, I am interested in why both the states that expanded Medicaid and the states that did not saw decreases in the number of uninsured visits. <br />
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==Related Articles==<br />
[[Community EHR Models]]<br />
<br />
== References ==<br />
<references/><br />
[[Category: Reviews]]<br />
[[Category: EHR][[Category:HI5313-2015-FALL]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/An_early_look_at_rates_of_uninsured_safety_net_clinic_visits_after_the_Affordable_Care_Act.An early look at rates of uninsured safety net clinic visits after the Affordable Care Act.2015-10-12T17:22:15Z<p>Annathehybrid: Annathehybrid moved page An early look at rates of uninsured safety net clinic visits after the Affordable Care Act. to An early look at rates of uninsured safety net clinic visits after the Affordable Care Act</p>
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<div>#REDIRECT [[An early look at rates of uninsured safety net clinic visits after the Affordable Care Act]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Measuring_and_improving_patient_safety_through_health_information_technology:_The_Health_IT_Safety_FrameworkMeasuring and improving patient safety through health information technology: The Health IT Safety Framework2015-10-02T00:02:41Z<p>Annathehybrid: /* Comments */</p>
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<div>This is a review of Hardeep Singh and Dean Sittig's "Measuring and improving patient safety through health information technology: The Health IT Safety Framework." <ref name="HIT framework">Hardeep Singh and Dean F. Sittig. Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Qual Saf. Published online first 2015 September. http://www.ncbi.nlm.nih.gov/pubmed/26369894?dopt=Abstract</ref><br />
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== Introduction ==<br />
<br />
Despite rapid adoption and use of [[Health information technology|health information technology (HIT or health IT)]] with the potential to improve patient safety outcomes, there is still no clear way to measure the impact of this technology on these outcomes. The health IT safety framework was created to contextualize "health IT-related patient safety measurement, monitoring, and improvement." <ref name="HIT framework"></ref><br />
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== Framework Rationale ==<br />
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Most organizations have not been focusing on health IT-related patient safety as they race to implement systems that meet meaningful use (MU) criteria. This framework will help put measurement of health IT-related patient safety at the forefront of an organization's existing patient safety efforts, which will be essential as use of HIT continues to flourish. The 3 essential elements this framework addresses are: <br />
<br />
"1. refine the science of measuring health IT-related patient safety <br />
2. make health IT-related patient safety an organizational priority by securing commitment from organizational leadership and refocusing the organization's clinical governance structure to facilitate measurement and monitoring <br />
3. develop an environment that is conducive to detecting, fixing and learning from system vulnerabilities." <ref name="HIT framework"></ref><br />
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== Overview of Framework ==<br />
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Follows principles of "continuous quality improvement."<br />
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=== Sociotechnical Work System ===<br />
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[[Sociotechnical systems]] are comprised of 8 components: <br />
*Hardware and software<br />
*Clinical content<br />
*Human-Computer interface<br />
*People<br />
*Workflow and communication<br />
*Internal organizational features<br />
*External rules and regulations<br />
*Measurement and monitoring<br />
<br />
The HITS Framework presupposes that patient safety events must be considered in the context of these 8 sociotechnical domains.<br />
<br />
=== Measurement of three overlapping domains of HITS ===<br />
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In addition to the sociotechnical system, there are 3 domains of health IT implementation and use: <br />
*Safe health IT<br />
*Safe use of health IT<br />
*Using health IT to improve safety<br />
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Measurement must occur in all 3 domains, both retrospectively and proactively in order to learn from past events and prevent those that could occur in the future.<br />
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Measures should be impactful, scientifically acceptable, feasible, usable, and transparent.<br />
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=== Expected Measurement Impact ===<br />
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Diverse stakeholders must come together to improve measurement of safety concerns related to or able to be determined via effective use of health IT. Organizations must continue to learn from the data these measures generate and must take a "360-degree approach" to analyzing and reacting to said data. If an organization prioritizes these efforts, they will develop a culture of health IT-related patient safety and will be able to learn how to improve safety of their HIT systems.<br />
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== Use of the Framework to Overcome Challenges of Real-World Measurement ==<br />
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The framework's components can work together to advance measurement of HIT-related safety. <br />
<br />
=== Uncover hidden HIT safety risks ===<br />
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Health care organizations need to be aware of the potential existence of "hidden" safety risks related to HIT. Proper measurement and analysis can help expose such concerns, and in order to address them, organizations should consider bringing in multidisciplinary teams of professionals with experience in these sorts of issues, such as informaticists or human factors engineers. <br />
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=== Facilitate organizational preparedness ===<br />
<br />
Prior to implementing these measurements, organizations need to assess their current state of HIT safety and understand how this is integrated with their patient safety paradigm. There are tools to help organizations assess risk, such as the ONC sponsored SAFER guides ([[ONC Issues Guides for SAFER EHRs]]).<br />
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== Advance Current Measurement Methods ==<br />
<br />
Current measurement methods for IT-related (and other patient safety) errors are mostly based on self-report, which is inadequate to determine true frequencies of such errors. Health care organizations will need to use alternative methods to collect data, analyze it, and then respond to these errors.<br />
<br />
Some potential methods of measurement moving forward are: <br />
*use of electronic trigger algorithms<br />
*helpdesk logs<br />
*provocative testing<br />
*real-time observations<br />
*feedback from users<br />
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=== Identify top priorities for measure development ===<br />
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The framework's potential supersedes health care organizations and can also be used to prioritize policy development with regard to safety of HIT. <br />
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== Conclusion ==<br />
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This all-encompassing framework will help health care organizations and policy-making organizations alike conceptualize patient safety as it relates to health IT, enabling the prioritization and development of measurement tools and systems to improve patient safety and safe use of health IT.<br />
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== Comments ==<br />
<br />
This article throws into sharp relief just how little we have advanced the use of health IT since its inception. It also provides a very thorough context and explanation for why health care organizations and the nation as a whole must strive to improve our ability to collect large sums of useful data from these systems and then learn from and act on it continuously in order to affect true system improvement. Unfortunately, I think most health care organizations are a long way off from considering their health IT safety in the context of a model such as this, but it is important that policymakers move towards this sort of framework so that the rest of the country follows suit. <br />
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== References ==<br />
<references/><br />
<br />
[[Category:Reviews]]<br />
[[Category:Methodologies and Frameworks]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Category:Privacy,_Confidentiality,_and_SecurityCategory:Privacy, Confidentiality, and Security2015-10-01T23:32:45Z<p>Annathehybrid: Created page with "Articles that are about privacy go here."</p>
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<div>Articles that are about privacy go here.</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Integrating_computerized_clinical_decision_support_systems_into_clinical_work:_A_meta-synthesis_of_qualitative_researchIntegrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research2015-10-01T23:25:12Z<p>Annathehybrid: Annathehybrid moved page Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research. to [[Integrating computerized clinical decision support systems into clinical work: A meta-synthesis o...</p>
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<div>===Introduction===<br />
[[Clinical decision support systems|Clinical decision support systems (CDSS)]] are integrated into electronic health records and intended to influence clinical decisions and improve quality of care processes. Evidence has shown improved clinical performance yet the improved health care quality and improved outcomes have been mixed. <ref name = 'integrating CDSS'> Miller, A. Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research. http://www.ncbi.nlm.nih.gov/pubmed/26391601</ref><br />
<br />
====Interesting research question==== <br />
What are the possible reasons and causes from healthcare clinicians’ perspectives for difficulties in integrating CDSS?<br />
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===Methods===<br />
The authors did a meta-synthesis associated with CDSS integration using research studies from actual CDSS clinical settings. They conducted a literature search using key words “CDSS in healthcare” and “clinicians experience of CDSS adoption”. PubMed and CINAHL databases were searched. Only peer reviewed journal articles from years 2000-2013 were selected. From the results, the bibliographies were reviewed for any additional relevant studies.<br />
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===Results===<br />
PubMed returned 3797 studies and CINAHL returned 361 studies for a total of 4158. Selecting only those studies that met criteria further narrowed the results. In total 81 studies were used. <br />
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===Conclusions===<br />
Overall, there was a lack of quality studies that addressed the clinicians experience with CDSS and overall studies with limited understanding of the clinicians’ workflow. CDSS provided alerts and reminders based on well-defined objectives yet provided little natural decision support or situational awareness. Five areas identified which needed further study. They were usability, clinician-patient-system integration, algorithm immaturity, and system immaturity.<br />
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====Area of interest====<br />
The human-computer interactions and the need to better understand the relationship between computational and human reasoning and problem solving.<br />
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===References===<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: Evidence Based Medicine (EBM)]]<br />
[[Category:HI5313-2015-FALL]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Integrating_computerized_clinical_decision_support_systems_into_clinical_work:_A_meta-synthesis_of_qualitative_research.Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research.2015-10-01T23:25:12Z<p>Annathehybrid: Annathehybrid moved page Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research. to [[Integrating computerized clinical decision support systems into clinical work: A meta-synthesis o...</p>
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<div>#REDIRECT [[Integrating computerized clinical decision support systems into clinical work: A meta-synthesis of qualitative research]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_InteroperabilityVendor Selection Criteria: Interoperability2015-09-27T21:09:05Z<p>Annathehybrid: </p>
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<div>=='''Interoperability''' ==<br />
<br />
When selecting a vendor for EHR implementation, interoperability or functionality should be considered. In a 2015 publication, "What makes an EHR "open" or interoperable?" there were five cases where interoperability should be considered when selecting an EHR. The following should be considered:<br />
<br />
*Clinicians- essential to provide safe and effective care<br />
*Researchers- critical to advance and understand disease processes<br />
*Administrators - to reduce the dependence on one EHR vendor<br />
*Software developers- to develop interface and software<br />
*Patients- important to access personal health information<br />
<br />
Widespread access to EHR information is important if the full potential of the electronic health care system is to be realized.<ref name = "interoperability">Sittig, D.F., Wright, A. (2015). What makes an EHR "open" or interoperable? Journal of the American Medical Informatics Association. http://jamia.oxfordjournals.org/cgi/doi/10.1093/jamia/ocv060</ref><br />
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The purpose of EHR is to provide access of patient information to the right people at the right time. Interoperability is the ability to exchange this information between different EHR systems and stakeholders. <ref name="HIT">http://www.healthit.gov/providers-professionals/faqs/what-ehr-interoperability-and-why-it-important</ref> There are standards considered by the Health IT and they are divided into 3 different categories: content, terminology and transport.<ref name="Hoyt">Hoyt, R. E., & Yoshihashi, A. K. (Eds.). (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals (6th edition)</ref> In addition, the exchange of information between systems is dependent on two entities: syntax and semantics. Syntax describes how the communication is put together. Semantics, on the other hand, describes what the communication means.<ref name="Hoyt"/> <br />
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In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers; 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians' capability to exchange varies by vendor and by state.<br />
<ref name="Physician Interoperability"> Patel, V., Swain, M. J., King, J., & Furukawa, M. F. (2013). Physician capability to electronically exchange clinical information, 2011. The American journal of managed care, 19(10), 835-843. </ref> <br />
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=== Importance of Interoperability ===<br />
<br />
The communication, interoperability and analysis of Electronic Health Records (EHRs) is of growing global importance as the functionality and use of an EHR system increases. Longitudinal EHRs can improve the quality and safety of care to individuals, provide the knowledge needed to improve the efficiency of healthcare services and population health programs and accelerate clinical research.<ref name="Tapuria 2013"></ref> <br />
<br />
Interoperability is of significant importance for multiple reasons:<br />
* Security: low standards of interoperability can lead to security hazards<br />
* Behavior change in patient health habits may be affected<br />
* Interactions between multiple branches of systems in the health industry depend on the interoperabilty of systems <ref name="Importance">Kahn, J. S., Aulakh, V., & Bosworth, A. (2009). What it takes: characteristics of the ideal personal health record. Health affairs, 28(2), 369-376. http://content.healthaffairs.org/content/28/2/369.long</ref><br />
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== Safety ==<br />
* Help deliver evidence-based health care<br />
* Help to improve safety by reducing errors and inequalities <ref name="Tapuria 2013">Tapuria, A., Kalra, D., & Kobayashi, S. (2013). Contribution of Clinical Archetypes, and the Challenges, towards Achieving Semantic Interoperability for EHRs. The Korean Society of Medical Informatics, 19(4), 286-292.</ref><br />
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== Patient Centered ==<br />
* Empower and involve citizens in their own health care.<br />
* Help to protect a patient's privacy. <ref name="Tapuria 2013"></ref><br />
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== References ==<br />
<br />
<references/><br />
<br />
<br />
<br />
=== Interoperability Considerations ===<br />
<br />
It is important to determine prior to selecting a vendor what type of data and devices a facility needs to exchange information. <ref name="Achieving IOP">Achieving INTEROPERABILITY: What's Happening Out There?<br />
Williams, Jill Schlabig; Jacobs, Brian, MD http://search.proquest.com.ezproxyhost.library.tmc.edu/docview/922925204?pq-origsite=summon&accountid=7034 </ref><br />
<br />
*PACS Systems<br />
*Medical Devices (Monitors, Ventilators, Anesthesia cart, etc.)<br />
*Pharmacy<br />
*Laboratory Orders and Results<br />
*Critical Values Reporting<br />
*Electronic Health Records to other facilities and/or physician's practices<br />
<br />
EMR needs to have interoperability specifications<br />
<br />
*Defined levels and mechanisms of desired semantic interoperability<br />
*Well-defined architecture and modularized interfaces to build transition plans for future upgrades<br />
*Patient data safety<ref name="IOP">Interoperability Hufnagel, Stephen P, Phdhttp://search.proquest.com.ezproxyhost.library.tmc.edu/docview/217053410?pq-origsite=summon&accountid=7034</ref><br />
<br />
Ensure that Information Technology, Biomed and EMR vendor are engaged in all conversations to achieve desired interoperability level. <ref name="Achieving IOP"></ref><br />
<br />
<br />
<br />
=== Content Standards ===<br />
* The content standards consist of [[Extensible Markup Language (XML)|XML]], [[HL7]], [[Clinical Document Architecture (CDA)|CDA]] and [[DICOM]].<ref name="Hoyt"/><br />
There are mainly two types of contents in clinical data; 1. Structured Data, which is computationally tractable and used in Billing, Lab reports, problem lists and others and 2. Unstructured Data, which is usually physician dictations that is free text, this is not computationally tractable and requires Natural Language Processing. Data extractors likes cTAKES, METAMAP and MEDLEE are used to process free texts.<ref name="Hoyt"> <Hoyt, R. E. Y. A. (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals (Sixth Edition) eBook: Robert E. Hoyt, Ann Yoshihashi: Kindle Store. Retrieved September 14, 2015, from http://www.amazon.com/gp/product/B00LBOO3Y8?psc=1&redirect=true&ref_=oh_aui_d_detailpage_o00_></ref><br />
<br />
=== Terminology Standards ===<br />
* The terminology standards consist of [[LOINC]], [[RxNorm]], [[SNOMED]] and MEDCIN.<ref name="Hoyt"/><br />
<br />
"MEDCIN is a clinical terminology designed to support medical documentation entry into electronic health record systems. MEDCIN was initially developed as “an intelligent clinical database for documentation at the time of care.”(16) MEDCIN's producer, Medicomp, states that their software “makes capture of the encounter information fast enough, sufficiently comprehensive and rewarding to overcome physician reluctance.” MEDCIN has evolved to include more than 250,000 concepts since 1978, and has been installed in several EHR systems as an interface terminology for clinical documentation including AHLTA, the EHR system developed for the US Department of Defense." (Brown et al. 2007) <ref name="Brown"> <Brown, S. H., Rosenbloom, S. T., Bauer, B. A., Wahner-Roedler, D., Froehling, D. A., Bailey, K. R., ... & Elkin, P. L. (2007). Direct comparison of MEDCIN® and SNOMED CT® for representation of a general medical evaluation template. In AMIA Annual Symposium Proceedings (Vol. 2007, p. 75). American Medical Informatics Association. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655894/></ref><br />
<br />
=== Transport Standards ===<br />
* The transport standards consist of ELINCS, [[IEEE 11073 Personal Health Device (PHD) Family of Standards|IEEE 11073]], NCPDP and ASC X12.<ref name="Hoyt"/><br />
ELINCS stands for EHR-LAB Interoperability and Connectivity Standards enables messaging between laboratory and clinicians ambulatory EHRs, IEEE 11073 is the transport standard for medical device connectivity and data exchange, National Council for Prescription Drug Program (NCPDP) is for the exchange of prescription related information and Accredited standards Committee<br />
(ASC)X12 is for electronic data interchange or computer-computer business data exchange. Other transport standards include Script (V10.10) for physician pharmacist communication, OpenID Connect helps web-based, mobile to connect to an authentication server and IHE-PCD based on IEEE integrates the healthcare enterprise and patient care device. <ref name="Hoyt"> <Hoyt, R. E. Y. A. (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals (Sixth Edition) eBook: Robert E. Hoyt, Ann Yoshihashi: Kindle Store. Retrieved September 14, 2015, from http://www.amazon.com/gp/product/B00LBOO3Y8?psc=1&redirect=true&ref_=oh_aui_d_detailpage_o00_></ref><br />
<br />
== 2015 Interoperability Standards Advisory ==<br />
<br />
On January 30, 2015, the ONC released a document entitled “2015 Interoperability Standards Advisory.”<ref name="onc art">Interoperability to help achieve better care, smarter spending, and healthier people http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/interoperability-electronic-health-and-medical-records/interoperability-roadmap-standards-advisory/</ref>The 2015 Interoperability Standard Advisory was created for two purposes regarding the healthcare professionals and Health Information Technology Interoperability. First it was developed to provide a single point of reference regarding interoperability for professionals in the Health IT field. Second, it was developed promote awareness of the different interoperability standards and to provoke opinions and input regarding these standards. By fulfilling these two purposes, the 2015 Interoperability Standard Advisory makes it easy for Health IT professionals to identify necessary standards and how they are to be implemented. The advisory standards also allow for better management of standards, potentially identifying standards that can be met by fulfilling one standard versus several standards.<ref name="2015 isa"></ref> It is essentially a document noting many standards that are recommended for interoperability among EHRs. There are criteria for content standards, structure standards, and transport standards, among other notable standards for interoperability.<ref name="2015 isa">2015 Interoperability Standards Advisory http://www.healthit.gov/standards-advisory/2015</ref> The document is subject to change as the ONC moves forward and also contains a section noting how changes to the document will take place.<ref name="2015 isa"></ref><br />
<br />
<br />
=== Section I ===<br />
<br />
Section 1 of the 2015 Interoperability standards Advisory identifies the standard specifications for terminology and code sets. From allergic reactions to unique device identification and more, Section 1 specifies standards implemented by the Systemized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), International Classification of Diseases, tenth edition, Clinical Modification (ICD-10-CM), and many more standards associated with the interoperability of Health IT.<ref name="2015 isa"></ref><br />
<br />
=== Section II ===<br />
<br />
Section 2 consist of standards for how data will be collected and stored in a Health IT device such as an EHR. Like Section 1, different systems have different standards. An example of standards that would be found in section two of the 2015 Standard Advisory would be on the exchange of data collection forms utilized abroad different systems for a patient. You would also find standards on how data would be entered into an EHR. <ref name="2015 isa"></ref><br />
<br />
=== Section III ===<br />
<br />
Section 3 lists the standards for the transport of data from data collection to database, from database to database, and database to computer. These standards are especially important due to the information being transported. Transporting Personal Identifiable Information (PII), Personal Health Information (PHI), or any other type of sensitive data can be risky. Failure to protect such information can result in hefty fines and or jail time. <ref name="2015 isa"></ref><br />
<br />
=== Section IV ===<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:43:32Z<p>Annathehybrid: /* something cool */</p>
<hr />
<div>== First review ==<br />
<br />
=== Introduction ===<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed. <ref name="2015 Kumar">Kumar, 2015. A content analysis of smartphone-based applications for hypertension management http://www.ncbi.nlm.nih.gov/pubmed/25660364</ref><br />
<br />
=== Methods ===<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
=== Interesting to me results ===<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
==== something cool ====<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the [[U.S. Food and Drug Administration (FDA)|FDA]].<br />
<br />
=== Conclusion ===<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.<br />
<br />
=== My comments ===<br />
I think it's great that there are so many apps targeted towards patients with hypertension, and a lot of those apps have fundamental functionalities such as blood pressure and heart rate tracking, and a significant number of apps also have analytical tools to help the patient know if their blood pressure is too high or something of that nature. The FDA is increasingly regulating such apps, and it will be interesting to see how it affects the marketplace of these apps.<br />
<br />
== Second review ==<br />
Write something here!<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category: Reviews]]<br />
[[Category: mHealth]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:42:04Z<p>Annathehybrid: </p>
<hr />
<div>== First review ==<br />
<br />
=== Introduction ===<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed. <ref name="2015 Kumar">Kumar, 2015. A content analysis of smartphone-based applications for hypertension management http://www.ncbi.nlm.nih.gov/pubmed/25660364</ref><br />
<br />
=== Methods ===<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
=== Interesting to me results ===<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
==== something cool ====<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
=== Conclusion ===<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.<br />
<br />
=== My comments ===<br />
I think it's great that there are so many apps targeted towards patients with hypertension, and a lot of those apps have fundamental functionalities such as blood pressure and heart rate tracking, and a significant number of apps also have analytical tools to help the patient know if their blood pressure is too high or something of that nature. The FDA is increasingly regulating such apps, and it will be interesting to see how it affects the marketplace of these apps.<br />
<br />
== Second review ==<br />
Write something here!<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category: Reviews]]<br />
[[Category: mHealth]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Category:MHealthCategory:MHealth2015-09-22T21:35:46Z<p>Annathehybrid: Created page with "mHealth or mobile technologies are phone-based technologies that help improve healthcare."</p>
<hr />
<div>mHealth or mobile technologies are phone-based technologies that help improve healthcare.</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:34:29Z<p>Annathehybrid: </p>
<hr />
<div>== Introduction ==<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed. <ref name="2015 Kumar">Kumar, 2015. A content analysis of smartphone-based applications for hypertension management http://www.ncbi.nlm.nih.gov/pubmed/25660364</ref><br />
<br />
== Methods ==<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
== Interesting to me results ==<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
=== something cool ===<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
== Conclusion ==<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.<br />
<br />
== My comments ==<br />
I think it's great that there are so many apps targeted towards patients with hypertension, and a lot of those apps have fundamental functionalities such as blood pressure and heart rate tracking, and a significant number of apps also have analytical tools to help the patient know if their blood pressure is too high or something of that nature. The FDA is increasingly regulating such apps, and it will be interesting to see how it affects the marketplace of these apps.<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category: Reviews]]<br />
[[Category: mHealth]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:32:48Z<p>Annathehybrid: </p>
<hr />
<div>== Introduction ==<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed. <ref name="2015 Kumar">Kumar, 2015. A content analysis of smartphone-based applications for hypertension management http://www.ncbi.nlm.nih.gov/pubmed/25660364</ref><br />
<br />
== Methods ==<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
== Interesting to me results ==<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
=== something cool ===<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
== Conclusion ==<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.<br />
<br />
== My comments ==<br />
I think it's great that there are so many apps targeted towards patients with hypertension, and a lot of those apps have fundamental functionalities such as blood pressure and heart rate tracking, and a significant number of apps also have analytical tools to help the patient know if their blood pressure is too high or something of that nature. The FDA is increasingly regulating such apps, and it will be interesting to see how it affects the marketplace of these apps.<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category: Reviews]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:31:39Z<p>Annathehybrid: </p>
<hr />
<div>== Introduction ==<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed. <ref name="2015 Kumar">Kumar, 2015. A content analysis of smartphone-based applications for hypertension management http://www.ncbi.nlm.nih.gov/pubmed/25660364</ref><br />
<br />
== Methods ==<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
== Interesting to me results ==<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
=== something cool ===<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
== Conclusion ==<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.<br />
<br />
== My comments ==<br />
I think it's great that there are so many apps targeted towards patients with hypertension, and a lot of those apps have fundamental functionalities such as blood pressure and heart rate tracking, and a significant number of apps also have analytical tools to help the patient know if their blood pressure is too high or something of that nature. The FDA is increasingly regulating such apps, and it will be interesting to see how it affects the marketplace of these apps.<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:29:59Z<p>Annathehybrid: </p>
<hr />
<div>== Introduction ==<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed.<br />
<br />
== Methods ==<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
== Interesting to me results ==<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
=== something cool ===<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
== Conclusion ==<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.<br />
<br />
== My comments ==<br />
I think it's great that there are so many apps targeted towards patients with hypertension, and a lot of those apps have fundamental functionalities such as blood pressure and heart rate tracking, and a significant number of apps also have analytical tools to help the patient know if their blood pressure is too high or something of that nature. The FDA is increasingly regulating such apps, and it will be interesting to see how it affects the marketplace of these apps.</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/MHealthMHealth2015-09-22T21:26:57Z<p>Annathehybrid: </p>
<hr />
<div><br />
==Introduction==<br />
<br />
<br />
'''MHealth''' (also '''m-health''' or '''mobile health''') while there is currently no generally accepted definition, the World Health organization defines it as: medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.(http://www.who.int/publications/goe_mhealth_web.pdf). It is generally considered to be a category of eHealth. e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. G Eisenbach. J Med Internet Res 2001;3(2):e20) doi:10.2196/jmir.3.2.e20 <br />
<br />
<br />
The promise of mHealth for the United States was stated by then Secretary of HHS Kathleen Sebelius in 2011 as "the biggest technology breakthrough of our time" and that it would "address our greatest national challenge" (Steinbuhl SR, Muse ED, Topol EJ. JAMA 2013;310:2395-2396). It has also been proposed as a breakthrough for so-called low and middle income countries as a way to reach a large underserved population that may not have read access to physicians and quality medical care, especially for chronic disease management.<br />
<br />
Mobile technologies have potential to be a more efficient way serve Healthcare to a wide population base but little has been studied to date. “It seems for now, that most studies have been done on a relatively small scale and still has many needs in developing ways to monitor patient activation and effective use over time”. (van Heerden A, Tomlinson M, Swartz L.) “Utilizing mobile phones for health management are promising tools both for the delivery of healthcare services, and the promotion of personal health.”( - LY, - DD, - SS, et al.) “Healthcare professionals, due to the high level of mobility they experience, require ubiquitous access to relevant and timely patient data in order to make critical care decisions.”( Koufi V, Malamateniou F, Vassilacopoulos G.). Powell States that , “The integration of leading edge networking technologies, such as web services and mobile communications, with PHRs can meet this requirement by enabling easy and immediate access to patient data from anywhere and via almost any device (Powell AC, Landman AB, Bates DW.) The end result is to “Help monitor an individual’s physiological parameters outside of healthcare institutions and store the results in a PHR in a way which is available, comprehensible, and beneficial to the individual concerned and to healthcare providers.”( Simon SK, Seldon HL.)<br />
Submitted by (Marc Sweet)<br />
<br />
[[Category:BMI512-SPRING-15]]<br />
<br />
==Terminology==<br />
<br />
Significant work has been done on smart wearable systems (SWS) in order to communicate information about the patient to a mobile device which then sends the information to a server. that server may or may not be able to incorporate that information directly into an EHR for further use. Some of the following terminology will be useful to know in understanding the process of capturing and send the information:<br />
*SWS: smart wearable systems<br />
*WCNs: wireless communication networks<br />
*BAN: body area network<br />
*BSN: body sensor network<br />
*PAN: personal area network<br />
*WAN: wide area network<br />
*MEMS: micro-electromechanical systems<br />
<br />
==Devices==<br />
<br />
For example, sensing systems can be worn as follows:<br />
*as jewelry, wristwatch, ring, necklace,etc:<br />
*as an electronic patch or "second skin"<br />
*as a chest belt or shirt with sensors incorporated into the fabric<br />
*as shoes for measuring gait during rehabilitation<br />
*as eyeglasses or (experimentally as of 2014) contact lenses<br />
*as gloves in order to receive and stimulate movements<br />
*validation of data<br />
(Chan M, Esteve D, Fourniols J-V, Escriba C, Campo E. Artificial Intelligence in Medicine 2012;56:137-156)<br />
<br />
The most widely used sensors are accelerometers that measure acceleration of objects in motion along reference axes to discern velocity and displacement by merging data with respect to time.(Appelboom G, Camacho E, Abraham ME, Bruce SS, Dumont ELP, Zacharia BR, D'Amico R, Slomian J, Reginster JY, Bruyere O, Connoly Jr. ES. Archives of Public Health 2014;72:28-37). One of the most used applications is for patients with diabetes in order to continuously monitor serum glucose levels. An investigational contact lens developed by Google is a contact lens that can monitor intraocular glucose levels and has an embedded LED that can activate to let the patient know their glucose level is out of range. Others have been trying to implement decision support systems into their sensor-smartphone interface in order to utilize past information stored in the server (EHR) to provide context to recommendations to the patient (Michael Marschollek. Medical Informatics and Decision Making 2012;12:43-52).<br />
<br />
Besides diabetes care, perhaps one of the most useful applications of mHealth may be hypertension which affects nearly 1/3 of all people in the U.S. Titration of blood pressure with real-time monitoring may facilitate pharmacologic therapy without the patient having to constantly come in to the doctor's office for blood pressure checks. This has been done with the Advanced Medical Monitor system (AMON) which is a wristwatch that can measure physical activity as well as blood pressure, oxygen saturation body temperature and electrocardiographic activity (Michael Marschollek. Medical Informatics and Decision Making 2012;12:43-52).<br />
<br />
==Drawbacks and Limitations==<br />
<br />
The following is a list of potential obstacles to successful implementation:<br />
*User perception and acceptance of the device as well as usability<br />
*Privacy issues with implementing acceptable levels of security of transmitted information<br />
*Interoperability with the EHR and other sensor derived information; there are currently no standards<br />
*Reimbursement; currently there are no codes for reimbursing clinicians for monitoring the data<br />
*Social inclusion of wearers<br />
*Technological capabilities of the system including power requirements<br />
(Chan M, Esteve D, Fourniols J-V, Escriba C, Campo E. Artificial Intelligence in Medicine 2012;56:137-156)<br />
<br />
Acceptance may be dependent on the age and operational understanding of the patient. One study looked at both patients ''and'' physicians in terms of their acceptance of these devices. They found that male physicians use of mobile devices was more common than that of female physicians. In fact, physicians overall were more likely to own and use a mobile device than their patients. For patients, there was a strong correlation between the use of mobile devices and age as well as level of education. As expected, younger patients were more familiar and comfortable with device use than the elderly. This was mirrored with level of education as well. Doctors were concerned of loss of physician-patient interaction as a potential problem. Both patients and physicians were wary of privacy issues. (Illiger K, Hupka M, von Jan U, Wichelhaus D, Albrecht U-V. Jmir Mhealth and Uhealth 2014;2:e42).<br />
<br />
Critics of the technology claim it is "overhyped". From a global health perspective, this technology was envisioned to become a basic tool for community health workers, especially in regions where few doctors can travel long distances to serve their populations. (CMAJ 2014. DOI:10.1503/cmaj.109-4861). Unfortunately, there is sparse literature demonstrating major outcome successes using this technology. <br />
<br />
Submitted by (Tamer Abd El Wahab Etman)<br />
[[Category:BMI512-WINTER-11]]<br />
<br />
== Patient Monitoring ==<br />
<br />
With the advent of smart phones in the past decade, patients can use their mobile phones to monitor their personal health and upload that information to an EHR for healthcare providers to review. For example, an iPhone 4 has the following types of sensor:<br />
<br />
• Accelerometer<br />
<br />
• GPS<br />
<br />
• Ambient light<br />
<br />
• Dual microphones<br />
<br />
• Proximity sensor<br />
<br />
• Dual cameras<br />
<br />
• Compass<br />
<br />
• Gyroscope<br />
<br />
<br />
An iPhone 4’s built-in accelerometer can be used to characterize the physical movements of the person carrying it, including specific movement patterns including sitting, standing, and walking (Lane, Miluzzo, Lu, Choudhury, & Campbell, 2010). The cameras and microphones can be employed to collect information about the patient’s daily routine and environment. The compass, GPS, and accelerometer can be used to collect information related to a person’s preferred mode of transport and daily activities.<br />
<br />
Specific apps can be downloaded to improve the effectiveness of this monitoring, and also allow for community sensing. Community sensing applications allow people to access information about recent outbreaks of disease, what general area or areas those outbreaks have occurred in, and what they can do to limit exposure (Lane et al., 2010).<br />
<br />
Apps and patient monitoring require a different approach to privacy and security to be compliant with privacy practices. HIPAA requires that electronic protected health information be encrypted at 128-bit blocks or better. Some commercial entities program to higher tolerances – Skype uses 256-bit encryption. Virtual private networks (VPNs) provide a secure way of transmitting information between authorized users (Luxton, Kavl, & Mishkind, 2012).<br />
<br />
<br />
Submitted by (Christopher A d'Autremont)<br />
<br />
[[Category:BMI512-FALL-12]]<br />
<br />
One of the benefits to mobile technology, especially in Smartphones and Tablets is the use of apps. Apps are programs offered usually by a carrier or phone manufacturer. Apple App Store, and Google Play are two examples of ways consumers download apps. You can find any kind of electronic media available on an app store. Anything from games, movies, and premium features that expand services are sold or unlocked in these two app marketplaces. These apps enable the ability to connect to Biosensors to read data on various vital signs. Some examples of biometric sensor capabilities are: Heart Rate Monitor, Blood Pressure Monitor, Respiratory measurement, Scales for weight loss tracking, and Blood Glucose monitors used in diabetes monitoring. <br />
<br />
Submitted by (Marc Sweet)<br />
<br />
[[Category:BMI512-SPRING-15]]<br />
<br />
== Clinical Decision Support (CDS) ==<br />
“Mobile technology holds enormous potential for transforming healthcare delivery systems which currently involve cumbersome processes that slow down care and decrease, rather than improve safety.”( Koufi V, Malamateniou F, Vassilacopoulos G. ) Software like EPIC has been developed by vendors to the healthcare industry that assist in day to day clinical workflow including CDS. These software technologies are a means to enhance the patient care without having to have on site expensive machines or specialized knowledge, Mobility assists in the issue of relevant retrieval of relevant data in real time. <br />
<br />
Submitted by (Marc Sweet)<br />
<br />
[[Category:BMI512-SPRING-15]]<br />
<br />
<br />
<br />
== [[MHealth Regulation]] ==<br />
<br />
Beginning with "Medical Device Data Systems" regulations (6) issued on February 15, 2011 with later [[MHealth Regulation]] guidance issued on September 25, 2013 and February 9, 2015 the Food and Drug Administration has provided an approach for development of MHealth.<br />
<br />
Because of these ambiguities in legitimacy, “The US Food and Drug Administration (FDA) has paid close attention to mHealth apps because it has the regulatory authority over their safety.”( Powell AC, Landman AB, Bates DW.) “mHealth apps acting as medical devices as accessories to medical devices will require FDA approval, whereas apps that provide users with the ability to log live events, retrieve medical content, or communication with clinicians or health centers will not be regulated under its jurisdiction.”( Powell AC, Landman AB, Bates DW.) Public opinion is a not scientific or accurate way to gauge the effectiveness of a device. “There is a need for alternative models for app review and certification that are sustainable and free of conflict of interest.”( Powell AC, Landman AB, Bates DW.) Without this governance false and damaging claims could be made. Currently the mHealth training institute of the national institutes of health is developing curriculum to encourage researchers to further the potential for mHealth and the ability to give thorough examinations using the intervention of mobile technologies. (Powell AC, Landman AB, Bates DW.) <br />
<br />
Submitted by (Marc Sweet)<br />
<br />
[[Category:BMI512-SPRING-15]]<br />
<br />
==Summary== <br />
<br />
Mobile Handheld Technology has heralded the opportunity to provide physicians with access to information, resources, and people at the right time and place. Mobility is an important component for health care delivery (7). Mobile technologies provide benefits of paper charts and desktop computers in their portability and support for information access anywhere and anytime (8). Handheld devices include tablet computers and personal digital assistants (PDAs). These devices are generally small, portable, lightweight computers with wireless network capability. A review demonstrated adoption among health care providers who are primarily hospital-based at 45% to 85% (9). Handheld devices uses include: administrative support (e.g., billing and scheduling); professional activities (e.g., patient tracking and electronic prescribing); documentation; decision support (e.g., clinical and drug references); education and research. Potentially benefits include improved productivity, increased information access, better communication, fewer medical errors, greater mobility, and improved quality and care. Another advantage of handheld devices is providing information and decision support access at the point-of -need. Disadvantages related to entering data, which is slower with a stylus, more erroneous and less satisfactory. Other limitations include smaller screen size designed for individual use so can limit collaboration, present challenges in viewing and entering data, which can lead to errors. However, the literature is limited on demonstrating that handheld devices improve outcomes and workflow efficiencies because of their mobility. Additional research needed to evaluate further the questions related to impacting these mobile devices has on work practices and outcomes (10).<br />
<br />
== Related articles ==<br />
<br />
* [[A content analysis of smartphone-based applications for hypertension management]]<br />
<br />
==References ==<br />
<br />
# Towards an application framework for context-aware m-Health applications, Tom Broens, Aart van Halteren, Martin van Sinderen, Katarzyna Wac.<br />
# http://en.wikipedia.org/wiki/MHealth]<br />
# http://www.mobih.org/observatory/]<br />
# Lane, N. D., Miluzzo, E., Lu, H., Peebles, D., Choudhury, T., & Campbell, A. T. (2010). A survey of mobile phone sensing. Communications Magazine, IEEE, 48(9), 140-150.<br />
# Luxton, D. D., Kayl, R. A., & Mishkind, M. C. (2012). mHealth data security: The need for HIPAA-compliant standardization. Telemedicine and e-Health, 18(4), 284-288.<br />
# Medical Devices; Medical Device Data<br />
# FDA Medical Device Data Systems Regulation [http://www.gpo.gov/fdsys/pkg/FR-2011-02-15/pdf/2011-3321.pdf]<br />
# JE. Activity-based computing: Support for mobility and collaboration in ubiquitous computing. Pers Ubiquit Comput 2005;9(5):312-22.<br />
# Kuziemsky CE, Laul F, Leung RC. A review on diffusion of personal digital assistants in healthcare. J Med Syst 2005;29(4):335-42.<br />
# Garritty C, El Elman K. Who’s using PDAs? Estimates of PDA use by health care providers: A systematic review of surveys. J Med Internet Res 2006;8(2):7.<br />
# Prgomet M, Beorgiou A, Westbrook JI, The impact of mobile technology on hospital physicians’ work practices and patient care: as systemic review. JAMIA. 2009;16:792-801.<br />
# van Heerden A, Tomlinson M, Swartz L. Point of care in your pocket: A research agenda for the field of m-health. Bull World Health Organ. 2012;90(5):393-394.<br />
# Yu Y, Li J, Liu J. M-HELP: A miniaturized total health examination system launched on a mobile phone platform. Telemedicine Journal & E-Health. 2013;19(11):857-865.<br />
# Simon SK, Seldon HL. Personal health records: Mobile biosensors and smartphones for developing countries. Studies in Health Technology & Informatics. 2012;182:125-132.<br />
# Powell AC, Landman AB, Bates DW. In search of a few good apps. JAMA. 2014;311(18):1851-1852.<br />
# Koufi V, Malamateniou F, Vassilacopoulos G. A sophisticated mechanism for enabling real-time mobile access to PHR data. Studies in Health Technology & Informatics. 2013;190:148-150.<br />
# LY, - DD, - SS, et al. - A global travelers' electronic health record template standard for personal health records. - J Am Med Inform Assoc.2012 Jan-Feb;19(1):134-6.doi: 10.1136/amiajnl-2011-000323.Epub 2011 Aug 17.<br />
<br />
<br />
<br />
<br />
Submitted by (Larry W. Holder)<br />
<br />
[[Category:BMI512-SP-10]]<br />
<br />
<br />
Submitted by (Richard A. Friedman)<br />
[[Category: BMI512-FALL-14]]<br />
<br />
Submitted by (Eric J. Vinson)<br />
[[Category: BMI512-SPRING-15]]<br />
<br />
Submitted by (Marc Sweet)<br />
<br />
[[Category:BMI512-SPRING-15]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:25:00Z<p>Annathehybrid: /* Introduction */</p>
<hr />
<div>== Introduction ==<br />
<br />
[[MHealth|Mobile health, or m-health technologies]], can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed.<br />
<br />
== Methods ==<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
== Interesting to me results ==<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
=== something cool ===<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
== Conclusion ==<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/A_content_analysis_of_smartphone-based_applications_for_hypertension_managementA content analysis of smartphone-based applications for hypertension management2015-09-22T21:22:46Z<p>Annathehybrid: Created page with "== Introduction == Mobile health, or m-health technologies, can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hyperte..."</p>
<hr />
<div>== Introduction ==<br />
<br />
Mobile health, or m-health technologies, can help treat the symptoms of hypertension (HTN), especially blood pressure (BP). However, the content of hypertension (HTN) smartphone-based apps are unknown. 107 apps from the Google Play and the Apple App store were analyzed.<br />
<br />
== Methods ==<br />
<br />
They typed in "hypertension" and "high blood pressure" into the Google Play and the Apple App store and picked the top 50 apps from each. This gave them 200 apps total, and 107 unique apps. They recorded the average rating, number of ratings, and number of downloads per app. Then they analyzed the functional characteristics of each app, such as hypertension education, tracking function, medication adherence tools, whether the app can make the smartphone a blood pressure reader or heart rate monitor, and access to support forums of people with hypertension.<br />
<br />
== Interesting to me results ==<br />
<br />
Most of the apps targeted patients (95.3%) and were tracking devices (71.9%). 69.1% could track blood pressure, and 61.7% could track heart rate. 66.3% had analytical tools that could tell you about trends in blood pressure and heart rate, like text-based feedback tools that would tell you if your blood pressure were too high. 43.9% could export information from the app to an excel file and send it to your email.<br />
<br />
=== something cool ===<br />
<br />
14% of the Android apps (7 of them) could turn your phone into a blood pressure or heart rate monitor. It was cuffless, and all you had to do was press your finger against the screen. None had a documentation of gold-standard validation and none were approved as measuring devices by the FDA.<br />
<br />
== Conclusion ==<br />
<br />
Over 90% of apps are targeted towards patients. Almost 3/4 of hypertension apps can record and track blood pressure and/or heart rate. Almost one half can export data out from the app.</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/An_integrated_approach_to_computer-based_decision_support_at_the_point_of_careAn integrated approach to computer-based decision support at the point of care2015-09-22T21:10:28Z<p>Annathehybrid: </p>
<hr />
<div>==INTRODUCTION ==<br />
<br />
Lack of adequate access to information among clinicians has been identified as prominent source of medical error. The author has investigated this problem systematically over the past few decades. His research has evolved from understanding information needs in general (and how those needs might be resolved through evidence-based practice), to designing applications for clinical information systems that link the clinician to information resources. His applications have evolved from a simple embedded "Medline Button" (renamed to "infobutton" with the advent of the World Wide Web), to the current "Infobutton Manager" (IM), a context-dependent application that attempts to match the clinician's and patient's characteristics, the task being performed, and the information needs with resources. This paper examines the IM technology, as well as the attendant user experiences and lessons learned.<br />
<br />
== METHODS ==<br />
<br />
Identifying Clinician Information Needs - methods including focus groups and surveys were abandoned due to discordance among the results. The author then transitioned to using a "portable usability lab", relying on keystroke and videotape transcription analysis to detect information needs. The needs were then coded according to a classification that characterizes: ''type of information need'', the ''likely resource for resolving the need'', and the ''subjects success in resolving the need''.<br />
<br />
=== Design of the Infobutton Manager ===<br />
Each information need discovered the the process noted above was then represented with a question ("what are the guidelines for heparin use") and a Web link that corresponded to the resource chosen to resolve the question. When the link was clicked by the user, the IM was invoked, allowing transmission of data such as patient age & gender, clinician's task, user profession/title, among others. <br />
<br />
The IM then matched the contextual information against its database of previously generated data questions, then presented its output (a ranked list of questions) to the user as Web links. The primary of evaluating the use of the IM was through review of the log files. An option for non-context specific information searching was left available on the clinicians's screen as a usage comparison with the Infobutton Manager.<br />
The IM application uses subscription information resources such as Harrison's and Up To Date to avoid the issue of outdated information.<br />
<br />
== RESULTS ==<br />
Observation of Clinician Information Needs - 251 subjects were observed, generating 250 information needs. Of those requiring resolution through use of an on-line information source, 101 questions have been created with appropriate Web links.<br />
<br />
=== Infobutton Manager Use === <br />
Over 2,700 user accessed information resources 28,519 times. Actual IM usage was defined as user selection of one of the prompted questions, after invoking the IM button. The IM usage was highest while reviewing inpatient drug orders (63-78% of the time), and lowest when reviewing diagnosis lists (10-24%). User feedback: 89% felt the system was easy to use, 74% felt IM has a positive impact on care, and that IM was helpful 77% of the time.<br />
<br />
== CONCLUSIONS ==<br />
IM represents a context-specific application that provides information resources at the point of care. The system has very positive usability features, and though utilization was found to vary according to the nature of the clinician's activity, an overall increase in information resource usage was seen in the institution.<br />
<br />
== COMMENTS ==<br />
<br />
The author has created a usable and valuable tool to facilitate information retrieval at the point of care. Whereas some clinicians may have the ability to perform a independent search on Medline or other Web service, many lack the skills or time to perform such a task. For those fortunate enough to have access to the Infobutton Manager, quality information retrieval has been greatly facilitated.<br />
<br />
Christopher Tessier, MD BMI512 Fall 2008<br />
<br />
[[Category: Reviews]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2015-09-18T21:08:30Z<p>Annathehybrid: </p>
<hr />
<div>The sections below detail the benefits, costs, and barriers in evaluating EMR implementations. Selecting, financing, and launching an EHR system is difficult.<br />
<br />
== Informational ==<br />
[[EMR Benefits: Informational]]<br />
<br />
== Security ==<br />
[[EMR Benefits: Security]] is an advantageous attribute which comes with EMR systems. Centers for Medicare and Medicaid Services (CMS) published a privacy, security & [[Meaningful Use|meaningful use]] guidelines which computer systems that store patient information need to conform to imply to [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA]] privacy guidelines. <ref name="Privacy-Standards-CMS">Centers for Medicare & Medicaid Services. Privacy and Security Standards. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/PrivacyandSecurityStandards.html</ref><br />
<br />
== Environmental ==<br />
[[EMR Benefits: Environmental]] positive impact through Electronic Health Records has the potential to improve the environmental footprint left by the health care industry. <ref name="turley 2011">Turley, M., Porter, C., Garrido, T., Gerwig, K., Young, S., Radler, L., & Shaber, R. (2011). Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs, 30(5), 938-946.</ref><br />
<br />
== Quality Outcomes ==<br />
<br />
EHR’s can be utilized to generate reports on quality measures in the effort to improve quality and patient satisfaction. With the ability to produce reports from EHR’s, clinicians can easily compare data to baseline data and quickly identify areas in need of improvement. Once areas in need of improvement have been identified, clinicians can compare data to manual reports and similar data to validate the reported information. Once an area of improvement has been identified it can be delivered to the performance improvement department where informatics professionals can perform gap analysis and identify methods to improve overall quality. , <ref name="Stefan 2011">Stefan, Susan (2011). Using clinical EHR metrics to demonstrate quality outcomes.http://ovidsp.tx.ovid.com.ezproxyhost.library.tmc.edu/sp-3.16.0b/ovidweb.cgi?QS2=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<br />
<br />
== Medical Education ==<br />
[[EMR Benefits: Medical education]]<br />
<br />
In a teaching facility EMRs can be a very useful tool for medical education and training. EMRs can be used to monitor how much time each trainee spends with patients and therefore their clinical experience in terms of patient diagnosis and procedures can be tracked and reported to enable optimization of workflow for both trainee and training programs. <ref name= "Tierney 2013">Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine</ref><br />
<br />
In addition the use of EMRs in a teaching environment allows trainees access to the most up to date information. “Point-of-care education accessed via CDS allows for easy access to relevant and up-to-date medical literature from which students and residents can draw to formulate diagnosis and management plans".<ref name= "Tierney 2013">Tierney et al, Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future Directions http://tmclibrary.summon.serialssolutions.com/search?s.q=tierney+m+j#!/search?ho=t&l=en&q=Medical%20education%20in%20the%20electronic%20medical%20record%20(EMR)%20era:%20Benefits,%20challenges,%20and%20future%20directions.%20Academic%20Medicine</ref><br />
<br />
== Financial ==<br />
[[EMR Benefits: Financial]]<br />
<br />
"Implementing an EMR system could cost a single physician approximately $163,765. As of May<br />
2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in<br />
financial incentives to more than 468,000 Medicare and Medicaid providers for implementing<br />
EMR systems. With a majority of Americans now having at least one if not multiple EMRs<br />
generated on their behalf, data breaches and security threats are becoming more common and are<br />
estimated by the American Action Forum (AAF) to have cost the health care industry as much as<br />
$50.6 billion since 2009." <ref name="O'Neill"> O'Neill, T. (2015, August). Are Electronic Medical Records Worth the Cost of Implementation.</ref><br />
<br />
Some of the ways that EMR systems can cut healthcare costs are due to savings based on "time-consuming paper-driven and labor-intensive tasks":<ref name="Medical Cost"> Kumar, S., & Bauer, K. (2011). Medical Practice Efficiencies & Cost Savings.http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings</ref><br />
<br />
* Reduced transcription costs<ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref> <br />
* Reduced chart pull, storage, and re-filing costs <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref> <br />
* Improved and more accurate reimbursement coding with improved documentation for highly compensated codes <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref> <br />
* Reduced medical errors through better access to patient data and error prevention alerts <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref> <br />
* Improved patient health/quality of care through better disease management and patient education <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref><br />
<br />
There are few comprehensive estimates of savings from Health Information Technology (HIT) at the national level. At 90 percent adoption, it is estimated that the potential HIT – enabled efficiency savings for both inpatient and outpatient care could average more than 77 billion per year.<ref name=”Hillestad 2005”> </ref> <ref name=”Hillestad 2005”> Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), 1103-1117.</ref><br />
<br />
Although the full extent of EMR advantages may not become apparent until further implementation and research is carried out, a clear benefit is the reduction of cost. Major administrative costs can be eliminated or reduced. Providers can do away with the costs of “chart pulls,” while substantially reducing dictation costs through the use of EMRs. Healthcare providers can also receive decision support regarding selection and costs of medications, radiographic studies, and laboratory tests.<ref name="Bates 2003"> Bates, D. W., Ebell, M., Gotlieb, E., Zapp, J., & Mullins, H. C. (2003). A proposal for electronic medical records in US primary care. Journal of the American Medical Informatics Association, 10(1), 1-10.</ref><br />
<br />
===Billing Accuracy===<br />
<br />
The benefits for small to medium private practices that have implemented EMR systems integrated with the practices' billing and prescription systems, can be increased efficiency and accuracy thanks to automatic coding leading to improved profitability. "Since installing the EMR, Medicare has audited only one of my charts. I had billed out as a level four and Medicare said it should have been billed as a level five, which, in essence, said that we should have been paid more. My EMR system gave the chart a level four and I believe it was right.” "Since adopting an EMR system, my practice receipts have increased about $4,000 per month."<ref name="Sonnenberg 2007">EMR ROI: A Pennsylvania family practice's investment in an EMR pays off three-fold. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE|A163469720&v=2.1&it=r&sid=summon&userGroup=txshracd2509</ref><br />
<br />
A nuanced view is appropriate here, however; improved billing can coincide with fewer patients seen. "EHR implementation ... increased reimbursements but reduced long-term practice productivity across all specialties"<ref name="Howley 2015">Howley et al, 2015. "The long-term financial impact of electronic health record implementation" http://jamia.oxfordjournals.org/content/22/2/443</ref> according to one study. This may be a net financial positive for the practice: "an EHR should greatly enhance physician effectiveness even if fewer patients are seen by the physician"<ref name="Howley 2015"></ref> due to gains in billing efficiency, but this also represents an artificial reduction in the supply of services.<br />
<br />
=== An EMR Cost Benefit Analysis ===<br />
<br />
Samsung Medical Center (SMC) performed a cost benefit analysis (CBA) on the cost benefits of implementing an electronic medical record (EMR) system. Costs of implementing the EMR system involved both '''direct costs''' to build the system infrastructure and '''induced costs''' to make a smooth transition to the new system. Benefits of implementing the EMR system include both cost reductions and increased revenue. Five types of cost reductions, mentioned by the authors, include:<br />
<br />
# Reduction of supplies for paper charts<br />
# Disposal of storage facilities used for paper chart storage<br />
# Reduction of full-time equivalent (FTE) employees for the paper chart management<br />
# Reduction in staff for outpatient clinics<br />
# Decreased supplies for medical devices<br />
<br />
The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).<br />
<br />
This CBA was based on an eight year period post EMR implementation. SMC determined the EMR system became cost effective shortly after 6 years. The outcomes of the CBA were calculated using the following formulas:<br />
<br />
* The primary outcome is the Net Present Value (NPV)<br />
** '''NPV = Present Value (PV) of benefit for the eight year period - PV of cost'''<br />
* The second outcome is the Benefit Cost Ratio (BCR)<br />
** '''BCR = PV of the benefit / PV of the cost'''<br />
* The third outcome is the Discounted Payback Period (DPP). <br />
**'''This is the time to reach the breakeven point'''.<br />
<br />
This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.<ref name="Choi 2013">Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/</ref><br />
<br />
== Improving Patient Care ==<br />
[[EMR Benefits: Healthcare quality]]<br />
<br />
Many EMRs have alert systems that ensure physicians do not forget to request important tests. As well as the legal benefits that this provides, EMR alerts remind physicians of the "preventive care needs for patients, which helps improve quality of care and office income by reminding us to do appropriate testing and provide vaccinations" recommended for some patient conditions e.g. asthma, emphysema or diabetes. <ref name= Block 2008">How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html</ref><br />
<br />
<br />
[[EMR Benefits: Reduction in no shows]]<br />
<br />
EMR system was used to improve on automated calls made to patients to remind them of their appointment which reduced the number of no call shows and improved patient satisfaction.<br />
<ref name= Block 2008">How We Improved Our Practice and Our Bottom Line With a New EMR System.Fam Pract Manag, 15(7), 25. http://www.aafp.org/fpm/2008/0700/p25.html</ref><br />
<br />
[[EMR Benefits: Medication Management]]<br />
<br />
"Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use."<ref name= journal of medical systems">The Meaningful Use of EMR in Chinese Hospitals: A Case Study on Curbing Antibiotic Abuse 15(7),</ref><br />
<br />
EMR systems have the ability to make evidence-based suggestions regarding patient care. With these suggestions, EMRs are able to use a patient’s information to identify preventative services that specific patient may need. The system is able to remind doctors that the patient is due for certain screening exams or other services which allows the doctor to discuss it with the patient and also allows the patient to decide whether or not they would like to schedule an appointment for that specific exam. This reminder has proven to benefit patient care by increasing compliance with preventative care. <br />
<br />
EMRs also benefit patient care by assisting in long-term chronic disease prevention and management. Case management systems in EMRs allow patients to communicate with a variety of specialists, which better enables them to manage their care. This system also allows healthcare providers to keep track of patient data, such as vital signs, and allows case management nurses to quickly respond to any issues that may occur. The system benefits the patient because it allows the patient’s acute issues to be handled promptly before they become bigger issues that may lead to a hospital admission.<br />
<br />
EMRs have the ability to eliminate up to 200,000 adverse drug events with the use of CPOE. Using reminders and alerts CPOEs are able to notify physicians about possible drug interactions that may occur when a new medication order is placed.<br />
<br />
EMRs have a direct correlation with the quality of healthcare offered to a patient. Problems in healthcare quality fell into three categories as stipulated by the National Roundtable on Health Care Quality. These three categories are the underuse, overuse, and misuse of healthcare services. Reducing overuse and misuse of healthcare services, as noted by the Roundtable, leads to an increase in health care quality while simultaneously lowering costs. In addition, reducing the underuse of healthcare services increases quality, but may in turn increase costs. “Computerized physician order [CPOE] entry may affect all three categories of health care quality problems, as well as inefficiencies in the health care system.” <ref name="Kuperman 2003">Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39.</ref><br />
<br />
== Research ==<br />
[[EMR Benefits: Research]]<br />
<br />
== Health Information Exchange (HIE) ==<br />
[[EMR Benefits: HIE]]<br />
<br />
== Personal Health Records ==<br />
[[EMR Benefits: PHR]]<br />
<br />
===Patient Participation===<br />
Patients can use personal health record (PHR) to keep track of information from doctor visits, record health-related information, and link to health-related resources. PHR, is an electronic application used by patients to maintain and manage their own health information. Connected PHRs are linked to a specific health care organization's EMR system that can increase patient and family participation in their own care. <ref name="PHR">http://www.healthit.gov/providers-professionals/patient-participation</ref><br />
<br />
== Electronic Dental Records ==<br />
[[EMR Benefits: EDR]]<br />
<br />
==Telehealth==<br />
[[EMR Benefits: Telehealth]]<br />
<br />
== E-Prescribing ==<br />
[[EMR Benefits: E-Prescribing]]<br />
<br />
E-Prescribing has many benefits, some of them include: <ref name="E-Prescribing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref><br />
* reduce illegibility <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref> <br />
* providing warning and alert systems, which reduce medication errors <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref> <br />
* access to patient's medical history <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref> <br />
* reduces or eliminates phone calls and call-backs to pharmacies <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref> <br />
*eliminates faxes to pharmacies <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref> <br />
*streamlines the refill and authorization processess <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref> <br />
* increases patient compliance <ref name="E-Prescibing">Healthcare IT News http://www.healthcareitnews.com/directory/e-prescribing </ref><br />
<br />
== Mobile EMRs ==<br />
[[EMR Benefits: mHealth]]<br />
<br />
== Physicians ==<br />
[[EMR Benefits: Physicians]]<br />
<br />
===Physicians Benefit===<br />
<br />
EMRs can greatly improve communication between physicians by allowing each full access to the patient’s medical record and by making it easier for physicians to follow up with patients. The electronic record provides up to the minute information on the patient allowing more efficient collaboration between disciplines. EMRs allow multiple providers to simultaneously access a patient’s record from any authorized computer.<ref name="MD">http://www.usfhealthonline.com/resources/healthcare/benefits-of-ehr/#.VfjJDXktDmQ<br />
</ref><br />
<br />
== Nurses ==<br />
[[EMR Benefits: Nurses]]<br />
<br />
Nurses use the EMR to identify newly admitted patients, track their location, and document admission information. The nursing SWAT team harnessed the power of EMR technology, and successfully re-organized nursing workflow to expedite the admission process, while maintaining patient and family centered care.<ref name="Journal of pediatric nursing ">http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S0882596314002413<br />
</ref><br />
<br />
== Versatile capabilities of EHRs in healthcare settings ==<br />
There are many studies showed that EHRs are capable to integrate with various standards systems such as billing codes, clinical notes, ICD diagnose codes, and medications, which essentially enhances effectiveness and efficiency of care and results in superior phenotyping performance compared with paper-based medical record systems. <ref name=" Wei 2015"> Wei, W.Q., Teixeira, P. L., Mo, H., Cronin, R. M., Warner, J. L., & Denny, J. C. Combining billing codes, clinical notes, and medications from electronic health records provides superior phenotyping performance. Journal of the American Medical Informatics Association: JAMIA. http://doi.org/10.1093/jamia/ocv130 </ref>.<br />
<br />
== Improvement of Spontaneous Reporting System for drug post-marketing safety surveillance ==<br />
In the healthcare settings, Spontaneous Reporting Systems (SRSs) are critical systems for monitoring drug post-marking safety and adverse drug reactions (ADRs). Although widespread utilization of SRSs has played a fundamental role in drug safety monitoring, there are certain limitations that hinder their efficacy and accuracy in practices. For example, multiple sources of data are needed for confirmation and validation; the nature of passive reactions to ADR events makes SRSs perform poorly in terms of pharmacovigilance. The integration of an SRS system into EHRs could have potential to improve efficiency and effectiveness of detection for ADR events. The combination of an SRS with EHRs could help collect data and information related to ADRs dynamically while avoiding the need of data validation from multiple sources and potentially reducing the costs. <ref name=" Pacurariu 2015"> Pacurariu, A. C. Useful Interplay Between Spontaneous ADR Reports and Electronic Healthcare Records in Signal Detection. Drug Safety. http://doi.org/10.1007/s40264-015-0341-5. </ref><br />
<br />
== Improvement of healthcare outcomes through interactive collaboration among stakeholders ==<br />
It has been reported that the integration of a Network-Based Learning Health System with EHRs can potentially improve a variety of healthcare outcomes. For example, integrating chronical care management, quality improvement, patients and their family engagement, and comparative research. <ref name=" Marsolo 2015"> Marsolo, K., Margolis, P. A., Forrest, C. B., Colletti, R. B., & Hutton, J. J. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research. EGEMS (Washington, DC), 3(1), 1168. </ref>. Therefore, EHRs can serve as an effective platform and infrastructure that fascinates online learning for all stakeholders, and patient-centered quality care and evidence-based medical research. <br />
<br />
<br />
== Costs ==<br />
<br />
[[Return on investment]]<br />
<br />
It is estimated that purchasing and installing an EMR can cost a provider anywhere from $15,000 to $70,000. There are several things to consider when looking for an EMR for your organization or practice. The prices vary based on number of providers using the EMR and whether it is a select on-site EHR deployment or web-based EHR deployment. Other factors to take into consideration of what costs you will incur include these 5 components of implementation: <ref name="How much is this going to cost me?">HealthcareIT.gov http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me http://www.healthit.gov/providers-professionals/faqs/how-much-going-cost-me </ref><br />
<br />
*Hardware: Hardware costs may include database servers, desktop computers, tablets/laptops, printers, and scanners. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref><br />
<br />
*EHR Software: Potential software costs include an EHR application, interface modules and upgrades to your EHR application. Remember, software costs vary depending on whether you select an on-site EHR deployment or a SaaS EHR deployment. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref><br />
<br />
*Implementation Assistance: Potential implementation assistance costs include IT contractor, attorney, electrician, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref><br />
<br />
*Training: Your organization will need to train your physicians, nurses, and office staff before and during EHR implementation. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref><br />
<br />
*Ongoing Network Fees and Maintenance: Potential ongoing costs include hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees. <ref name="Medical Cost">Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings </ref><br />
<br />
*Although the initial cost of an EMR may (and typically does) result in an immediate increase in administrative cost, through the reduction of other “removable and or defunct items or process the implementation of the EMR showed a positive improvement in the BCR and NPV. <ref name= "Removable or defunct"> Removable or Defunct http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810528/ </ref><br />
examples: remodeling of paper-chart storage areas, medical transcriptions, shorter chain of communication, reduction of administrative material<br />
<br />
==Cost vs Time == (A reduction of time spent on a common process can lead to reduced cost and better efficiency) <br />
*EMRs can greatly reduce or make more efficient use of time. <br />
A recent study (July-2015)EMR decision support systems where proven to have reduced and or made more efficient use of the time needed for “Colorectal cancer screening where the immediate harms are balanced with longer-term benefits.” By providing a “personalized benefit/harm assessment”. <ref name="Cost vs Time"> Cost vs Time http://www.ajmc.com/journals/issue/2015/2015-vol21-n7/Pilot-of-Decision-Support-to-Individualize-Colorectal-Cancer-Screening-Recommendations/</ref><br />
<br />
<br />
<br />
<br />
==Implementaion==<br />
For a proper return on investment a proper implementation of EHR is needed.<br />
lots of things have to be kept in mind for a successful implementation of an EHR. <br />
<br />
*Benefits and risks of the EHR.<br />
*cost<br />
*specifications of our needs and what we want and what the EHR have. <br />
*vendor certifications.<br />
*preparations for implementation and after. <br />
The journal of Emergency medicine titled with "computers in Emergency medicine" talks about all aspects of EHR implementation. <ref name="implementation"> IMPLEMENTING ELECTRONIC HEALTH RECORDS IN THE<br />
EMERGENCY DEPARTMENT. http://www.jem-journal.com/article/S0736-4679(08)00321-1.</ref><br />
<br />
<br />
<br />
<br />
=== Neonatal Informatics and CPOE ===<br />
<br />
Computerized physician order entry (CPOE) can be considered one of the major contributions to patient safety and health care quality from an EMR system implementation. CPOE and clinical decision support (CDS) systems have the potential to impact care of the critically ill neonatal patients to an even greater extent than other patient groups. Implementation of CPOE with CDS has been shown to specifically benefit Neonatal care intensive care units (NICU) with improved medication turnaround times, decreased medication errors, reduced adverse drug effects, and improved radiology turnaround times.<ref>Corder, L., Kuehn, L., Kumar R.R., Mekhjian, H.S. Impact of computerized physican order entry on clinical practice in a newborn intensive care unit. J Perinatol. 2004;24:88-93. [Pubmed: 14872207].</ref><br />
<br />
While studies have shown these benefits to be consistent with CPOE and CDS equipped institutions, the effects of these systems on morbidity and mortality have been ambiguous. A 2005 article reported an increase in mortality rate with the implementation of an EMR system with CPOE in a pediatric intensive care unit (PICU).<ref>Han, Y.Y., Carcillo, J.A., Venkataraman, S.T., et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506-1512. [PubMed: 16322178].</ref> The informaticists and hospital administration, determined that errors with the implementation process of the CPOE system resulted in these negative results. They stressed that a change in the workflow design was essential for a safer CPOE implementation. A more recent 2010 article reported a decrease in neonatal mortality rate using the exact same CPOE system.<ref>Longhurst, C.A., Parast, L., Sandborg, C.I. et al. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2010;126:14-21. [PubMed: 20439590].</ref>These findings indicate that the implementation of the CPOE system needs to include careful consideration of workflow analysis. However, even with the utmost attention being given to ensure the safety of a new CPOE system, inadvertent issues may still arise with human error. An example of such would be a physician order entry on the wrong patient.<ref name="Palma 2011">Palma, J.P., Sharek, P.J., Classen, D.C., & Longhurst, C.A. (2011). Neonatal Informatics: Computerized Physician Order Entry. Neoreviews. 12:393-396. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3146345/</ref><br />
<br />
<br />
== Specialty clinics ==<br />
<br />
EHR’s can significantly improve the productivity for specialty physician clinics such as for ophthalmology. Incorporating an EHR, a clinic can reduce process and time spent on recording patient data, as most diagnostic equipment can communicate with EHR’s. With medical and diagnostic equipment communicating with EHR’s, staff and technicians can focus more on the patient. <Ref name== "Misch, 2012"> Misch, D.M. Specialty-specific EHR system benefits both practice, patients: technologic innovation: how using EHR, practice management platform can improve standard of care and efficiency. http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?p=HRCA&u=txshracd2509&id=GALE|A312290264&v=2.1&it=r&sid=summon&userGroup=txshracd2509</ref><br />
<br />
== Benefits Database ==<br />
[[EMR Benefits: Benefits Database]]<br />
<br />
==Compliance==<br />
[[EMR Benefits: Compliance]]<br />
<br />
<br />
18. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs. Health Affairs, 1103-1117. doi:10.1377/hlthaff.24.5.1103 Health Aff September 2005 vol. 24 no. 5 1103-1117<br />
<br />
<br />
<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: EHR]]<br />
[[Category: EMR]]</div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T20:12:53Z<p>Annathehybrid: /* Transparency */</p>
<hr />
<div><br />
Most vendors typically fall into one of the three categories:<br />
<br />
# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
<br />
<br />
== Vendor Proposal (Request) ==<br />
<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
<br />
* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
<br />
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
<br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
<br />
<br />
== Vendor Financing ==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
==Separate vendors for each identified core IT implementation areas==<br />
<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
<br />
===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
<br />
===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
<br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
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*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
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<br />
<br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
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<br />
== Vendor viability ==<br />
<br />
*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
<br />
*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
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* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
<br />
* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
<br />
* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
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* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
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* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
<br />
*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
<br />
*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
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*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
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*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
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<br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
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<br />
== Face the Interfaces == <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
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Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
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=== Interface History === <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
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*Which vendors (and which of their applications) have they interfaced with?<br />
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*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
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*How many interfaces were built, and what is the maximum the system can support?<br />
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*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
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*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
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=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
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=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
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=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
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* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
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=== Transparency ===<br />
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EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
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* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
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*Disclosure of information that has been independently developed by the disclosing party<br />
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*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
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*Are there any hidden fees associated with training, support, consultant costs?<br />
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The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T20:12:32Z<p>Annathehybrid: </p>
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<div><br />
Most vendors typically fall into one of the three categories:<br />
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# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
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The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
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== Vendor Proposal (Request) ==<br />
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*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
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* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
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== Regional Selection Center EHR Selection Criteria ==<br />
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The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
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*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
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== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
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Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
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== Vendor Financing ==<br />
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A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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== Analyzing EHR Business Requirements ==<br />
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The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
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* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
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==Separate vendors for each identified core IT implementation areas==<br />
<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
<br />
===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
<br />
===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
<br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
<br />
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
<br />
<br />
<br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
<br />
<br />
== Vendor viability ==<br />
<br />
*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
<br />
*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
<br />
* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
<br />
* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
<br />
* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
<br />
* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
<br />
* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
<br />
*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
<br />
*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
<br />
*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
<br />
*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
<br />
<br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
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<br />
<br />
== Face the Interfaces == <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
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=== Interface History === <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
<br />
*Which vendors (and which of their applications) have they interfaced with?<br />
<br />
*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
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*How many interfaces were built, and what is the maximum the system can support?<br />
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*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
<br />
*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
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=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
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=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
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=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
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*Disclosure of information that has been independently developed by the disclosing party<br />
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*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
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*Are there any hidden fees associated with training, support, consultant costs?<br />
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The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T20:10:48Z<p>Annathehybrid: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
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Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
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== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
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== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
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== Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
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== Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
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== Vendor assessment ==<br />
[[Vendor Selection Criteria: Vendor assessment]]<br />
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== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
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== Evaluation post implementation ==<br />
[[Vendor Selection Criteria: Evaluation post implementation]]<br />
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== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T20:10:27Z<p>Annathehybrid: </p>
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<div><br />
Most vendors typically fall into one of the three categories:<br />
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# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
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The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
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== Vendor Proposal (Request) ==<br />
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*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
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* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
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== Regional Selection Center EHR Selection Criteria ==<br />
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The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
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*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
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== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
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Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
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== Vendor Financing ==<br />
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A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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== Analyzing EHR Business Requirements ==<br />
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The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
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* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
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==Separate vendors for each identified core IT implementation areas==<br />
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Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
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===Personalization of HIT===<br />
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For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
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===Transparency in communication with stakeholders for collaboration===<br />
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This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
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The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
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== Misc considerations ==<br />
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* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
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*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
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=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
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== Vendor viability ==<br />
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*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
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*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
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* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
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* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
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* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
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* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
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* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
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*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
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*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
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*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
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*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
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== Extensive Testing of EMR Software Prior to Implementation == <br />
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Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
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*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
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== Face the Interfaces == <br />
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One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
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Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
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Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
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Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
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Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
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* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
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=== Interface History === <br />
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One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
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*Which vendors (and which of their applications) have they interfaced with?<br />
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*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
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*How many interfaces were built, and what is the maximum the system can support?<br />
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*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
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*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
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=== User Satisfaction : ''User-Centric Selection'' ===<br />
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* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
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=== Check Vendor References ===<br />
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*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
<br />
*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
<br />
*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T20:10:18Z<p>Annathehybrid: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
<br />
<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
<br />
== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Vendor Selection Criteria: Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
<br />
== Vendor Selection Criteria: Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
<br />
== Vendor Selection Criteria: Vendor assessment ==<br />
[[Vendor Selection Criteria: Vendor assessment]]<br />
<br />
== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
== Vendor Selection Criteria: Evaluation post implementation ==<br />
[[Vendor Selection Criteria: Evaluation post implementation]]<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_ResearchVendor Selection Criteria: Research2015-09-18T20:09:38Z<p>Annathehybrid: Created page with " == Research Functionality == * Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability ..."</p>
<hr />
<div><br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Evaluation_post_implementationVendor Selection Criteria: Evaluation post implementation2015-09-18T20:08:05Z<p>Annathehybrid: Created page with " === Dr. Sittig's Overview of EMR Vendor Selection === #Make The Plan ##Identify Decision makers #Set Goals ##Make a Checklist of what should the EMR accomplish ##Map your Wo..."</p>
<hr />
<div><br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
<br />
==New Non Traditional Approach Overview==<br />
<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T20:06:00Z<p>Annathehybrid: /* Basic EHR Criteria */</p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
<br />
<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
<br />
== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Vendor Selection Criteria: Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
<br />
== Vendor Selection Criteria: Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
<br />
== Vendor Selection Criteria: Vendor assessment ==<br />
[[Vendor Selection Criteria: Vendor assessment]]<br />
<br />
== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
<br />
==New Non Traditional Approach Overview==<br />
<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
<br />
===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
<br />
===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
<br />
===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
<br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
<br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
<br />
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
<br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Certification_and_meaningful_useVendor Selection Criteria: Certification and meaningful use2015-09-18T20:05:56Z<p>Annathehybrid: </p>
<hr />
<div>Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:<br />
<br />
== Product Requirements ==<br />
<br />
* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
<br />
=== Meaningful Use (MU) === <br />
<br />
Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. <ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref> A gap analysis can be performed:<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
<br />
==== Meaningful Use Gap Analysis ====<br />
<br />
* Is it ONC Certified? [http://oncchpl.force.com/ehrcert?q=chpl]<br />
* Does it meet all Meaningful Use objectives?<br />
* Does it provide automated MU & Clinical Quality Measure Reports?<br />
* Does the vendor provide MU Training Guides/Resources?<br />
* Does the system facilitate easy MU Data capture such as required data fields?<br />
* Does it provide audit logs, usage monitoring, etc?<br />
* Does it allow/include data migration from previous EMR?<br />
* Does it contain CDS Rules to improve performance on high priority health conditions?<br />
* Does it have capability to electronically submit Clinical Quality Measures to CMS?<br />
* Does it have Public/Cancer Registry Reporting Capabilities? <br />
* Does it provide 24/7 technical support?<br />
* Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? <ref name="CMS.gov">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html</ref><br />
* Is the ONC certification current or does the product require inherited certification/ gap certification?<ref name="healthIT.gov">http://healthit.gov/sites/default/files/final2015certedfactsheet.022114.pdf</ref><br />
<br />
<br />
<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T20:04:46Z<p>Annathehybrid: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
<br />
<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
<br />
== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Vendor Selection Criteria: Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
<br />
== Vendor Selection Criteria: Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
<br />
== Vendor Selection Criteria: Vendor assessment ==<br />
[[Vendor Selection Criteria: Vendor assessment]]<br />
<br />
== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
<br />
== Basic EHR Criteria ==<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
<br />
==New Non Traditional Approach Overview==<br />
<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
<br />
===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
<br />
===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
<br />
===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
<br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
<br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
<br />
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
<br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Core_clinical_featuresVendor Selection Criteria: Core clinical features2015-09-18T20:04:39Z<p>Annathehybrid: </p>
<hr />
<div>Core clinical functionalities include a not only medication lists, allergy lists, order sets, and lab ordering, but also can include a fully integrated pharmacy/medication management interface.<br />
<br />
== Core Clinical Features ==<br />
<br />
In 2003, the DHHS [http://www.hhs.gov/] asked the IOM [http://www.iom.edu/] to provide guidance on the basic functionalities of electronic health records systems. The committee concluded that the core functionalities should address the following areas:<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation and <br />
* Integration of hospital services<br />
In the Journal of Healthcare Information Management Kranny et. al discussed the importance of an application in the EHR which will promote continuity of care. During the selection of a vendor it is imperative for the decision committee to find out if there is an integration of inpatient, clinical and outpatient interface systems. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref> The patient's progress in house and discharge summary should be accessible by his primary care provider upon discharge. Medications that were discontinued during hospitalization should be updated in the patient's outpatient medication profile so wrong medications are not refilled by the patient. In addition, when new medications are added to the patient medication regimen it should be accessible by the primary care provider and outpatient pharmacist.<br />
<br />
The IOM committee decided that the core functionalities of EHR system should cover the following areas: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation<br />
<br />
Jain et al. (2010), in the article Evaluating EHR Systems, describes a few criteria to look for in EHR selection. Considerations for EHR selection should include privacy of patient data, interoperability, ease of use( for physicians and support staff) and efficiency of the integrated systems. Management support during implementation is crucial. <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/747986471?accountid=7034</ref><br />
<br />
Based on these areas, the they identified eight categories of core functionalities, including: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
<br />
* Health information and data<br />
* Results management<br />
* [[CPOE|Order entry/management]]<br />
* [[CDS|Decision support]]<br />
* Electronic communication and connectivity<br />
* Patient support; administrative processes<br />
* Reporting and population health management<br />
<br />
<br />
<br />
<br />
=== EHR System Feature List ===<br />
<br />
* Information to be considered to store in the system:<br />
** Demographics details<br />
** Patient specific problem or CC (Chief Complaint) with [[ICD|ICD-9 or ICD-10]] numbering<br />
*** Acute/Chronic Indicator<br />
*** Worsening/Resolving Indicator<br />
*** Injuries List<br />
*** Present Illness Description<br />
** Procedures<br />
** Diagnoses <br />
** Medications<br />
** Allergies<br />
** Family medical history <br />
** Consultations<br />
** Signs & Symptoms<br />
** Vitals<br />
** Progress Notes<br />
** Discharge Summaries<br />
** Appointments/Admissions/Visits<br />
** Advance Directives<br />
** Clinical Reminders [Immunizations, Screenings, Risks]<br />
* Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)<br />
** Review and search results easily by sorting test types, test time, test administers, test results and so on<br />
** Choose one or several test types, such as HGB, and/or WBC, and/or blood sugar and chart on their results for showing trends<br />
* Is the software configuration flexible to customize for future needs? How much customization to the EMR can the vendor offer to meet the institution’s needs? Will there be a surplus of unusable or insufficient components to the EMR? <ref name="himss-ama-pms">American Medical Association. 15 questions to ask before signing an EMR/EHR agreement. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Is this EHR system compatible with any other systems such as adverse drug reaction system, case based reasoning system and rule based reasoning systems?<br />
* The proposed EHR software should bring minimal to no new limitations to the existing workflows of the institution <ref name="himss-ama-pms"> </ref><br />
* Does the system meet all existing required operational tasks?<br />
* Does the EHR tested in any other provider sites?<br />
* Does the EHR allow for expandability to mobile devices, mobile medical applications and upcoming mobile technologies?<br />
* Does the EHR have integrated practice management to avoid having to interface with a 3rd party practice management system?<ref name="himss-ama-pms"> </ref><br />
* Does the software provide a tool for workflow mapping/charting?<br />
* Is it possible to migrate existing legacy EMR system institute use to the new EMR database schema?<br />
* Can the software be easily configured/adapted to changing workflows?<br />
* Does the EHR provide on-screen flags to indicate patient visit status? <br />
* Does the EHR allow customization of work flows by the provider, clinician, or other health care professional?<br />
* Does the EHR documentation method support error checking for vital sign data entry? <br />
* Does the EHR/EMR system allow multiple terminals (physician, nurses' station, X-ray, labs, etc.) to log in to the same patient's record simultaneously? Certain systems only allow one terminal to access a patient record at a time - they must log out before any other terminal can access patient EHR/EMR. (For example, if a nurse forgets to log out at their station, the lab cannot access that patient's record.)<br />
* Does the product have a standardized electronic patient handoff tool to facilitate physician workflow, increase physician satisfaction and ultimately potentially improve patient outcomes?<br />
<br />
* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system? <br />
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based<br />
Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref><br />
<br />
* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref><br />
<br />
<br />
== CPOE ==<br />
<br />
* [[CPOE| Computerized Physician Order Entry (CPOE)]], [[Electronic prescribing| e-Prescribing]]<br />
* Computerized Physician Order Entry system that integrates and provides for two-way communication with the Pharmacy, Laboratory, Registration systems, and that allows for scanning and downloading of health information as needed. The EHR system should have a completely understood interface and provide for [[HIE|interoperability]] with all current and future systems and between clinics and providers.<br />
* CPOE will generally allow for the organization to specify a default dose for a medication order. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The CPOE team will need to review what happens when non-formulary items are entered. The workflow for non-formulary items will also need to be determined. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The EHR should have the capabilities to interface with the various labs the hospital or physician uses to order and receive patient lab work automatically.<br />
* Does the EHR have a referral management system so that within large organizations, specialty and primary care departments can easily communication with each other and have similar information on a patient that is using both offices to treat their illness?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the system allow each provider to create customized order sets including laboratory order sets, procedure order sets, presurgical order sets, and postsurgical order sets? <ref>http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
<br />
== Clinical decision support (CDS) ==<br />
* [[Earlier Clinical Decision Support (CDS) Tools]]<br />
* [[Historical Challenges of Clinical Decision Support (CDS) Tools]]<br />
* [[Benefits of Various types of Clinical Decision Support(CDS) Tools]]<br />
* [[CDS|Decision Support]] (Drug Interaction, Drug information and other Prescription Supports, Clinical Guidelines [Plans & Protocols] and disease information, Diagnosis and differential diagnosis Support, Risk Assessments, Clinical Checklists, Medical References, etc)<br />
* Formulary Database Support<br />
* Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)<br />
* Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)<br />
* Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)<br />
* Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.<br />
* [[PHR|Patient Portal for online personal health record access]]<br />
* Clinical policies and procedures guidelines<br />
* Produce visit summary and complete medical record printout and data export on demand for patient use.<br />
* Electronic Health Record (EHR) systems should be capable of accommodating multiple users working concurrently within the system and within the same patient file or document. EHR systems should also be capable of protecting the integrity of data in the system so that no data loss occurs when multiple users are working concurrently with the same patient file or document.<br />
** Provide direct decision support explanation link to [[EBM|evidence based knowledge]] (through such as "infobutton",etc) about needed test information, such as purpose and methods of conducting that test, normal range of that test, clinical indications when abnormal results occurred and suggestions what to do, etc.<br />
** Provide abnormal alerts to providers and/or patients through various ways, such as online display, cell phone text messages, etc if the patients/doctors register for this service.<br />
* The organization will need to strike a balance between displaying so many alerts that it causes clinical care to slow. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
*Does the EHR have an aspect of the CPOE that can manage patient protocols and treatment plans? <ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the software have “Clinical/Business Intelligence” capability based on local clinic medical trends, e.g. if there is above normal upper respiratory infection clinic visits, perhaps a flu season is imminent and may warrant stocking of flu vaccine in the clinic?<br />
* Does the system support patient-specific dosing? When entering medication orders, can the system recommend dosages based on the patient's age, weight, and comorbidities? <ref>http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
<br />
== Data Storage and Retrieval ==<br />
<br />
* EHR systems should be capable of capturing, storing, indexing, retrieving and displaying externally created documents. Indexing of captured documents should include not only patient identifiers and descriptive information, but also date/time stamps and document type.<br />
* EHR systems should be capable of retaining all system data until such data is archived or intentionally purged from the system.<br />
* The system should load patient records in a timely manner to not interrupt workflow. <br />
* This system should present chronological data of patients like medicine history, progress of diseases. <br />
* Also, system provides gene information or drug allergies of patients to avoid [[Adverse drug event|ADE]].<br />
* System should be compatible with old system to reduce re-entry time.<br />
* System should update regularly.<br />
* system should be able to have Patient prescription plan eligibility, prescription product formulary and external medication history.<br />
* System should be able to have insurance retrieval capabilities (i.e. insurance firms, sum insured, premium dues, etc.).[11]<br />
* Capability to integrate with other products such as practice management software, billing systems and public health interfaces.<br />
<br />
== Functional Requirements ==<br />
<br />
Functional requirements are those processes that you want a system to perform <ref name="stratishealth"> Requirements Analysis. http://www.stratishealth.org/documents/HITToolkitHospital/1.Adopt/1.3Select/1.3Requirements_Analysis.doc. </ref>.<br />
The electronic health record’s architecture, or its relationship across any existing or future systems at the organization’s practice, directly influences what functions the EHR can support <ref name="ehrchecklist"> EHR Checklist: Functional and Technical Essentials. http://www.poweryourpractice.com/electronic-health-records/ehr-checklist-functional-and-technical-essentials/. </ref>.<br />
The following functional requirements have been broken into the following areas that correspond to EHR functional categories:<br />
==== Clinical Documentation Requirements ====<br />
Clinical documentation is used throughout healthcare to describe care provided to a patient,communicate essential information between healthcare providers and to maintain a patient medical record <ref name="clindoc"> Boone,K.W. Clinical Documentation. 2011. http://www.springer.com/cda/content/document/cda_downloaddocument/9780857293350-c1.pdf?SGWID=0-0-45-1140144-p174097770. </ref>.<br />
* Document and View Medication History<br />
** Will the EHR have the ability to perform basic clinical documentation, including medication history?<br />
** Will the current, active medications be viewable on demand?<br />
** Will the system have the ability to display a complete medication history from information available within the EHR? <ref name="functional"> EHR Functional Requirements. http://www.nyehealth.org/images/files/File_Repository16/pdf/Version_2_2_EHR_Functional_Requirements-16_Nov_09.pdf. </ref><br />
* Treatment plan<br />
** Will the system be able to document a treatment plan and create any new orders?<br />
** As part of that treatment plan, will clinician have the ability to confirm previous medications and prescribe any potential new medications or make dose changes, and the ability to electronically submit orders such as labs, radiology, physical therapy, and other supportive services?<br />
** Will the EHR be able to create structured treatment plan as part of patient encounter? <ref name="functional"></ref><br />
* Consult Note<br />
** Will the system be able to document a consult note with appropriate clinical information from the medical record, including a clinical recommendation, and surgical clearance? <ref name="functional"></ref><br />
*Chief Complaint, Problems, Vital Sign, History, Visits, Medication List, Allergies<br />
** Will the appropriate clinical staff be able to electronically document chief complaint, vital signs, reason for visit, new history, MD visits, problem list, and medication lists?<br />
** Will the system permit appropriate clinical staff to document, review and update patient problems, medications, and allergies or adverse drug reactions in the EHR?<ref name="functional"></ref><br />
*History of Present Illness/Review of Systems/Family History/Medical History/Surgical History/Social History and Physical Exam<br />
** Will the system allow the complete physical assessment, including all necessary examinations based on the current standards of care for the applicable condition, to be documented in a standardized manner with consistent nomenclature? <ref name="functional"></ref><br />
*Patient Educational Materials<br />
** Will the system have patient education material available within the application either from the application itself or from a third party solution? <ref name="functional"></ref><br />
* Does the system support various methods of documentation creation? Can documents be created through traditional dictation and transcription and imported into the patient record? Does the vendor support interfaces for importing documents?<br />
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<br />
== Formulary Management ==<br />
<br />
# Data repository for formulary information, maintain real time update of medication information with national drug information database<br />
# Support periodic update of formulary, restricted formulary, and nonformulary medications<br />
# Cross reference patient’s insurance formulary list to allow for generic medications to be selected when e-prescribing.<br />
<br />
== Drug dispense and delivery===<br />
<br />
# Support outpatient pharmacy operation functionality: <br />
## Maintain outpatient prescription data<br />
## Management of prescription fill, refill and dispense activities<br />
## Support billing protocols with governmental and private insurance<br />
# Support inpatient pharmacy operation functionality<br />
## Maintain inpatient medication ordering data<br />
## Real-time monitoring of IV and oral medication compounding and delivery<br />
## Support real-time data interface with automatic dispensing cabinet<br />
<br />
== Nursing Functionality ==<br />
# Supporting eMAR: supporting real-time electronic medication administration record and [http://www.ncbi.nlm.nih.gov/pubmed/20445181 bar code medication administration technology].<br />
## Does the system track refusal of medications? <ref name="ELECTRONIC MEDICATION ADMINISTRATION RECORD (EMAR)">http://www.healthsecure-emr.com/jail-emr-emar</ref><br />
## Does the eMar have the ability to send encrypted messages directly to the pharmacy? <br />
# Supporting bedside automation in medication delivery: Support data interface and real-time monitoring of [http://www.ncbi.nlm.nih.gov/pubmed/15753744 smart infusion pumps] and home infusion pumps <br />
# Ease of use of Nursing flow sheets: Rows in the EHR to be filled by nurses for consistent patient care processes.<ref name="ICU Accept">Carayon, P. Cartmill, R. Blosky, M. Brown, R. Hackenberg, M. Hoonakker, P. Hundt, A. Norfolk, E. Wetterneck, T. Walker, J. (2011).ICU nurses’ acceptance of electronic health records. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197984/pdf/amiajnl-2010-000018.pdf </ref><br />
# Ease of access and usability of EHR for nursing administration and clinical documentation for nurses. <ref name="Disputes Risks">Raasikh, . What the others haven't told you: lessons learned to avoid disputes and risks in EHR implementation.http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?action=interpret&id=GALE%7CA365889941&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&authCount=1</ref><br />
# Clinical decision support and risk assessment tools for issues related to nurse care delivery, such as falls, medication delivery, skin ulcers etc. <ref name="Impact Nurse">Dowding,D. Turley, M. and Garrido, T. (2012). The impact of an electronic health record on nurse<br />
sensitive patient outcomes: an interrupted time<br />
series analysis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384108/pdf/amiajnl-2011-000504.pdf</ref><br />
<br />
== Pharmacy Operation ==<br />
Hospitals and physician practices need to keep their patients safe and well managed by using a pharmacy information system also called a medication management system. The system must have several core functions including in and outpatient order entry, dispensing, and inventory and purchasing management. The system must also be able to connect to other systems within the enterprise, including an EMR, computerized physician order entry (CPOE), barcode technology, and smart IV infusion pumps.<ref name="Pharmacy Information Systems">10 Popular Pharmacy Information Systems".http://www.informationweek.com/healthcare/clinical-information-systems/10-popular-pharmacy-information-systems/d/d-id/1104805?</ref><br />
<br />
# Connect to other systems within the enterprise including EMRs<br />
# Computerized physician order entry (CPOE)<br />
# Barcode technology<br />
# Smart IV infusion pumps<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Certification_and_meaningful_useVendor Selection Criteria: Certification and meaningful use2015-09-18T20:04:14Z<p>Annathehybrid: </p>
<hr />
<div>Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:<br />
<br />
== Product Requirements ==<br />
<br />
* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
<br />
=== Meaningful Use (MU) === <br />
<br />
Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. <ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref> A gap analysis can be performed:<br />
<br />
==== Meaningful Use Gap Analysis ====<br />
<br />
* Is it ONC Certified? [http://oncchpl.force.com/ehrcert?q=chpl]<br />
* Does it meet all Meaningful Use objectives?<br />
* Does it provide automated MU & Clinical Quality Measure Reports?<br />
* Does the vendor provide MU Training Guides/Resources?<br />
* Does the system facilitate easy MU Data capture such as required data fields?<br />
* Does it provide audit logs, usage monitoring, etc?<br />
* Does it allow/include data migration from previous EMR?<br />
* Does it contain CDS Rules to improve performance on high priority health conditions?<br />
* Does it have capability to electronically submit Clinical Quality Measures to CMS?<br />
* Does it have Public/Cancer Registry Reporting Capabilities? <br />
* Does it provide 24/7 technical support?<br />
* Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? <ref name="CMS.gov">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html</ref><br />
* Is the ONC certification current or does the product require inherited certification/ gap certification?<ref name="healthIT.gov">http://healthit.gov/sites/default/files/final2015certedfactsheet.022114.pdf</ref><br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T20:02:57Z<p>Annathehybrid: </p>
<hr />
<div><br />
Most vendors typically fall into one of the three categories:<br />
<br />
# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
<br />
<br />
== Vendor Proposal (Request) ==<br />
<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
<br />
* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
<br />
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
<br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
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== Vendor Financing ==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
<br />
<br />
== Vendor viability ==<br />
<br />
*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
<br />
*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
<br />
* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
<br />
* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
<br />
* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
<br />
* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
<br />
* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
<br />
*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
<br />
*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
<br />
*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
<br />
*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
<br />
<br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
<br />
<br />
<br />
== Face the Interfaces == <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
<br />
=== Interface History === <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
<br />
*Which vendors (and which of their applications) have they interfaced with?<br />
<br />
*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
<br />
*How many interfaces were built, and what is the maximum the system can support?<br />
<br />
*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
<br />
*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
<br />
=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
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*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
<br />
*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T20:02:25Z<p>Annathehybrid: </p>
<hr />
<div><br />
Most vendors typically fall into one of the three categories:<br />
<br />
# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
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<br />
== Vendor Proposal (Request) ==<br />
<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
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* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
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== Vendor Financing ==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
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<br />
== Vendor viability ==<br />
<br />
*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
<br />
*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
<br />
* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
<br />
* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
<br />
* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
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* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
<br />
* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
<br />
*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
<br />
*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
<br />
*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
<br />
*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
<br />
<br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
<br />
<br />
<br />
== Face the Interfaces == <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
<br />
=== Interface History === <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
<br />
*Which vendors (and which of their applications) have they interfaced with?<br />
<br />
*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
<br />
*How many interfaces were built, and what is the maximum the system can support?<br />
<br />
*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
<br />
*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
<br />
=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
<br />
*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
<br />
*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T20:02:20Z<p>Annathehybrid: /* Cost and Budget */</p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
<br />
<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
<br />
== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Vendor Selection Criteria: Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
<br />
== Vendor Selection Criteria: Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
<br />
== Vendor Selection Criteria: Vendor assessment ==<br />
[[Vendor Selection Criteria: Vendor assessment]]<br />
<br />
== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
<br />
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
<br />
== Basic EHR Criteria ==<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
<br />
<br />
== Product Requirements ==<br />
<br />
* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
<br />
* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system? <br />
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based<br />
Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref><br />
<br />
* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref><br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
<br />
==New Non Traditional Approach Overview==<br />
<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
<br />
===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
<br />
===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
<br />
===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
<br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
<br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
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*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
<br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
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== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T19:58:34Z<p>Annathehybrid: </p>
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<div><br />
Most vendors typically fall into one of the three categories:<br />
<br />
# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
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<br />
== Vendor Proposal (Request) ==<br />
<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
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* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
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<br />
== Vendor Financing ==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
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<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
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== Vendor viability ==<br />
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*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
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*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
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* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
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* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
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* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
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* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
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* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
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*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
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*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
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*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
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*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
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== Extensive Testing of EMR Software Prior to Implementation == <br />
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Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
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*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
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<br />
<br />
== Face the Interfaces == <br />
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One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
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Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
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Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
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Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
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Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
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* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
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=== Interface History === <br />
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One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
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*Which vendors (and which of their applications) have they interfaced with?<br />
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*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
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*How many interfaces were built, and what is the maximum the system can support?<br />
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*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
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*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
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=== User Satisfaction : ''User-Centric Selection'' ===<br />
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* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
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=== Check Vendor References ===<br />
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*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
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*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
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*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T19:58:27Z<p>Annathehybrid: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
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<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
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<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
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== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
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== Vendor Selection Criteria: Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
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== Vendor Selection Criteria: Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
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== Vendor Selection Criteria: Vendor assessment ==<br />
[[Vendor Selection Criteria: Vendor assessment]]<br />
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== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
<br />
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
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*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
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== Basic EHR Criteria ==<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
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<br />
== Product Requirements ==<br />
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* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
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* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system? <br />
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based<br />
Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref><br />
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* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref><br />
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=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
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==New Non Traditional Approach Overview==<br />
<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
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===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
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===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
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===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
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The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
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== Research Functionality ==<br />
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* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
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* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
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<br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
<br />
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
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<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T19:56:08Z<p>Annathehybrid: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
<br />
<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
<br />
== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Vendor Selection Criteria: Future relationship with vendor ==<br />
[[Vendor Selection Criteria: Future relationship with vendor]]<br />
<br />
== Vendor Selection Criteria: Certification and meaningful use ==<br />
[[Vendor Selection Criteria: Certification and meaningful use]]<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
<br />
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
<br />
== Basic EHR Criteria ==<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
<br />
<br />
== Product Requirements ==<br />
<br />
* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
<br />
* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system? <br />
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based<br />
Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref><br />
<br />
* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref><br />
<br />
== Vendor Proposal (Request) ==<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
<br />
* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
<br />
==New Non Traditional Approach Overview==<br />
<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
<br />
===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
<br />
===Personalization of HIT===<br />
<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
<br />
===Transparency in communication with stakeholders for collaboration===<br />
<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
<br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
<br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
<br />
<br />
== Vendor Financing ==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
<br />
<br />
<br />
<br />
==== Face the Interfaces ==== <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
<br />
===== Interface History ===== <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
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*Which vendors (and which of their applications) have they interfaced with?<br />
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*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
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*How many interfaces were built, and what is the maximum the system can support?<br />
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*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
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*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
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=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
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=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
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* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
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=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
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* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
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*Disclosure of information that has been independently developed by the disclosing party<br />
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*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
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*Are there any hidden fees associated with training, support, consultant costs?<br />
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The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
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== Misc considerations ==<br />
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* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
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*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
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<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
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=== Physician Quality Reporting System (PQRS) ===<br />
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PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
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Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
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== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
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== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Vendor_assessmentVendor Selection Criteria: Vendor assessment2015-09-18T19:55:07Z<p>Annathehybrid: Created page with " Most vendors typically fall into one of the three categories: # Vendors that develop their own software organically on a single source code, one database, single instance. #..."</p>
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<div><br />
Most vendors typically fall into one of the three categories:<br />
<br />
# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
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*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
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*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
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* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
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* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
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* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
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* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
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* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
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*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
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*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
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*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
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*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Certification_and_meaningful_useVendor Selection Criteria: Certification and meaningful use2015-09-18T19:54:03Z<p>Annathehybrid: Created page with " == Regulatory Compliance == Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meet..."</p>
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== Regulatory Compliance ==<br />
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Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:<br />
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=== Meaningful Use (MU) === <br />
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Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. <ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref> A gap analysis can be performed:<br />
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==== Meaningful Use Gap Analysis ====<br />
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* Is it ONC Certified? [http://oncchpl.force.com/ehrcert?q=chpl]<br />
* Does it meet all Meaningful Use objectives?<br />
* Does it provide automated MU & Clinical Quality Measure Reports?<br />
* Does the vendor provide MU Training Guides/Resources?<br />
* Does the system facilitate easy MU Data capture such as required data fields?<br />
* Does it provide audit logs, usage monitoring, etc?<br />
* Does it allow/include data migration from previous EMR?<br />
* Does it contain CDS Rules to improve performance on high priority health conditions?<br />
* Does it have capability to electronically submit Clinical Quality Measures to CMS?<br />
* Does it have Public/Cancer Registry Reporting Capabilities? <br />
* Does it provide 24/7 technical support?<br />
* Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? <ref name="CMS.gov">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html</ref><br />
* Is the ONC certification current or does the product require inherited certification/ gap certification?<ref name="healthIT.gov">http://healthit.gov/sites/default/files/final2015certedfactsheet.022114.pdf</ref><br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Future_relationship_with_vendorVendor Selection Criteria: Future relationship with vendor2015-09-18T19:51:31Z<p>Annathehybrid: Created page with "Purchasing an EMR is a long-term decision with many hidden costs to consider. == Future Relationships: Vendor Partnership == * Talk to vendor's existing customers, making ..."</p>
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<div>Purchasing an EMR is a long-term decision with many hidden costs to consider.<br />
<br />
<br />
<br />
== Future Relationships: Vendor Partnership ==<br />
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* Talk to vendor's existing customers, making sure to also contact some vendor customers independently, as the vendors tend to only provide contacts to their most satisfied customers.<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and prepare a Request for Proposals (RFP). <br />
*Composing the RFP can be a daunting task. AHIMA has created a guidelines for a template that may be used to write the RFP. The guidelines are extensive and include several particular components that must be included. It can be found [http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959 here]. <ref name="RFI/RFP Template (Updated)">AHIMA http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959</ref><br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
*Ensure there will be well-laid out contractual agreement regards the 'source code' that will satisfy/cover necessary conditions: "When does the company get the 'source code?, How does the company get the source code?"<br />
*If there are workflow changes within the organization, after the product is implemented, is the product flexible enough to allow for changes without major outages or disruptions to daily activity?<br />
*What are the vendors’ contingency plans if technical glitches occur, post implementation?<br />
*Is technical support offered by the vendor 24 hours per day/ 7 days a week?<br />
*In the event of need for support from the vendor, what is the approximate response time to calls that vendor the projects?<br />
* What is the cost of providing this technical support per hour?<br />
* What size, in terms of employees, is the EHR vendor? Do they have the staff to fully address the support needs of their current client base and, can they accommodate the added support load of your institution?<br />
*In terms of clinical decision support, how often are drug list and drug interaction list updated? Once updated, how long will it take for the changes to be accessible by the end users?<br />
* When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?<br />
*In "EMR Vendor Selection" on [http://www.healthtechnologyreview.com/emr-vendor-selection.php Health Technology Review website], it states an old adage in the Software industry that consumers will buy a product based on features, but will leave the vendor based on a lack of support. Therefore, it is important to check references for the vendor related to post-implementation technical support satisfaction.<br />
* Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?<br />
* Will the source code be placed in escrow so that the system could be maintained and modified by internal IT staff in the event that the vendor ceases operation.<br />
* Does the vendor have local support personnel or will all issues be handled by a distant team?<br />
* What is an average time for installing and testing upgrades to the system? If an upgrade is missed or skipped, does the subsequent upgrade(s) have all prior changes included or just the current fix or feature for that version?<br />
* Is there going to be a vendor-institution confidentiality agreement or can the vendor share institutional information and dealings with other establishments?<br />
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'''* Does the vendor's produce meet our needs and goals for our practice? Carryout a test drive of our specific needs with the vendor's product and provide the vendor with patient and office scenarios or mock trial that they may use to customize their produce demonstration.'''<br />
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=== Upgrades ===<br />
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* Does the vendor share the organization's '''vision''' for the EHR?<br />
* Does the product provided by the vendor has all the '''key functions''' needed to fulfill the vision of the organization?<br />
* Is the vendor utilizing the desired technology?<br />
*Is the vendor stable and does it has presence in the region where the system will be implemented?<ref name="Upgrade EHR">Upgrade to a Certified EHR http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
*Is the system capable of integrating with other product such as billing systems, practice management software and public health interfaces?<ref name="Upgrade EHR"></ref><br />
* Compare retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
* Electronic replacement for traditional reportable disease notifications to health departments, may become part of biosurveillance in the future.<br />
* Is it possible to virtualize or [http://en.wikipedia.org/wiki/Sandbox_(software_development) sandbox] the system to test updates? This functionality would allow site specific testing of new features and systems with less risk of corruption of the current system. It would also allow testing of new features functionality and allow easy rollback if features end up being unwanted.<br />
* Does the system allow outreach/growth to affiliates as a "subset" of the existing clinical provider group? Does that outreach include full or limited functionality? How does that data interface with the existing clinical record?<br />
*How does the system scale? Is the vendor able to provide support and functionality as a practice grows or can they provide functionality to a small, regional branch?<br />
* Provision of EHR systems that support the capture of public health data from Clinical Information Systems.<br />
* Does the system can combine with EHR in long term health care area as a reminder of senior people?<br />
* Ensure that your vendor will be around when you need help. While specific vendor qualifications vary, generally information to be considered in the vendor vetting process, besides functional and technical details, includes vendor reputation, staff experience and qualifications, and financial solvency. <ref name="Chao"> (Chao, C., & Goldbort, J. (2012). Lessons Learned from Implementation of a Perinatal Documentation System. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(5), 599-608. doi:10.1111/j.1552-6909.2012.01378.x </ref><br />
*Does the vendor allow discrete data capture and easy reporting of critical data that needs to be submitted for reimbursement by the national and state policies on healthcare?<br />
*Is the vendor at the forefront of research in healthcare and does the software offer clinical dashboards and predictive models for easy tracking and analysis of patient data and efficient decision making by clinicians.<br />
*Does the vendor require hiring of outside consultants for training?<br />
* Does the vendor, as part of their 18-24 month roadmap, include Direct-Trust (commonly referred to as Blue Button) to facilitate a more automated Provider to Provider data exchange as a replacement for FAX machine?<ref>Transmitting Data Using the Direct Protocol. (2013, February 4). Retrieved February 3, 2015, from http://bluebuttonplus.org/transmit-using-direct.html</ref><br />
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* Does the vendor, as part of their 18-24 month roadmap, include Fast Healthcare Interoperability Resource (FHIR) protocol as well as Human APIs implementation to facilitate bi-directional data exchange between Provider and Patient?<ref>HL7 Fast Healthcare Interoperability Resources Specification (FHIR™), Release 1. (n.d.). Retrieved February 5, 2015, from http://www.hl7.org/implement/standards/product_brief.cfm?product_id=343</ref><br />
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* Does the vendor, as part of their 18-24 month roadmap, include not only Member Eligibility data but History data, Formulary data as well as Drug Utilization Review (DUR) data in their ePrescription Hub?<ref>Pennell, U. (2013, August 21). What is E-prescribing and What are the benefits? - EMRConsultant. Retrieved February 7, 2015, from http://www.emrconsultant.com/emr-education-center/emr-selection-and-implementation/what-is-e-prescribing-and-what-are-the-benefits/?s=dur</ref><br />
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*Does the system offers privacy and security capabilities?<ref name="Upgrade EHR"></ref><br />
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== Contracts ==<br />
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Contracts are as much a business tool as they are a purchasing agreement. <ref name="ehr contract">Carolyn Hartley - signing an EHR contract http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
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* Project Payments<br />
* Contract Terms [http://calhipso.org/documents/ehr_contracting_terms_final_508_compliant.pdf]<br />
* All costs, current and future, associated with the implementation<br />
Details of the total cost incurred by the institution also called total cost of ownership (TCO) is an important consideration in the selection process. It helps to predict the longevity of the program. The request for proposal to vendors should include a request for information about vendor license and implementation costs. Vendors should deliniate the assumptions made when preparing the TCO so the decision committee is able to verify that they are parallel to the goals and objectives of the insitutions. If the same assumptions are encorporated in all request for proposals one can better compare the applications. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref><br />
Institutions must also consider the intangible return on their investments such as reduced adverse events, decreased hospital stay, accurate and timely billing and improved management of supplies.<br />
* Does the vendor have any hidden fees?<br />
* Time commitment from vendor with regard to implementation and training<br />
* Penalties for delays in implementation<br />
* Code escrow - be sure code will be available if vendor goes out of business<br />
* Indemnification and hold harmless clauses <br />
* Confidentiality and nondisclosure agreements <br />
* Warranties and disclaimers <br />
* Limits on liability <br />
* Dispute resolution <br />
* Termination and wind down<br />
* Intellectual property disputes <br />
* IT support agreement<br />
* Training Contract<br />
* Applied area contract<br />
* User and vender liability<br />
* Disputation judgment <br />
* Attorney of vender and clients<br />
* User License - The person who has access to data using a user ID and password. Pricing structures vary according to the definition of user.<br />
* Consider variation of user licenses according to the needs: one price per MD, tiered price (MD, nurse or administrator), site license (25+ providers in the same facility), and enterprise license (multiple users in multiple departments). <ref name="user license">Signing an EHR contract. Tips to control costs. http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
* Interface - The EHR vendor's contract includes the cost of interfaces. These include interfaces such as those with your scanner or fax machine; and more complex interfaces such <br />
* Hardware Contract - Review the EHR vendor's hardware quote, but research may lower costs. Check the vendor's website for hardware specifications the vendor supports. Hardware includes servers, high-speed scanners, computers, handhelds, computer on wheels (COW), wall mounts, etc. Hardware installation to a wholesaler means assembling the server and software to make it work at their location prior to delivering it to you. It usually does NOT mean the installation at your location, a difference that will create a significant budget surprise. Clarify the term "installation" with any hardware wholesaler before making the purchase.<br />
* Third Party Software Contracts – Software includes encryption, speech-recognition, password management, Microsoft™ suite, anti-virus, golden image, bar-coding or webcams.<br />
* Business Associate Agreement - To be HIPAA-compliant you will need a business associate agreement with the vendor, and must ensure the vendor meets HIPAA security and privacy requirements.<ref name="HIMSS-AMA-BAA">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Core_clinical_featuresVendor Selection Criteria: Core clinical features2015-09-18T19:49:00Z<p>Annathehybrid: </p>
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<div>Core clinical functionalities include a not only medication lists, allergy lists, order sets, and lab ordering, but also can include a fully integrated pharmacy/medication management interface.<br />
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== Core Clinical Features ==<br />
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In 2003, the DHHS [http://www.hhs.gov/] asked the IOM [http://www.iom.edu/] to provide guidance on the basic functionalities of electronic health records systems. The committee concluded that the core functionalities should address the following areas:<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation and <br />
* Integration of hospital services<br />
In the Journal of Healthcare Information Management Kranny et. al discussed the importance of an application in the EHR which will promote continuity of care. During the selection of a vendor it is imperative for the decision committee to find out if there is an integration of inpatient, clinical and outpatient interface systems. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref> The patient's progress in house and discharge summary should be accessible by his primary care provider upon discharge. Medications that were discontinued during hospitalization should be updated in the patient's outpatient medication profile so wrong medications are not refilled by the patient. In addition, when new medications are added to the patient medication regimen it should be accessible by the primary care provider and outpatient pharmacist.<br />
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The IOM committee decided that the core functionalities of EHR system should cover the following areas: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
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* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation<br />
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Jain et al. (2010), in the article Evaluating EHR Systems, describes a few criteria to look for in EHR selection. Considerations for EHR selection should include privacy of patient data, interoperability, ease of use( for physicians and support staff) and efficiency of the integrated systems. Management support during implementation is crucial. <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/747986471?accountid=7034</ref><br />
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Based on these areas, the they identified eight categories of core functionalities, including: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
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* Health information and data<br />
* Results management<br />
* [[CPOE|Order entry/management]]<br />
* [[CDS|Decision support]]<br />
* Electronic communication and connectivity<br />
* Patient support; administrative processes<br />
* Reporting and population health management<br />
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=== EHR System Feature List ===<br />
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* Information to be considered to store in the system:<br />
** Demographics details<br />
** Patient specific problem or CC (Chief Complaint) with [[ICD|ICD-9 or ICD-10]] numbering<br />
*** Acute/Chronic Indicator<br />
*** Worsening/Resolving Indicator<br />
*** Injuries List<br />
*** Present Illness Description<br />
** Procedures<br />
** Diagnoses <br />
** Medications<br />
** Allergies<br />
** Family medical history <br />
** Consultations<br />
** Signs & Symptoms<br />
** Vitals<br />
** Progress Notes<br />
** Discharge Summaries<br />
** Appointments/Admissions/Visits<br />
** Advance Directives<br />
** Clinical Reminders [Immunizations, Screenings, Risks]<br />
* Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)<br />
** Review and search results easily by sorting test types, test time, test administers, test results and so on<br />
** Choose one or several test types, such as HGB, and/or WBC, and/or blood sugar and chart on their results for showing trends<br />
* Is the software configuration flexible to customize for future needs? How much customization to the EMR can the vendor offer to meet the institution’s needs? Will there be a surplus of unusable or insufficient components to the EMR? <ref name="himss-ama-pms">American Medical Association. 15 questions to ask before signing an EMR/EHR agreement. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Is this EHR system compatible with any other systems such as adverse drug reaction system, case based reasoning system and rule based reasoning systems?<br />
* The proposed EHR software should bring minimal to no new limitations to the existing workflows of the institution <ref name="himss-ama-pms"> </ref><br />
* Does the system meet all existing required operational tasks?<br />
* Does the EHR tested in any other provider sites?<br />
* Does the EHR allow for expandability to mobile devices, mobile medical applications and upcoming mobile technologies?<br />
* Does the EHR have integrated practice management to avoid having to interface with a 3rd party practice management system?<ref name="himss-ama-pms"> </ref><br />
* Does the software provide a tool for workflow mapping/charting?<br />
* Is it possible to migrate existing legacy EMR system institute use to the new EMR database schema?<br />
* Can the software be easily configured/adapted to changing workflows?<br />
* Does the EHR provide on-screen flags to indicate patient visit status? <br />
* Does the EHR allow customization of work flows by the provider, clinician, or other health care professional?<br />
* Does the EHR documentation method support error checking for vital sign data entry? <br />
* Does the EHR/EMR system allow multiple terminals (physician, nurses' station, X-ray, labs, etc.) to log in to the same patient's record simultaneously? Certain systems only allow one terminal to access a patient record at a time - they must log out before any other terminal can access patient EHR/EMR. (For example, if a nurse forgets to log out at their station, the lab cannot access that patient's record.)<br />
* Does the product have a standardized electronic patient handoff tool to facilitate physician workflow, increase physician satisfaction and ultimately potentially improve patient outcomes?<br />
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== CPOE ==<br />
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* [[CPOE| Computerized Physician Order Entry (CPOE)]], [[Electronic prescribing| e-Prescribing]]<br />
* Computerized Physician Order Entry system that integrates and provides for two-way communication with the Pharmacy, Laboratory, Registration systems, and that allows for scanning and downloading of health information as needed. The EHR system should have a completely understood interface and provide for [[HIE|interoperability]] with all current and future systems and between clinics and providers.<br />
* CPOE will generally allow for the organization to specify a default dose for a medication order. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The CPOE team will need to review what happens when non-formulary items are entered. The workflow for non-formulary items will also need to be determined. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The EHR should have the capabilities to interface with the various labs the hospital or physician uses to order and receive patient lab work automatically.<br />
* Does the EHR have a referral management system so that within large organizations, specialty and primary care departments can easily communication with each other and have similar information on a patient that is using both offices to treat their illness?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the system allow each provider to create customized order sets including laboratory order sets, procedure order sets, presurgical order sets, and postsurgical order sets? <ref>http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
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== Clinical decision support (CDS) ==<br />
* [[Earlier Clinical Decision Support (CDS) Tools]]<br />
* [[Historical Challenges of Clinical Decision Support (CDS) Tools]]<br />
* [[Benefits of Various types of Clinical Decision Support(CDS) Tools]]<br />
* [[CDS|Decision Support]] (Drug Interaction, Drug information and other Prescription Supports, Clinical Guidelines [Plans & Protocols] and disease information, Diagnosis and differential diagnosis Support, Risk Assessments, Clinical Checklists, Medical References, etc)<br />
* Formulary Database Support<br />
* Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)<br />
* Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)<br />
* Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)<br />
* Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.<br />
* [[PHR|Patient Portal for online personal health record access]]<br />
* Clinical policies and procedures guidelines<br />
* Produce visit summary and complete medical record printout and data export on demand for patient use.<br />
* Electronic Health Record (EHR) systems should be capable of accommodating multiple users working concurrently within the system and within the same patient file or document. EHR systems should also be capable of protecting the integrity of data in the system so that no data loss occurs when multiple users are working concurrently with the same patient file or document.<br />
** Provide direct decision support explanation link to [[EBM|evidence based knowledge]] (through such as "infobutton",etc) about needed test information, such as purpose and methods of conducting that test, normal range of that test, clinical indications when abnormal results occurred and suggestions what to do, etc.<br />
** Provide abnormal alerts to providers and/or patients through various ways, such as online display, cell phone text messages, etc if the patients/doctors register for this service.<br />
* The organization will need to strike a balance between displaying so many alerts that it causes clinical care to slow. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
*Does the EHR have an aspect of the CPOE that can manage patient protocols and treatment plans? <ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the software have “Clinical/Business Intelligence” capability based on local clinic medical trends, e.g. if there is above normal upper respiratory infection clinic visits, perhaps a flu season is imminent and may warrant stocking of flu vaccine in the clinic?<br />
* Does the system support patient-specific dosing? When entering medication orders, can the system recommend dosages based on the patient's age, weight, and comorbidities? <ref>http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
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== Data Storage and Retrieval ==<br />
<br />
* EHR systems should be capable of capturing, storing, indexing, retrieving and displaying externally created documents. Indexing of captured documents should include not only patient identifiers and descriptive information, but also date/time stamps and document type.<br />
* EHR systems should be capable of retaining all system data until such data is archived or intentionally purged from the system.<br />
* The system should load patient records in a timely manner to not interrupt workflow. <br />
* This system should present chronological data of patients like medicine history, progress of diseases. <br />
* Also, system provides gene information or drug allergies of patients to avoid [[Adverse drug event|ADE]].<br />
* System should be compatible with old system to reduce re-entry time.<br />
* System should update regularly.<br />
* system should be able to have Patient prescription plan eligibility, prescription product formulary and external medication history.<br />
* System should be able to have insurance retrieval capabilities (i.e. insurance firms, sum insured, premium dues, etc.).[11]<br />
* Capability to integrate with other products such as practice management software, billing systems and public health interfaces.<br />
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== Functional Requirements ==<br />
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Functional requirements are those processes that you want a system to perform <ref name="stratishealth"> Requirements Analysis. http://www.stratishealth.org/documents/HITToolkitHospital/1.Adopt/1.3Select/1.3Requirements_Analysis.doc. </ref>.<br />
The electronic health record’s architecture, or its relationship across any existing or future systems at the organization’s practice, directly influences what functions the EHR can support <ref name="ehrchecklist"> EHR Checklist: Functional and Technical Essentials. http://www.poweryourpractice.com/electronic-health-records/ehr-checklist-functional-and-technical-essentials/. </ref>.<br />
The following functional requirements have been broken into the following areas that correspond to EHR functional categories:<br />
==== Clinical Documentation Requirements ====<br />
Clinical documentation is used throughout healthcare to describe care provided to a patient,communicate essential information between healthcare providers and to maintain a patient medical record <ref name="clindoc"> Boone,K.W. Clinical Documentation. 2011. http://www.springer.com/cda/content/document/cda_downloaddocument/9780857293350-c1.pdf?SGWID=0-0-45-1140144-p174097770. </ref>.<br />
* Document and View Medication History<br />
** Will the EHR have the ability to perform basic clinical documentation, including medication history?<br />
** Will the current, active medications be viewable on demand?<br />
** Will the system have the ability to display a complete medication history from information available within the EHR? <ref name="functional"> EHR Functional Requirements. http://www.nyehealth.org/images/files/File_Repository16/pdf/Version_2_2_EHR_Functional_Requirements-16_Nov_09.pdf. </ref><br />
* Treatment plan<br />
** Will the system be able to document a treatment plan and create any new orders?<br />
** As part of that treatment plan, will clinician have the ability to confirm previous medications and prescribe any potential new medications or make dose changes, and the ability to electronically submit orders such as labs, radiology, physical therapy, and other supportive services?<br />
** Will the EHR be able to create structured treatment plan as part of patient encounter? <ref name="functional"></ref><br />
* Consult Note<br />
** Will the system be able to document a consult note with appropriate clinical information from the medical record, including a clinical recommendation, and surgical clearance? <ref name="functional"></ref><br />
*Chief Complaint, Problems, Vital Sign, History, Visits, Medication List, Allergies<br />
** Will the appropriate clinical staff be able to electronically document chief complaint, vital signs, reason for visit, new history, MD visits, problem list, and medication lists?<br />
** Will the system permit appropriate clinical staff to document, review and update patient problems, medications, and allergies or adverse drug reactions in the EHR?<ref name="functional"></ref><br />
*History of Present Illness/Review of Systems/Family History/Medical History/Surgical History/Social History and Physical Exam<br />
** Will the system allow the complete physical assessment, including all necessary examinations based on the current standards of care for the applicable condition, to be documented in a standardized manner with consistent nomenclature? <ref name="functional"></ref><br />
*Patient Educational Materials<br />
** Will the system have patient education material available within the application either from the application itself or from a third party solution? <ref name="functional"></ref><br />
* Does the system support various methods of documentation creation? Can documents be created through traditional dictation and transcription and imported into the patient record? Does the vendor support interfaces for importing documents?<br />
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<br />
<br />
<br />
== Formulary Management ==<br />
<br />
# Data repository for formulary information, maintain real time update of medication information with national drug information database<br />
# Support periodic update of formulary, restricted formulary, and nonformulary medications<br />
# Cross reference patient’s insurance formulary list to allow for generic medications to be selected when e-prescribing.<br />
<br />
== Drug dispense and delivery===<br />
<br />
# Support outpatient pharmacy operation functionality: <br />
## Maintain outpatient prescription data<br />
## Management of prescription fill, refill and dispense activities<br />
## Support billing protocols with governmental and private insurance<br />
# Support inpatient pharmacy operation functionality<br />
## Maintain inpatient medication ordering data<br />
## Real-time monitoring of IV and oral medication compounding and delivery<br />
## Support real-time data interface with automatic dispensing cabinet<br />
<br />
== Nursing Functionality ==<br />
# Supporting eMAR: supporting real-time electronic medication administration record and [http://www.ncbi.nlm.nih.gov/pubmed/20445181 bar code medication administration technology].<br />
## Does the system track refusal of medications? <ref name="ELECTRONIC MEDICATION ADMINISTRATION RECORD (EMAR)">http://www.healthsecure-emr.com/jail-emr-emar</ref><br />
## Does the eMar have the ability to send encrypted messages directly to the pharmacy? <br />
# Supporting bedside automation in medication delivery: Support data interface and real-time monitoring of [http://www.ncbi.nlm.nih.gov/pubmed/15753744 smart infusion pumps] and home infusion pumps <br />
# Ease of use of Nursing flow sheets: Rows in the EHR to be filled by nurses for consistent patient care processes.<ref name="ICU Accept">Carayon, P. Cartmill, R. Blosky, M. Brown, R. Hackenberg, M. Hoonakker, P. Hundt, A. Norfolk, E. Wetterneck, T. Walker, J. (2011).ICU nurses’ acceptance of electronic health records. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197984/pdf/amiajnl-2010-000018.pdf </ref><br />
# Ease of access and usability of EHR for nursing administration and clinical documentation for nurses. <ref name="Disputes Risks">Raasikh, . What the others haven't told you: lessons learned to avoid disputes and risks in EHR implementation.http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?action=interpret&id=GALE%7CA365889941&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&authCount=1</ref><br />
# Clinical decision support and risk assessment tools for issues related to nurse care delivery, such as falls, medication delivery, skin ulcers etc. <ref name="Impact Nurse">Dowding,D. Turley, M. and Garrido, T. (2012). The impact of an electronic health record on nurse<br />
sensitive patient outcomes: an interrupted time<br />
series analysis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384108/pdf/amiajnl-2011-000504.pdf</ref><br />
<br />
== Pharmacy Operation ==<br />
Hospitals and physician practices need to keep their patients safe and well managed by using a pharmacy information system also called a medication management system. The system must have several core functions including in and outpatient order entry, dispensing, and inventory and purchasing management. The system must also be able to connect to other systems within the enterprise, including an EMR, computerized physician order entry (CPOE), barcode technology, and smart IV infusion pumps.<ref name="Pharmacy Information Systems">10 Popular Pharmacy Information Systems".http://www.informationweek.com/healthcare/clinical-information-systems/10-popular-pharmacy-information-systems/d/d-id/1104805?</ref><br />
<br />
# Connect to other systems within the enterprise including EMRs<br />
# Computerized physician order entry (CPOE)<br />
# Barcode technology<br />
# Smart IV infusion pumps<br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_Core_clinical_featuresVendor Selection Criteria: Core clinical features2015-09-18T19:47:36Z<p>Annathehybrid: </p>
<hr />
<div>Core clinical functionalities include a not only medication lists, allergy lists, order sets, and lab ordering, but also can include a fully integrated pharmacy/medication management interface.<br />
<br />
== Core Clinical Features ==<br />
<br />
In 2003, the DHHS [http://www.hhs.gov/] asked the IOM [http://www.iom.edu/] to provide guidance on the basic functionalities of electronic health records systems. The committee concluded that the core functionalities should address the following areas:<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation and <br />
* Integration of hospital services<br />
In the Journal of Healthcare Information Management Kranny et. al discussed the importance of an application in the EHR which will promote continuity of care. During the selection of a vendor it is imperative for the decision committee to find out if there is an integration of inpatient, clinical and outpatient interface systems. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref> The patient's progress in house and discharge summary should be accessible by his primary care provider upon discharge. Medications that were discontinued during hospitalization should be updated in the patient's outpatient medication profile so wrong medications are not refilled by the patient. In addition, when new medications are added to the patient medication regimen it should be accessible by the primary care provider and outpatient pharmacist.<br />
<br />
The IOM committee decided that the core functionalities of EHR system should cover the following areas: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation<br />
<br />
Jain et al. (2010), in the article Evaluating EHR Systems, describes a few criteria to look for in EHR selection. Considerations for EHR selection should include privacy of patient data, interoperability, ease of use( for physicians and support staff) and efficiency of the integrated systems. Management support during implementation is crucial. <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/747986471?accountid=7034</ref><br />
<br />
Based on these areas, the they identified eight categories of core functionalities, including: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
<br />
* Health information and data<br />
* Results management<br />
* [[CPOE|Order entry/management]]<br />
* [[CDS|Decision support]]<br />
* Electronic communication and connectivity<br />
* Patient support; administrative processes<br />
* Reporting and population health management<br />
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<br />
<br />
=== EHR System Feature List ===<br />
<br />
* Information to be considered to store in the system:<br />
** Demographics details<br />
** Patient specific problem or CC (Chief Complaint) with [[ICD|ICD-9 or ICD-10]] numbering<br />
*** Acute/Chronic Indicator<br />
*** Worsening/Resolving Indicator<br />
*** Injuries List<br />
*** Present Illness Description<br />
** Procedures<br />
** Diagnoses <br />
** Medications<br />
** Allergies<br />
** Family medical history <br />
** Consultations<br />
** Signs & Symptoms<br />
** Vitals<br />
** Progress Notes<br />
** Discharge Summaries<br />
** Appointments/Admissions/Visits<br />
** Advance Directives<br />
** Clinical Reminders [Immunizations, Screenings, Risks]<br />
* Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)<br />
** Review and search results easily by sorting test types, test time, test administers, test results and so on<br />
** Choose one or several test types, such as HGB, and/or WBC, and/or blood sugar and chart on their results for showing trends<br />
* Is the software configuration flexible to customize for future needs? How much customization to the EMR can the vendor offer to meet the institution’s needs? Will there be a surplus of unusable or insufficient components to the EMR? <ref name="himss-ama-pms">American Medical Association. 15 questions to ask before signing an EMR/EHR agreement. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Is this EHR system compatible with any other systems such as adverse drug reaction system, case based reasoning system and rule based reasoning systems?<br />
* The proposed EHR software should bring minimal to no new limitations to the existing workflows of the institution <ref name="himss-ama-pms"> </ref><br />
* Does the system meet all existing required operational tasks?<br />
* Does the EHR tested in any other provider sites?<br />
* Does the EHR allow for expandability to mobile devices, mobile medical applications and upcoming mobile technologies?<br />
* Does the EHR have integrated practice management to avoid having to interface with a 3rd party practice management system?<ref name="himss-ama-pms"> </ref><br />
* Does the software provide a tool for workflow mapping/charting?<br />
* Is it possible to migrate existing legacy EMR system institute use to the new EMR database schema?<br />
* Can the software be easily configured/adapted to changing workflows?<br />
* Does the EHR provide on-screen flags to indicate patient visit status? <br />
* Does the EHR allow customization of work flows by the provider, clinician, or other health care professional?<br />
* Does the EHR documentation method support error checking for vital sign data entry? <br />
* Does the EHR/EMR system allow multiple terminals (physician, nurses' station, X-ray, labs, etc.) to log in to the same patient's record simultaneously? Certain systems only allow one terminal to access a patient record at a time - they must log out before any other terminal can access patient EHR/EMR. (For example, if a nurse forgets to log out at their station, the lab cannot access that patient's record.)<br />
* Does the product have a standardized electronic patient handoff tool to facilitate physician workflow, increase physician satisfaction and ultimately potentially improve patient outcomes?<br />
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<br />
== CPOE ==<br />
<br />
* [[CPOE| Computerized Physician Order Entry (CPOE)]], [[Electronic prescribing| e-Prescribing]]<br />
* Computerized Physician Order Entry system that integrates and provides for two-way communication with the Pharmacy, Laboratory, Registration systems, and that allows for scanning and downloading of health information as needed. The EHR system should have a completely understood interface and provide for [[HIE|interoperability]] with all current and future systems and between clinics and providers.<br />
* CPOE will generally allow for the organization to specify a default dose for a medication order. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The CPOE team will need to review what happens when non-formulary items are entered. The workflow for non-formulary items will also need to be determined. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The EHR should have the capabilities to interface with the various labs the hospital or physician uses to order and receive patient lab work automatically.<br />
* Does the EHR have a referral management system so that within large organizations, specialty and primary care departments can easily communication with each other and have similar information on a patient that is using both offices to treat their illness?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the system allow each provider to create customized order sets including laboratory order sets, procedure order sets, presurgical order sets, and postsurgical order sets? <ref>http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
<br />
== Clinical decision support (CDS) ==<br />
* [[Earlier Clinical Decision Support (CDS) Tools]]<br />
* [[Historical Challenges of Clinical Decision Support (CDS) Tools]]<br />
* [[Benefits of Various types of Clinical Decision Support(CDS) Tools]]<br />
* [[CDS|Decision Support]] (Drug Interaction, Drug information and other Prescription Supports, Clinical Guidelines [Plans & Protocols] and disease information, Diagnosis and differential diagnosis Support, Risk Assessments, Clinical Checklists, Medical References, etc)<br />
* Formulary Database Support<br />
* Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)<br />
* Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)<br />
* Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)<br />
* Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.<br />
* [[PHR|Patient Portal for online personal health record access]]<br />
* Clinical policies and procedures guidelines<br />
* Produce visit summary and complete medical record printout and data export on demand for patient use.<br />
* Electronic Health Record (EHR) systems should be capable of accommodating multiple users working concurrently within the system and within the same patient file or document. EHR systems should also be capable of protecting the integrity of data in the system so that no data loss occurs when multiple users are working concurrently with the same patient file or document.<br />
** Provide direct decision support explanation link to [[EBM|evidence based knowledge]] (through such as "infobutton",etc) about needed test information, such as purpose and methods of conducting that test, normal range of that test, clinical indications when abnormal results occurred and suggestions what to do, etc.<br />
** Provide abnormal alerts to providers and/or patients through various ways, such as online display, cell phone text messages, etc if the patients/doctors register for this service.<br />
* The organization will need to strike a balance between displaying so many alerts that it causes clinical care to slow. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
*Does the EHR have an aspect of the CPOE that can manage patient protocols and treatment plans? <ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the software have “Clinical/Business Intelligence” capability based on local clinic medical trends, e.g. if there is above normal upper respiratory infection clinic visits, perhaps a flu season is imminent and may warrant stocking of flu vaccine in the clinic?<br />
* Does the system support patient-specific dosing? When entering medication orders, can the system recommend dosages based on the patient's age, weight, and comorbidities? <ref>http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
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== Data Storage and Retrieval ==<br />
<br />
* EHR systems should be capable of capturing, storing, indexing, retrieving and displaying externally created documents. Indexing of captured documents should include not only patient identifiers and descriptive information, but also date/time stamps and document type.<br />
* EHR systems should be capable of retaining all system data until such data is archived or intentionally purged from the system.<br />
* The system should load patient records in a timely manner to not interrupt workflow. <br />
* This system should present chronological data of patients like medicine history, progress of diseases. <br />
* Also, system provides gene information or drug allergies of patients to avoid [[Adverse drug event|ADE]].<br />
* System should be compatible with old system to reduce re-entry time.<br />
* System should update regularly.<br />
* system should be able to have Patient prescription plan eligibility, prescription product formulary and external medication history.<br />
* System should be able to have insurance retrieval capabilities (i.e. insurance firms, sum insured, premium dues, etc.).[11]<br />
* Capability to integrate with other products such as practice management software, billing systems and public health interfaces.<br />
<br />
== Functional Requirements ==<br />
<br />
Functional requirements are those processes that you want a system to perform <ref name="stratishealth"> Requirements Analysis. http://www.stratishealth.org/documents/HITToolkitHospital/1.Adopt/1.3Select/1.3Requirements_Analysis.doc. </ref>.<br />
The electronic health record’s architecture, or its relationship across any existing or future systems at the organization’s practice, directly influences what functions the EHR can support <ref name="ehrchecklist"> EHR Checklist: Functional and Technical Essentials. http://www.poweryourpractice.com/electronic-health-records/ehr-checklist-functional-and-technical-essentials/. </ref>.<br />
The following functional requirements have been broken into the following areas that correspond to EHR functional categories:<br />
==== Clinical Documentation Requirements ====<br />
Clinical documentation is used throughout healthcare to describe care provided to a patient,communicate essential information between healthcare providers and to maintain a patient medical record <ref name="clindoc"> Boone,K.W. Clinical Documentation. 2011. http://www.springer.com/cda/content/document/cda_downloaddocument/9780857293350-c1.pdf?SGWID=0-0-45-1140144-p174097770. </ref>.<br />
* Document and View Medication History<br />
** Will the EHR have the ability to perform basic clinical documentation, including medication history?<br />
** Will the current, active medications be viewable on demand?<br />
** Will the system have the ability to display a complete medication history from information available within the EHR? <ref name="functional"> EHR Functional Requirements. http://www.nyehealth.org/images/files/File_Repository16/pdf/Version_2_2_EHR_Functional_Requirements-16_Nov_09.pdf. </ref><br />
* Treatment plan<br />
** Will the system be able to document a treatment plan and create any new orders?<br />
** As part of that treatment plan, will clinician have the ability to confirm previous medications and prescribe any potential new medications or make dose changes, and the ability to electronically submit orders such as labs, radiology, physical therapy, and other supportive services?<br />
** Will the EHR be able to create structured treatment plan as part of patient encounter? <ref name="functional"></ref><br />
* Consult Note<br />
** Will the system be able to document a consult note with appropriate clinical information from the medical record, including a clinical recommendation, and surgical clearance? <ref name="functional"></ref><br />
*Chief Complaint, Problems, Vital Sign, History, Visits, Medication List, Allergies<br />
** Will the appropriate clinical staff be able to electronically document chief complaint, vital signs, reason for visit, new history, MD visits, problem list, and medication lists?<br />
** Will the system permit appropriate clinical staff to document, review and update patient problems, medications, and allergies or adverse drug reactions in the EHR?<ref name="functional"></ref><br />
*History of Present Illness/Review of Systems/Family History/Medical History/Surgical History/Social History and Physical Exam<br />
** Will the system allow the complete physical assessment, including all necessary examinations based on the current standards of care for the applicable condition, to be documented in a standardized manner with consistent nomenclature? <ref name="functional"></ref><br />
*Patient Educational Materials<br />
** Will the system have patient education material available within the application either from the application itself or from a third party solution? <ref name="functional"></ref><br />
* Does the system support various methods of documentation creation? Can documents be created through traditional dictation and transcription and imported into the patient record? Does the vendor support interfaces for importing documents?<br />
<br />
<br />
<br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_IT_and_technical_requirementsVendor Selection Criteria: IT and technical requirements2015-09-18T19:45:49Z<p>Annathehybrid: </p>
<hr />
<div><br />
== IT and Technical Requirements ==<br />
<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non-upgraded system? For how long?<br />
* Does the system use [http://medical.nema.org/ DICOM] standards for the transmission of image data?<br />
* Does the system provide an imaging database or allow customized program attachments of imaging needs of specific departments in the hospital?<br />
* What are the hardware requirements?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Do the upgrades come with a fee?<br />
*Is the vendor’s application (system) platform independent? <br />
*Is the system using standards such as Snomed, [http://www.who.int/classifications/icd/en/ ICD 10]; [http://hl7book.net/index.php?title=HL7_version_2 HL7 Version 2] or [http://hl7book.net/index.php?title=HL7_version_3 3]; HL7 infobutton…)<br />
*How does the system handle multiple logins of the same user at different locations/instances?<br />
*How does the system handle user inactivity? (auto-logout, discarding\saving changes, draft creation)<br />
* Is the software capable of using biometric data for rapid login by providers who are mobile between patients/sites?<br />
* How does the system lend itself to automated back-ups? Does the vendor provide IT support team to implement specific back-up plans that will work with the hospital's IT team? <br />
* Can the system allow login remotely – off site transcription or home or other clinic?<br />
* Does the system provide the ability to identify all users who have accessed an individual's chart over a given time period, including date and time of access?<br />
* Does the vendor offer a Software as a Service (SaaS) solution, also know as an Application Service Provider (ASP), or a client-server solution?<br />
* With existing systems, how tightly integrated will the new EHR system be and what prep work is required to make the integration possible?<br />
* Does the system have modules for automatic update of knowledge sets at regular intervals, more like automatic update of antivirus definitions?<br />
* How often does the software need to be upgraded?<br />
* Does the software allow generation of customized reports such that desired information can be extracted periodically for performance improvement projects or performance monitoring.<br />
* Does the vendor utilize the desired technology?<br />
* Is remote access available for mobile devices?<br />
** Is this web-access or a dedicated app?<br />
** In what way is this mobile access limited? Does it have access to all functionality?<br />
** What devices can access the mobile apps? (e.g. iPad, iPhone, Android, etc.)<br />
* Is remote access cross platform? The use of open standards (e.g. HTML5, [[Extensible Markup Language (XML)|XML)]] allows users on any platform, including smartphones and tablets, to have equivocal access to the system.<br />
* Does the system support web-based working environment?<br />
* Does the system provide extension package or software for IT engineers or users? <br />
* Does the system comply with HIMMS standard?<br />
* Can the system be installed on Windows or IOS operating systems?<br />
* How does the system’s IT infrastructure requirement align with the institution’s current infrastructure and the institution’s infrastructure five-year strategic road map?<br />
* What hardware technology (Server) does the database support? And does the supported hardware provide built-in high availability?<br />
* Does the system’s application (not database) support virtual environments? Will it run on a virtual server? <br />
* Is your ticketing system capable of interfacing with [name of ITSM software utilized by your institution]?<br />
* Negotiate the terms and prices of the interface system: to/from PM system, scanner, fax machine, laboratory, health information exchange partners such as hospitals, ambulatory surgical centers, radiology, ePrescribing.<br />
* Can the system be hosted and supported remotely by the vendor? <br />
* How scalable is the IT infrastructure? Is there a peak limit on the number of concurrent users utilizing the system? (this comes in handy during mergers & acquisitions in which you may exponentially increase in size of user base) <br />
* Does the system support dictation function?<br />
* Does the system support speech recognition?<br />
* Does the system have a spell check tool for notes (progress notes, letters, and H&P notes)? <br />
* What are the data back up options available in case of natural calamity? <br />
* Is the EHR system compatible with other systems in the event of termination or vendor's insolvency? <ref name="obsolete technology">Neal, D. (2011). Choosing an Electronic Health Records System: Professional Liability Considerations. Innovations in Clinical Neuroscience, 8(6), pg. 45.</ref><br />
* Are scanning capabilities available and if so, is there a particular scanner make and model required?<br />
* Are scanning licenses needed? How much are the scanning licenses and are they needed per user or per pc?<br />
<br />
=== Legacy systems ===<br />
<br />
* How does the vendor compare in [http://www.klasresearch.com/ KLAS] rankings of similar systems and applications?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Does the vendor provide services to convert and transfer data from legacy systems into the new system, and if so, what is the cost?<ref name="himss-ama-legacy">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? <br />
*Make sure the vendors give accurate information for the Request for Proposal. So the stakeholders can make informed decisions on the comparison of vendors.<br />
-Zoker 9/17/2011<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems?<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the [http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page? AMA Current Procedural Terminology] (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* How does the vendor manage diagnosis documentation and coding? Does the system require specific coding terminology or does it allow provider synonyms for coding terms? How is that updated and maintained? <br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are certified Health IT products through the [http://oncchpl.force.com/ehrcert/ehrproductsearch Office of the National Coordinator (ONC) for HIT.] Previously [http://www.cchit.org/ CCHIT] provided a list of certified EMR but as of late 2014 is no longer in operation.<br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? <br />
* What is the company policy regarding data ownership for the ASP EHR? <br />
* The EHR product should be certified for the standards and certification criteria issued by the Office of the National Coordinator for Health Information Technology (ONC-HIT)? How many criteria does it satisfy?<br />
* How is documentation managed and preserved over time? How is documentation protected from being altered, in all parts of the system including the underlying databases?<ref name="Legal EHR">The Legal Electronic Health Record.www.himss.org/files/HIMSSorg/content/files/LegalEMR_Flyer3.pdf</ref><br />
*Does the vendor retain, ensure availability, and destroy health record information according to organizational standards? For instance, retaining all EHR data and clinical documents for the time period designated by policy or legal requirement; retaining inbound documents as originally received (unaltered); ensuring availability of information for the legally prescribed period of time; and provide the ability to destroy EHR data/records in a systematic way according to policy and after the legally prescribed retention period.<ref name="EHR Functions">Understanding Features & Functions of an EHR.http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
<br />
=== Troubleshooting ===<br />
<br />
* Immediate trouble shooting ability<br />
* Once the problem is identified, the first step is to ascertain the scope<ref name="Kevin MD"></ref><br />
* If the scope of outage is large and the root cause is unknown, raise alarm bells early<ref name="Kevin MD"></ref><br />
* Bring visibility to the process by having hourly updates,and multiple eyes on the problem<ref name="Kevin MD"></ref><br />
* Over communicate with the users<ref name="Kevin MD">http://www.kevinmd.com/blog/2010/09/10-tips-troubleshooting-complex-ehr-infrastructure-problems.html</ref><br />
* Do not let pride get in the way<ref name="Kevin MD"></ref><br />
* It is important to set deadlines in the response plan<ref name="Kevin MD"></ref><br />
* The simplest explanation is usually the correct one<ref name="Kevin MD"></ref><br />
* Regular connect with customers about their problems<br />
* The system shall include documentation that describes the patch (hot-fix) handling process the vendor will use for EHR, operating system and underlying tools (e.g. a specific web site for notification of new patches, an approved patch list, special instructions for installation, and post-installation test).<br />
* The system shall include documented procedures for product installation, start-up and/or connection.<br />
* What options does the EMR have for upfront abstraction and scanning? Are these costs included in the purchase of the EMR?<br />
* Can the vendor support the organization desired implementation strategy?<br />
* How can the [http://en.wikipedia.org/wiki/Electronic_health_record#Quality quality of EHR] technology be useful for electronic exchange of clinical health information among providers and patient authorized entities?<br />
<br />
=== EHR Disaster Recovery ===<br />
<br />
Either internal hardware problems or external sources (especially in EHR systems that store data in the cloud) may cause unexpected EHR system failures. The EHR may be unavailable for a few hours or for a week or more. Disaster recovery must always be considered when selecting a vendor to ensure that data is secure in these emergency situations. Questions to consider include:<br />
<br />
* Does the EHR use internal hosting or an ASP model? <ref name="himssdisaster">EHR and Disaster Recovery. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=6469</ref><br />
* Is the EHR system adherent to the HIPAA Security Rule and provides both a contingency plan and secure data back-up reserves in case of system failure? <br />
* Has the EHR provided users with a detailed disaster plan during implementation of the EHR that includes how to cope with unexpected system failure?<br />
* Has the EHR provided training packets and educational materials for end users to study to prepare for unscheduled downtime of the EHR?<br />
* Will the EHR notify users immediately when system failure occurs and provide information about the breadth of the failure and the time anticipated before the EHR will be restored?<br />
* What happens when small private EHR vendors go out of business for any reason? Will you have a backup of the source code when that happens? Are we able to access that source code for our use?<br />
* Is off-site back-up and recovery supported in the event of a natural disaster or other catastrophic event?<br />
* Is training available for catastrophic event recovery?<br />
* What safeguards does the software have to warn users/administrator of an impending major failure?<br />
* Does the software monitor the hardware that it runs on? <br />
* Is there a technical relationship between the EHR/EMR vendor and hardware vendors?<br />
<br />
Some of the criteria I will like to see in an EHR system in the event that it crashes or during downtime*****<br />
<br />
1. What backup system does it have in place during such an event so that patient care continues without reverting to a paper system? <br />
<br />
2. How is data updated into the system when it is back up and running again?<br />
<br />
3. Where is the data stored so that in the event of a catastrophic crash historical data is not lost?<br />
<br />
=== Health information exchange, connectivity, and standards ===<br />
Because healthcare providers rarely use the same EHR system integration between providers in a state or region is being addressed by healthcare information exchange (HIEs). Patients will often see different providers from different groups. An exchange that provides one of more standards methods for integrating with it means that a provider needs to integrate just once, to the exchange, rather than dozens of times.<ref name="Healthcare Electronic REcords TEchnology and Government Funding">Healthcare Electronic Records Technology and Government Funding:Improving Patient Care.http://www.myemrstimulus.com/tag/ehr-application/</ref><br />
<br />
* Does it meet the following connectivity standards: [[HL7]], HL7 CDA, CCR, HL7 CCD, ELINCS and Vendor software specifications? <ref name="whitepaper emr connectivity">What is Your EHR Connectivity Strategy? http://www.corepointhealth.com/sites/default/files/whitepapers/emr-connectivity-strategy-healthcare-interoperability.pdf </ref><br />
* How flexible is there connection framework? Can it negotiate multiple standards?<br />
* How quickly can you build and implement an interface within the interface engine?<br />
* Can our facility support the space needed for the installation and implementation of an EHR? <br />
* Make sure wireless connection is accessible in all parts of the hospital is your facility is planning to use portable devices (tablets, computers on wheels, etc.) to access the system.<br />
* Is there a cost to connecting the EMR/EHR to an HIE? <ref name="HIE"> How to implement EHRs? http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
* Does the vendor meet the certification requirements to allow patient data to go from different EHRs to meet Meaningful Use? <ref name= "Health Information Exchange"> How to connect Health Information Exchange (HIE) with Electronic Medical Records.http://www.practicefusion.com/blog/how-to-connect-health-information/</ref><br />
* Does the system support C-CDA? Can the system accept, parse, and integrate a CDA document as well as create and export a CDA document as specified in C-CDA?<br />
<br />
<br />
<br />
=== Mobile Devices ===<br />
One of the most logical reasons to have an EHR System linked up to a mobile device, such as a cell phone, is for the convenience aspect. “According to a 2012 Vitera Healthcare survey, a reported 91 percent of physicians are interested in a mobile EHR access, along with 66 percent of practice administrators.” <ref name="Mobile EHR Access">Mobile EHR Access http://www.hitechanswers.net/mobile-ehr-access-healthcares-next-big-thing/</ref><br />
<br />
Advantages: <ref name="Mobile EHR Access"></ref><br />
* Accessibility is the greatest advantage derived from being able to view patient data. A physician can view necessary patient records whether he/she is at the clinic or at home.<br />
* Clinical documents can be virtually updated from anywhere, speeding up the healthcare process. Medical personnel will be able to avoid the necessity of having to fax or scan documents.<br />
* Patient perception of a physician speaking to him/her from a desktop has been identified as negative. With a mobile device, this barrier is dropped and the patient can feel more in control speaking face-to-face and viewing results on a screen.<br />
* The small size of a cell phone enables a physician or home health worker to avoid the bulkiness of carrying a tablet. The only necessary tool when walking into a consultation will be the mobile device. Hand written notes and large electronic devices will be a thing of the past.<br />
<br />
Disadvantages: <ref name="Mobile EHR Access"></ref><br />
* Sensitive nature of Patient Health Information<br />
* Providers will have to look into providing Mobile Device Management (MDM) in order to have data stored safely.<br />
* Lost or stolen devices will need to have the ability of having information completely wiped from a remote location<br />
* The durability of a mobile device is a concern for hospitals and clinics if they are going to issue out devices to employees. Many mobile devices are very fragile and tend to have an average life span of 2-3 years.<br />
<br />
<br />
<br />
=== Hardware ===<br />
Most physician practices will need to upgrade existing hardware (computers and servers) in order to run the EHR. Typically the vendor will give the organization a “shopping list” for hardware so that the organization will purchase equipment that is compatible with the EHR. <ref name="Selecting a vendor">HEY, WHO DID THIS?Note: there needs to be something here</ref><br />
*Will the new hardware include tablets, laptops, desktops, servers, routers, printers, and scanners? <ref name=”hadware”> How do I plan for hardware purchases? http://www.healthit.gov/providers-professionals/faqs/EHR-infrastructure-investment. </ref><br />
<br />
==== Desktops ====<br />
Advantages:<ref name="Hardware">www.aafp.org/practice-management/health-it/product/hardware.html</ref><br />
* Desktops are low-cost and available from a wide variety of vendors.<br />
* Because desktop PCs are standardized, it is relatively easy and inexpensive to find spare parts and support, or to replace a machine.<br />
* Desktops will run just about any software you need.<br />
* Additional devices such as microphones, speakers, and headsets are readily available at low cost.<br />
<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Because it's stationary, you need to buy a desktop PC for each room in which you need access to your EHR software.<br />
* Desktops typically take up more space than a laptop or tablet PC. While flat screen monitors and tower units save actual desktop space, the standard desktop computer requires more room than either a laptop or tablet PC.<br />
* You must purchase additional equipment to take full advantage of voice recognition and/or handwriting recognition programs.<br />
<br />
==== Laptops ====<br />
<br />
Advantages:<ref name="Hardware"></ref><br />
* A laptop has a smaller footprint and can easily be turned to allow patients to view information on the screen.<br />
* A laptop is less obtrusive during patient interviews.<br />
* Most have fairly long battery life and/or an A/C adaptor.<br />
* Laptops use standard PC inputs such as keyboard and mouse and/or touchpad.<br />
<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Although laptops are portable, they can be heavy to carry, typically weighing five to eight pounds.<br />
* Repairs and maintenance tend to be more expensive because laptops use non-standard or proprietary parts. You may have to send a laptop off-site for diagnosis and repair.<br />
<br />
==== Tablet PCs ====<br />
<br />
Advantages:<ref name="Hardware"></ref><br />
* Tablets are truly portable and lightweight, typically weighing three to four pounds.<br />
* It is as powerful as a PC, but it doesn't require a keyboard. Instead, you add information by writing on the screen with a digital pen or stylus, much like you do in a paper chart.<br />
* Handwriting recognition software developed for tablet PCs is excellent, even for very poor handwriting.<br />
* Tablet PCs have integrated dictation capability with voice recognition software that transcribes directly into the patient record.<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Writing with a stylus takes getting used to; there is a longer learning curve in adapting to a new way of using a computer.<br />
* Handwriting recognition dictionaries have not yet fully integrated medical terminology and acronyms, requiring more correction.<br />
* There is not as much standardized software yet available for tablets.<br />
* Screens are easily scratched and can become unusable without screen protectors purchased at additional cost.<br />
* Some EHRs/EMRs require a higher/lower resolution than others and won't work on a tablet. ex: Amazing Charts (AC) will not work on the Surface Pro 2 but will work on a Surface Pro 3.<br />
* Some EHRs/EMRs can work on a tablet but licenses/support will cost more. ex: To use Amazing Charts on an iPad will require the clinic to purchase their "Cloud Based" package. It is slightly more expensive since AC will host the data vs hosting the EMR on a server built by the clinic or hospital. Amazing charts charges $39 a month in addition to license and support fees, per user for their "cloud." When a clinic or hospital hosts AC on their own server, they only pay the license and annual support fees. <ref name="AC">No Servers to set up. No software to install. http://amazingcharts.com/products/web-based-ehr/</ref><br />
<br />
=== Software ===<br />
*Identify and budget for required systems changes<br />
** Software changes<br />
** Increased system storage capacity<br />
*Know if the necessary upgrades are covered by current vendor contracts<br />
*Identify for what upgrade costs the practice will be responsible <ref name="mgma"> Is your practice ready? 5010 and ICD-10 vendor questions and guidelines. 20143. http://www.mgma.com/government-affairs/issues-overview/health-information-technology/icd-10/5010-and-icd-10-vendor-questions-and-guidelines </ref><br />
<br />
== Privacy and Security ==<br />
* Does the system provide roadmaps for adherence to organizational policies (such as HIPAA)?<br />
* Does the vendor’s EMR source code comply with the Patient Safety & Quality Improvement Act of 2005 (PSQIA)?<br />
* The system shall allow an authorized administrator to enable or disable auditing for events or groups of related events to properly collect evidence of compliance with implementation-specific policies. Note: In response to a [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA-mandated risk analysis]] and management, there will be a variety of implementation- specific organizational policies and operational limits.<br />
* Internet Connectivity and Redundancy Contract - There are three main types of connections for clinical data connections: business class digital subscriber line (DSL), business class cable, and T1 connection. Redundant back up systems and procedures to ensure your data will be backed up in multiple locations and securely stored off-site. <br />
* Will the system allow staff administrators to create and manage users and [[Data security|user security profiles]]?<br />
* The system restore functionality shall result in a fully operational and secure state. This state shall include the restoration of the application data, [[Security|security credentials]], and log/audit files to their previous state.<br />
* If the system includes hardware, the system shall include documentation that covers the expected physical environment necessary for proper secure and reliable operation of the system including: electrical, HVAC, sterilization, and work area.<br />
* How well does the EMR work with antivirus, antispyware and other security software?<br />
* What is the vendor’s history with cyber attacks? <ref name="mit cybersecurity">MIT Geospactial Data Center: Protecting EMR Data (1 of 2) http://cybersecurity.mit.edu/2012/11/protecting-emr-data-1-of-2/</ref><br />
* Does the system allow for off-site access to files/data and how does the technology protect against external breech or diversion of patient information?<br />
* Does the system have role based permission and access? Different job roles should only be able to access what is required of their job. <ref name="Ensuring Security of High Risk Information in EHRs">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_039956.hcsp?dDocName=bok1_039956</ref><br />
* Are all messaging capabilities within the EMR encrypted? <ref name="Electronic Health Records: Privacy, Confidentiality, and Security">http://journalofethics.ama-assn.org/2012/09/stas1-1209.html </ref><br />
* Does the system have the ability to audit / monitor user activity if needed?<ref name="Electronic Health Records: Privacy, Confidentiality, and Security">http://journalofethics.ama-assn.org/2012/09/stas1-1209.html </ref><br />
* Does the system have time-stamp functionality (name, date, & time)? <ref name="Security Risk Analysis Tipsheet: Protecting Patients’ Health Information">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf</ref><br />
* Is the system in compliance with the organization’s HIPPA policy?<br />
* How will the decrease the unauthorized disclosure of information?<br />
* What procedures does the vendor have to handle disaster recovery and high availability issues?<br />
* Does the vendor offer policy and procedures in regards to disposal of Protected Health Information?<ref name="FAQs About the Disposal of PHI">http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/disposalfaqs.pdf</ref><br />
* How often do users have to update password information and credentials?<br />
* What does the vendor offer in regards to data backup procedures to ensure privacy and security integrity?<br />
* How often are user ID’s audits performed for inactive users?<ref name="information security">Information security policy template. (2011). Retrieved from http://www.healthit.gov/sites/default/files/info_security_policy_template_v1_0.docx.</ref><br />
<br />
=== Results Management Requirements ===<br />
Results management is an important clinical activity that requires a structured approach in order to be effective. Results management is in accord with the precepts of Meaningful Use. Incorporation of clinical lab results into the EHR as structured data is an ongoing MU objective. <ref name="results Mgt"> Carter, J. A New Look at Results Management. 2012. http://www.americanehr.com/blog/2012/07/a-new-look-at-results-management/ </ref><br />
* Lab Results<br />
** Will the system send the lab request electronically?<br />
** Will lab results populate electronically into the EHR with flags for abnormal result?<br />
** Will Physicians be able to review and publish lab results as well result notes to patients electronically?<ref>Patient Results. https://www.labcorp.com/wps/portal/patient/results</ref><br />
** Will the system suggest follow up test depending of test done and results obtained?<br />
* LOINC Codes<br />
** Will the EHR accept LOINC-mapped electronic lab results if available from the source lab <ref name="functional"></ref>?<br />
*Radiology Results<br />
** Will the system accept radiology results and reports electronically from imaging centers or through the HIE? <ref name="functional"></ref><br />
** Does the EHR support the direct viewing of DICOM medical images without having to log into the separate PACS system?<ref>Radiology Today. http://www.radiologytoday.net/archive/rt0513p18.shtml </ref><br />
** Does the EHR has time tracking of performed or to be performed procedures that are happening in the imaging in the form of “in progress”, “completed” or “discontinued”?<br />
** Does the EHR consist critical result notification application?<br />
** Does the EHR allow insurance authorization upon imaging order?<ref name=“ IT REference Guide for the Practicing Radiologist “> Kevin W. McEney MD. Radiology Information Systems and Electronic Medical Records http://www.acr.org/~/media/ACR/Documents/PDF/Advocacy/IT%20Reference%20Guide/IT%20Ref%20Guide%20RISEMR.pdf</ref><br />
* Reminder of next test due<br />
** Will the system set a reminder for recommended time frame for next lab test <ref name="functional"></ref>?<br />
<br />
===Specialty Needs (Pediatrics)===<br />
EHRs in pediatric care may increase patient safety through standardization of care and reducing error and variability in the entry and communication of patient data.4-9 While EHRs may improve safety, implementation of general EHR systems that do not meet pediatric functionality and workflow demands could be potentially dangerous.Healthcare organization have to be careful to select prospective EMR vendor to determine if they have incorporated a variety of Pediatric specific workflows into their system. <br />
For instance,<br />
*Are EHR provide child'a age in years or EHR have the ability to determine ages in hours, days, weeks and months in addition to years?<br />
*Are dosing models consistent with taking care of a pediatric patient population?<br />
*are they provide pediatric specific EHR features such as Intake forms,Demographics that support various family structures,Well child / Preventative,Immunization administration and management,Growth Charts,Genetic information, maintenance, and reporting,School Physical,Sports Physical,Camp Physical,Daycare Physical,Reportable Communicable Disease management,Child abuse reporting forms,Referral entry and tracking,VIS (Vaccine Information Sheet),CDC link,Flack Pain scale,Behavioral tools,ADD/HD tools,Age Specific,Birth Data,Instrumentation integration (vital signs, EKG, spirometry, etc,Pediatric protocols for pediatric triage,Patient Portals,Pediatric Specific templates?<br />
<br />
=== Specialty Needs (OBGYN) ===<br />
There are unique requirements from electronic medical records systems for obstetrics and gynecology, and rooting out vendors that provide the ability to support those requirements can be challenging.Unfortunately, until CCHIT adds OB/GYN as a specialty endorsement (not slated until 2012),there are no externally validated organizations that assure the prospective purchaser that the product meets all of the required needs. Of course, should one be in a sub-specialty practice (MFM, REI), there are even fewer assurances offered on suitability; it will be up to the individual/organization to sift through the vendors and product capabilities to match with the stipulated needs.<ref>http://www.acog.org/About-ACOG/ACOG-Departments/Health-Information-Technology/EMR-Vendor-Selection-Process</ref><br />
<br />
===Specialty Needs (Anesthesiology)===<br />
<br />
Anesthesiology is a unique medical specialty, as it is a field of acute care for medicine. Due to the fast-paced nature of emergency situations, critical pieces of information to make decisions are necessary to determine a good or bad outcome. Elements such as body weight, drug metabolism, drug interactivity and allergies are emphasized. The communication of the anesthesia provider during the case is more profound between him/herself and the operating room staff (surgeon, circulating nurse, scrub technician) than with the patient. <br />
<br />
====EMR Requirements====<br />
<br />
Anesthesiology-specific workflow templates reduce errors by automatically populating patient data and supporting treatment.<br />
<br />
* '''Vital Signs Device Integration''' - Capture physiologic data—including ECG, oxygen saturation, heart rate, blood pressure, end-tidal CO2, temperature and respiration—from anesthesia machine to ensure appropriate levels of anesthetization. <br />
* '''Interaction with Current System EMR''' - After capturing the physiologic data from operating room specific devices, the EMR should integrate it automatically into the patient's chart to be part of the permanent medical record.<br />
* '''Alarms''' - Due to the potent nature of anesthetic drugs, alarms should be available to monitor drug-drug interactions and vital signs should have trend monitors to predict the possibility of impending cardiopulmonary arrest.<br />
* '''Timers''' - Medicines given in this specialty are very time-sensitive in their time of onset and duration of action. Having the capability of tracking the last dosage and time since the last dosage or due time of the next dosage would be extremely beneficial.<br />
* '''Graphing Capabilities''' - With continuous fluctuations in vital signs, the ability to graph these allows the care provider to quickly and easily view changes over time and treat any issue immediately and appropriately.<br />
* '''Medication Pump Integration''' -Anesthetic gases, such as sevoflurane and isoflurane, and pain medications, such as remifentanyl, are given continuously in some surgical cases, and with the interoperability of the EMR with these pumps, allows for accurate recording of quantities and doses administered to the patient as well as time-sensitive recordings.<br />
* '''Unique user sign-ons''' -With the capability of having unique user sign-ons, it allows the ability to track all anesthetic personnel associated with the record and who administered the medications or completed an activity.<br />
* '''Narrative Capability''' - By allowing the ability to also include narratives, in addition to automatically sync information, it allows the clinician to provide as much detail as deemed appropriate regarding a situation or case.<br />
<br />
=== Other Clinical Functionality ===<br />
<br />
* Does the system promote delivery of safe care?<br />
* The system shall require documentation of the audit support functionality in the vendor provided user guides and other support documentation, including how to identify and retrospectively reconstruct all data elements in the audit log including date, time.<br />
* Can the system identify the chronic disease management subgroups?<br />
* Is the EHR scalable to different medical specialties and practice demographics (i.e., Neurology vs. Cardiology, small satellite practice vs. intensive care unit) <br />
* Can the system support future clinical models (i.e., Medical Home)?<br />
* Does the EHR system support accurate, consistent and effective clinical documentation by appropriately balancing data auto-population, structured data entry, and unrestricted physician entry of natural-language narrative?<br />
* Does the EMR have the capability to display data over time graphically, such as growth charts?<br />
* The system shall provide the ability to query for a patient by more than one form of identification<br />
* Can it integrate with external knowledge sources such as links to journal references or other knowledge base systems (such as [http://www.hopkinsguides.com/ John Hopkins Guidelines System]) to provide more academic information and update on particular patient problem?<br />
* Does the EHR store the identity of the user and associate the ID with the additions or changes made to the system?<br />
* Can the EHR system be used to capture clinical trial data? How the clinical trial specific data is managed?<br />
* Does the EHR system have the ability to import and export data (interact) in a standard format to EHR systems from other vendors?<br />
*In outpatient departments, does the EHR have a patient-to-physician email and/or web access abilities for the outpatient department to communicate directly with the patient in case more information is needed or the office needs the patient to take some action?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the vendor’s product provide the key functionality needed to achieve the organization vision?<br />
* Does the EHR provide outcomes data in terms of key metrics (cost savings, medication error reduction, disease management) in line with the vision of the organization?<br />
* How does the system import data from personal health devices?<br />
* Can patient data be directly imported from patient portals or [[PHR|personal health records]]?<br />
* Does the vendor provide an EHR system that can be integrated with and is interoperable with other systems?<br />
* Can the vendor provide an EHR system with standard terminology that is cross platform with other EHR systems?<br />
* Does the vendor provide safe log in for patients and clients?<br />
* Does the EMR could provide appropriate information on screen without cramming too much information?<br />
* If the EMR/EHR system allows users to access through mobile devices (through the web or an app), is the mobile version similar to the computer-based version? Is it user-friendly? Will mobile access require additional training, or will user feel comfortable with it after training on the computer-based version?<br />
* What type of system is built into the EHR for clinicians, staff and any other users to provide feedback?<br />
* Does the EMR/EHR integrate with off the shelf software currently in use? (i.e. Microsoft products, adobe, etc.) and will new software/upgrades need to be purchased to enable inter-operability?<br />
* Is the EMR capable of sending a Virtual Consultation Summary to another Physician via HIE?<br />
<br />
==== Continuity of Care: Outpatient vs Inpatient EMR ====<br />
If there is no communication between the ambulatory (outpatient) and the inpatient (hospital admissions) EMR services, the clinical information does not get accurately or completely transmitted between transitions of care. This need for continuity of care must be addressed by the EMR vendors by looking at the integration between their outpatient and inpatient clinical systems. The level of integration can be-<br />
#at the user interface level (for example, separate inpatient and outpatient applications, minimal data sharing with separate databases, viewable in same shell)<br />
#at the database level (such as having two separate applications and one database, with the ability to manually transfer data between applications)<br />
#at the workflow level (with one application and one database, with data displays in the context of care setting and full accommodation for workflow) <br />
A discharge note writer is needed to generate a transition of care document (discharge summary) so that the patient can be handed off from one setting of care to another. According to JCAHO (Joint Commission) ''medication reconciliation'' must be done at every transition of care. There is very little literature that addresses the direct financial ROI for an ambulatory EMR, as opposed to the inpatient arena, where more evidence exists.<ref name="Continuity of Care">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref><br />
#Cerner Ambulatory and Cerner Inpatient<br />
Cerner has recently deployed their “Cerner Integrated” platform that does “speak” to inpatient Cerner. Cerner deployed this to "improve the quality and accessibility of clinical documentation across the inpatient and outpatient venues of care while reducing costs of transcription and document scanning." Jim Shave, President of Cerner in Canada, stated “This integration between inpatient and outpatient systems will provide a seamless experience for patients and clinicians, particularly with the large volume of Ontario residents who use outpatient hospital care.” It is still fairly new and not a lot of hospitals and outpatient clinics have had the opportunity to experience the flow of this integrated platform but this is a step in the right direction for continuity of care. <ref name="Cerner">Cerner Hospital Information System in Extended to Ambulatory Clinics in Three Ontario Hospitals. http://www.cerner.com/Cerner_Hospital_Information_System_is_Extended_to_Ambulatory_Clinics_in_Three_Ontario_Hospitals/</ref><br />
<br />
=== Management and Reporting Requirements ===<br />
<br />
The [[Request for Proposal|request for proposal (RFP)]] should include requirement of a risk management plan which includes risk identification, risk analysis and risk mitigation. Status of the risk management plan should be included in project status reports. <ref name=”CMTP”> Texas Comptroller of Public Accounts (2014). Texas government project management. Contract Management Training and Certification. http://www.comptroller.texas.gov/procurement/prog/training-cert/cmt/</ref><br />
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back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
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== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T19:45:36Z<p>Annathehybrid: /* Privacy and Security */</p>
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<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
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Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
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<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
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<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
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== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
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The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
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*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
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== Basic EHR Criteria ==<br />
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* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
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== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
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== Vendor Assessment ==<br />
Most vendors typically fall into one of the three categories:<br />
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# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
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*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
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*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
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* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
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* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
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* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
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* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
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* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
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* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
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*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
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*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
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*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
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*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
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*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
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*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
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*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
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== Product Requirements ==<br />
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* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
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* Does the EHR system employ current technology and have all the core clinical functionality, including a fully integrated pharmacy/medication management interface? <br />
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* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system? <br />
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based<br />
Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref><br />
<br />
* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref><br />
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== Vendor Proposal (Request) ==<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
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* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
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==New Non Traditional Approach Overview==<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
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===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
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===Personalization of HIT===<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
===Transparency in communication with stakeholders for collaboration===<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
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=== Nursing Functionality ===<br />
# Supporting eMAR: supporting real-time electronic medication administration record and [http://www.ncbi.nlm.nih.gov/pubmed/20445181 bar code medication administration technology].<br />
## Does the system track refusal of medications? <ref name="ELECTRONIC MEDICATION ADMINISTRATION RECORD (EMAR)">http://www.healthsecure-emr.com/jail-emr-emar</ref><br />
## Does the eMar have the ability to send encrypted messages directly to the pharmacy? <br />
# Supporting bedside automation in medication delivery: Support data interface and real-time monitoring of [http://www.ncbi.nlm.nih.gov/pubmed/15753744 smart infusion pumps] and home infusion pumps <br />
# Ease of use of Nursing flow sheets: Rows in the EHR to be filled by nurses for consistent patient care processes.<ref name="ICU Accept">Carayon, P. Cartmill, R. Blosky, M. Brown, R. Hackenberg, M. Hoonakker, P. Hundt, A. Norfolk, E. Wetterneck, T. Walker, J. (2011).ICU nurses’ acceptance of electronic health records. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197984/pdf/amiajnl-2010-000018.pdf </ref><br />
# Ease of access and usability of EHR for nursing administration and clinical documentation for nurses. <ref name="Disputes Risks">Raasikh, . What the others haven't told you: lessons learned to avoid disputes and risks in EHR implementation.http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?action=interpret&id=GALE%7CA365889941&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&authCount=1</ref><br />
# Clinical decision support and risk assessment tools for issues related to nurse care delivery, such as falls, medication delivery, skin ulcers etc. <ref name="Impact Nurse">Dowding,D. Turley, M. and Garrido, T. (2012). The impact of an electronic health record on nurse<br />
sensitive patient outcomes: an interrupted time<br />
series analysis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384108/pdf/amiajnl-2011-000504.pdf</ref><br />
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=== Pharmacy Operation ===<br />
Hospitals and physician practices need to keep their patients safe and well managed by using a pharmacy information system also called a medication management system. The system must have several core functions including in and outpatient order entry, dispensing, and inventory and purchasing management. The system must also be able to connect to other systems within the enterprise, including an EMR, computerized physician order entry (CPOE), barcode technology, and smart IV infusion pumps.<ref name="Pharmacy Information Systems">10 Popular Pharmacy Information Systems".http://www.informationweek.com/healthcare/clinical-information-systems/10-popular-pharmacy-information-systems/d/d-id/1104805?</ref><br />
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# Connect to other systems within the enterprise including EMRs<br />
# Computerized physician order entry (CPOE)<br />
# Barcode technology<br />
# Smart IV infusion pumps<br />
<br />
<br />
==== Formulary Management ====<br />
<br />
# Data repository for formulary information, maintain real time update of medication information with national drug information database<br />
# Support periodic update of formulary, restricted formulary, and nonformulary medications<br />
# Cross reference patient’s insurance formulary list to allow for generic medications to be selected when e-prescribing.<br />
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==== Drug dispense and delivery ====<br />
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# Support outpatient pharmacy operation functionality: <br />
## Maintain outpatient prescription data<br />
## Management of prescription fill, refill and dispense activities<br />
## Support billing protocols with governmental and private insurance<br />
# Support inpatient pharmacy operation functionality<br />
## Maintain inpatient medication ordering data<br />
## Real-time monitoring of IV and oral medication compounding and delivery<br />
## Support real-time data interface with automatic dispensing cabinet<br />
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== Research Functionality ==<br />
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* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
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* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
<br />
== Vendor Financin g==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
<br />
==== Face the Interfaces ==== <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
<br />
===== Interface History ===== <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
<br />
*Which vendors (and which of their applications) have they interfaced with?<br />
<br />
*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
<br />
*How many interfaces were built, and what is the maximum the system can support?<br />
<br />
*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
<br />
*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
<br />
== Future Relationships: Vendor Partnership ==<br />
<br />
* Talk to vendor's existing customers, making sure to also contact some vendor customers independently, as the vendors tend to only provide contacts to their most satisfied customers.<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and prepare a Request for Proposals (RFP). <br />
*Composing the RFP can be a daunting task. AHIMA has created a guidelines for a template that may be used to write the RFP. The guidelines are extensive and include several particular components that must be included. It can be found [http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959 here]. <ref name="RFI/RFP Template (Updated)">AHIMA http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959</ref><br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
*Ensure there will be well-laid out contractual agreement regards the 'source code' that will satisfy/cover necessary conditions: "When does the company get the 'source code?, How does the company get the source code?"<br />
*If there are workflow changes within the organization, after the product is implemented, is the product flexible enough to allow for changes without major outages or disruptions to daily activity?<br />
*What are the vendors’ contingency plans if technical glitches occur, post implementation?<br />
*Is technical support offered by the vendor 24 hours per day/ 7 days a week?<br />
*In the event of need for support from the vendor, what is the approximate response time to calls that vendor the projects?<br />
* What is the cost of providing this technical support per hour?<br />
* What size, in terms of employees, is the EHR vendor? Do they have the staff to fully address the support needs of their current client base and, can they accommodate the added support load of your institution?<br />
*In terms of clinical decision support, how often are drug list and drug interaction list updated? Once updated, how long will it take for the changes to be accessible by the end users?<br />
* When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?<br />
*In "EMR Vendor Selection" on [http://www.healthtechnologyreview.com/emr-vendor-selection.php Health Technology Review website], it states an old adage in the Software industry that consumers will buy a product based on features, but will leave the vendor based on a lack of support. Therefore, it is important to check references for the vendor related to post-implementation technical support satisfaction.<br />
* Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?<br />
* Will the source code be placed in escrow so that the system could be maintained and modified by internal IT staff in the event that the vendor ceases operation.<br />
* Does the vendor have local support personnel or will all issues be handled by a distant team?<br />
* What is an average time for installing and testing upgrades to the system? If an upgrade is missed or skipped, does the subsequent upgrade(s) have all prior changes included or just the current fix or feature for that version?<br />
* Is there going to be a vendor-institution confidentiality agreement or can the vendor share institutional information and dealings with other establishments?<br />
<br />
'''* Does the vendor's produce meet our needs and goals for our practice? Carryout a test drive of our specific needs with the vendor's product and provide the vendor with patient and office scenarios or mock trial that they may use to customize their produce demonstration.'''<br />
<br />
=== Upgrades ===<br />
<br />
* Does the vendor share the organization's '''vision''' for the EHR?<br />
* Does the product provided by the vendor has all the '''key functions''' needed to fulfill the vision of the organization?<br />
* Is the vendor utilizing the desired technology?<br />
*Is the vendor stable and does it has presence in the region where the system will be implemented?<ref name="Upgrade EHR">Upgrade to a Certified EHR http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
*Is the system capable of integrating with other product such as billing systems, practice management software and public health interfaces?<ref name="Upgrade EHR"></ref><br />
* Compare retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
* Electronic replacement for traditional reportable disease notifications to health departments, may become part of biosurveillance in the future.<br />
* Is it possible to virtualize or [http://en.wikipedia.org/wiki/Sandbox_(software_development) sandbox] the system to test updates? This functionality would allow site specific testing of new features and systems with less risk of corruption of the current system. It would also allow testing of new features functionality and allow easy rollback if features end up being unwanted.<br />
* Does the system allow outreach/growth to affiliates as a "subset" of the existing clinical provider group? Does that outreach include full or limited functionality? How does that data interface with the existing clinical record?<br />
*How does the system scale? Is the vendor able to provide support and functionality as a practice grows or can they provide functionality to a small, regional branch?<br />
* Provision of EHR systems that support the capture of public health data from Clinical Information Systems.<br />
* Does the system can combine with EHR in long term health care area as a reminder of senior people?<br />
* Ensure that your vendor will be around when you need help. While specific vendor qualifications vary, generally information to be considered in the vendor vetting process, besides functional and technical details, includes vendor reputation, staff experience and qualifications, and financial solvency. <ref name="Chao"> (Chao, C., & Goldbort, J. (2012). Lessons Learned from Implementation of a Perinatal Documentation System. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(5), 599-608. doi:10.1111/j.1552-6909.2012.01378.x </ref><br />
*Does the vendor allow discrete data capture and easy reporting of critical data that needs to be submitted for reimbursement by the national and state policies on healthcare?<br />
*Is the vendor at the forefront of research in healthcare and does the software offer clinical dashboards and predictive models for easy tracking and analysis of patient data and efficient decision making by clinicians.<br />
*Does the vendor require hiring of outside consultants for training?<br />
* Does the vendor, as part of their 18-24 month roadmap, include Direct-Trust (commonly referred to as Blue Button) to facilitate a more automated Provider to Provider data exchange as a replacement for FAX machine?<ref>Transmitting Data Using the Direct Protocol. (2013, February 4). Retrieved February 3, 2015, from http://bluebuttonplus.org/transmit-using-direct.html</ref><br />
<br />
* Does the vendor, as part of their 18-24 month roadmap, include Fast Healthcare Interoperability Resource (FHIR) protocol as well as Human APIs implementation to facilitate bi-directional data exchange between Provider and Patient?<ref>HL7 Fast Healthcare Interoperability Resources Specification (FHIR™), Release 1. (n.d.). Retrieved February 5, 2015, from http://www.hl7.org/implement/standards/product_brief.cfm?product_id=343</ref><br />
<br />
* Does the vendor, as part of their 18-24 month roadmap, include not only Member Eligibility data but History data, Formulary data as well as Drug Utilization Review (DUR) data in their ePrescription Hub?<ref>Pennell, U. (2013, August 21). What is E-prescribing and What are the benefits? - EMRConsultant. Retrieved February 7, 2015, from http://www.emrconsultant.com/emr-education-center/emr-selection-and-implementation/what-is-e-prescribing-and-what-are-the-benefits/?s=dur</ref><br />
<br />
*Does the system offers privacy and security capabilities?<ref name="Upgrade EHR"></ref><br />
<br />
== Contracts ==<br />
<br />
Contracts are as much a business tool as they are a purchasing agreement. <ref name="ehr contract">Carolyn Hartley - signing an EHR contract http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
<br />
* Project Payments<br />
* Contract Terms [http://calhipso.org/documents/ehr_contracting_terms_final_508_compliant.pdf]<br />
* All costs, current and future, associated with the implementation<br />
Details of the total cost incurred by the institution also called total cost of ownership (TCO) is an important consideration in the selection process. It helps to predict the longevity of the program. The request for proposal to vendors should include a request for information about vendor license and implementation costs. Vendors should deliniate the assumptions made when preparing the TCO so the decision committee is able to verify that they are parallel to the goals and objectives of the insitutions. If the same assumptions are encorporated in all request for proposals one can better compare the applications. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref><br />
Institutions must also consider the intangible return on their investments such as reduced adverse events, decreased hospital stay, accurate and timely billing and improved management of supplies.<br />
* Does the vendor have any hidden fees?<br />
* Time commitment from vendor with regard to implementation and training<br />
* Penalties for delays in implementation<br />
* Code escrow - be sure code will be available if vendor goes out of business<br />
* Indemnification and hold harmless clauses <br />
* Confidentiality and nondisclosure agreements <br />
* Warranties and disclaimers <br />
* Limits on liability <br />
* Dispute resolution <br />
* Termination and wind down<br />
* Intellectual property disputes <br />
* IT support agreement<br />
* Training Contract<br />
* Applied area contract<br />
* User and vender liability<br />
* Disputation judgment <br />
* Attorney of vender and clients<br />
* User License - The person who has access to data using a user ID and password. Pricing structures vary according to the definition of user.<br />
* Consider variation of user licenses according to the needs: one price per MD, tiered price (MD, nurse or administrator), site license (25+ providers in the same facility), and enterprise license (multiple users in multiple departments). <ref name="user license">Signing an EHR contract. Tips to control costs. http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
* Interface - The EHR vendor's contract includes the cost of interfaces. These include interfaces such as those with your scanner or fax machine; and more complex interfaces such <br />
* Hardware Contract - Review the EHR vendor's hardware quote, but research may lower costs. Check the vendor's website for hardware specifications the vendor supports. Hardware includes servers, high-speed scanners, computers, handhelds, computer on wheels (COW), wall mounts, etc. Hardware installation to a wholesaler means assembling the server and software to make it work at their location prior to delivering it to you. It usually does NOT mean the installation at your location, a difference that will create a significant budget surprise. Clarify the term "installation" with any hardware wholesaler before making the purchase.<br />
* Third Party Software Contracts – Software includes encryption, speech-recognition, password management, Microsoft™ suite, anti-virus, golden image, bar-coding or webcams.<br />
* Business Associate Agreement - To be HIPAA-compliant you will need a business associate agreement with the vendor, and must ensure the vendor meets HIPAA security and privacy requirements.<ref name="HIMSS-AMA-BAA">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
<br />
=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
<br />
*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
<br />
*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
<br />
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
<br />
== Regulatory Compliance ==<br />
<br />
Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:<br />
<br />
=== Meaningful Use (MU) === <br />
<br />
Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. <ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref> A gap analysis can be performed:<br />
<br />
==== Meaningful Use Gap Analysis ====<br />
<br />
* Is it ONC Certified? [http://oncchpl.force.com/ehrcert?q=chpl]<br />
* Does it meet all Meaningful Use objectives?<br />
* Does it provide automated MU & Clinical Quality Measure Reports?<br />
* Does the vendor provide MU Training Guides/Resources?<br />
* Does the system facilitate easy MU Data capture such as required data fields?<br />
* Does it provide audit logs, usage monitoring, etc?<br />
* Does it allow/include data migration from previous EMR?<br />
* Does it contain CDS Rules to improve performance on high priority health conditions?<br />
* Does it have capability to electronically submit Clinical Quality Measures to CMS?<br />
* Does it have Public/Cancer Registry Reporting Capabilities? <br />
* Does it provide 24/7 technical support?<br />
* Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? <ref name="CMS.gov">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html</ref><br />
* Is the ONC certification current or does the product require inherited certification/ gap certification?<ref name="healthIT.gov">http://healthit.gov/sites/default/files/final2015certedfactsheet.022114.pdf</ref><br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_Criteria:_IT_and_technical_requirementsVendor Selection Criteria: IT and technical requirements2015-09-18T19:45:17Z<p>Annathehybrid: </p>
<hr />
<div><br />
== IT and Technical Requirements ==<br />
<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non-upgraded system? For how long?<br />
* Does the system use [http://medical.nema.org/ DICOM] standards for the transmission of image data?<br />
* Does the system provide an imaging database or allow customized program attachments of imaging needs of specific departments in the hospital?<br />
* What are the hardware requirements?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Do the upgrades come with a fee?<br />
*Is the vendor’s application (system) platform independent? <br />
*Is the system using standards such as Snomed, [http://www.who.int/classifications/icd/en/ ICD 10]; [http://hl7book.net/index.php?title=HL7_version_2 HL7 Version 2] or [http://hl7book.net/index.php?title=HL7_version_3 3]; HL7 infobutton…)<br />
*How does the system handle multiple logins of the same user at different locations/instances?<br />
*How does the system handle user inactivity? (auto-logout, discarding\saving changes, draft creation)<br />
* Is the software capable of using biometric data for rapid login by providers who are mobile between patients/sites?<br />
* How does the system lend itself to automated back-ups? Does the vendor provide IT support team to implement specific back-up plans that will work with the hospital's IT team? <br />
* Can the system allow login remotely – off site transcription or home or other clinic?<br />
* Does the system provide the ability to identify all users who have accessed an individual's chart over a given time period, including date and time of access?<br />
* Does the vendor offer a Software as a Service (SaaS) solution, also know as an Application Service Provider (ASP), or a client-server solution?<br />
* With existing systems, how tightly integrated will the new EHR system be and what prep work is required to make the integration possible?<br />
* Does the system have modules for automatic update of knowledge sets at regular intervals, more like automatic update of antivirus definitions?<br />
* How often does the software need to be upgraded?<br />
* Does the software allow generation of customized reports such that desired information can be extracted periodically for performance improvement projects or performance monitoring.<br />
* Does the vendor utilize the desired technology?<br />
* Is remote access available for mobile devices?<br />
** Is this web-access or a dedicated app?<br />
** In what way is this mobile access limited? Does it have access to all functionality?<br />
** What devices can access the mobile apps? (e.g. iPad, iPhone, Android, etc.)<br />
* Is remote access cross platform? The use of open standards (e.g. HTML5, [[Extensible Markup Language (XML)|XML)]] allows users on any platform, including smartphones and tablets, to have equivocal access to the system.<br />
* Does the system support web-based working environment?<br />
* Does the system provide extension package or software for IT engineers or users? <br />
* Does the system comply with HIMMS standard?<br />
* Can the system be installed on Windows or IOS operating systems?<br />
* How does the system’s IT infrastructure requirement align with the institution’s current infrastructure and the institution’s infrastructure five-year strategic road map?<br />
* What hardware technology (Server) does the database support? And does the supported hardware provide built-in high availability?<br />
* Does the system’s application (not database) support virtual environments? Will it run on a virtual server? <br />
* Is your ticketing system capable of interfacing with [name of ITSM software utilized by your institution]?<br />
* Negotiate the terms and prices of the interface system: to/from PM system, scanner, fax machine, laboratory, health information exchange partners such as hospitals, ambulatory surgical centers, radiology, ePrescribing.<br />
* Can the system be hosted and supported remotely by the vendor? <br />
* How scalable is the IT infrastructure? Is there a peak limit on the number of concurrent users utilizing the system? (this comes in handy during mergers & acquisitions in which you may exponentially increase in size of user base) <br />
* Does the system support dictation function?<br />
* Does the system support speech recognition?<br />
* Does the system have a spell check tool for notes (progress notes, letters, and H&P notes)? <br />
* What are the data back up options available in case of natural calamity? <br />
* Is the EHR system compatible with other systems in the event of termination or vendor's insolvency? <ref name="obsolete technology">Neal, D. (2011). Choosing an Electronic Health Records System: Professional Liability Considerations. Innovations in Clinical Neuroscience, 8(6), pg. 45.</ref><br />
* Are scanning capabilities available and if so, is there a particular scanner make and model required?<br />
* Are scanning licenses needed? How much are the scanning licenses and are they needed per user or per pc?<br />
<br />
=== Legacy systems ===<br />
<br />
* How does the vendor compare in [http://www.klasresearch.com/ KLAS] rankings of similar systems and applications?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Does the vendor provide services to convert and transfer data from legacy systems into the new system, and if so, what is the cost?<ref name="himss-ama-legacy">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? <br />
*Make sure the vendors give accurate information for the Request for Proposal. So the stakeholders can make informed decisions on the comparison of vendors.<br />
-Zoker 9/17/2011<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems?<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the [http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page? AMA Current Procedural Terminology] (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* How does the vendor manage diagnosis documentation and coding? Does the system require specific coding terminology or does it allow provider synonyms for coding terms? How is that updated and maintained? <br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are certified Health IT products through the [http://oncchpl.force.com/ehrcert/ehrproductsearch Office of the National Coordinator (ONC) for HIT.] Previously [http://www.cchit.org/ CCHIT] provided a list of certified EMR but as of late 2014 is no longer in operation.<br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? <br />
* What is the company policy regarding data ownership for the ASP EHR? <br />
* The EHR product should be certified for the standards and certification criteria issued by the Office of the National Coordinator for Health Information Technology (ONC-HIT)? How many criteria does it satisfy?<br />
* How is documentation managed and preserved over time? How is documentation protected from being altered, in all parts of the system including the underlying databases?<ref name="Legal EHR">The Legal Electronic Health Record.www.himss.org/files/HIMSSorg/content/files/LegalEMR_Flyer3.pdf</ref><br />
*Does the vendor retain, ensure availability, and destroy health record information according to organizational standards? For instance, retaining all EHR data and clinical documents for the time period designated by policy or legal requirement; retaining inbound documents as originally received (unaltered); ensuring availability of information for the legally prescribed period of time; and provide the ability to destroy EHR data/records in a systematic way according to policy and after the legally prescribed retention period.<ref name="EHR Functions">Understanding Features & Functions of an EHR.http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
<br />
=== Troubleshooting ===<br />
<br />
* Immediate trouble shooting ability<br />
* Once the problem is identified, the first step is to ascertain the scope<ref name="Kevin MD"></ref><br />
* If the scope of outage is large and the root cause is unknown, raise alarm bells early<ref name="Kevin MD"></ref><br />
* Bring visibility to the process by having hourly updates,and multiple eyes on the problem<ref name="Kevin MD"></ref><br />
* Over communicate with the users<ref name="Kevin MD">http://www.kevinmd.com/blog/2010/09/10-tips-troubleshooting-complex-ehr-infrastructure-problems.html</ref><br />
* Do not let pride get in the way<ref name="Kevin MD"></ref><br />
* It is important to set deadlines in the response plan<ref name="Kevin MD"></ref><br />
* The simplest explanation is usually the correct one<ref name="Kevin MD"></ref><br />
* Regular connect with customers about their problems<br />
* The system shall include documentation that describes the patch (hot-fix) handling process the vendor will use for EHR, operating system and underlying tools (e.g. a specific web site for notification of new patches, an approved patch list, special instructions for installation, and post-installation test).<br />
* The system shall include documented procedures for product installation, start-up and/or connection.<br />
* What options does the EMR have for upfront abstraction and scanning? Are these costs included in the purchase of the EMR?<br />
* Can the vendor support the organization desired implementation strategy?<br />
* How can the [http://en.wikipedia.org/wiki/Electronic_health_record#Quality quality of EHR] technology be useful for electronic exchange of clinical health information among providers and patient authorized entities?<br />
<br />
=== EHR Disaster Recovery ===<br />
<br />
Either internal hardware problems or external sources (especially in EHR systems that store data in the cloud) may cause unexpected EHR system failures. The EHR may be unavailable for a few hours or for a week or more. Disaster recovery must always be considered when selecting a vendor to ensure that data is secure in these emergency situations. Questions to consider include:<br />
<br />
* Does the EHR use internal hosting or an ASP model? <ref name="himssdisaster">EHR and Disaster Recovery. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=6469</ref><br />
* Is the EHR system adherent to the HIPAA Security Rule and provides both a contingency plan and secure data back-up reserves in case of system failure? <br />
* Has the EHR provided users with a detailed disaster plan during implementation of the EHR that includes how to cope with unexpected system failure?<br />
* Has the EHR provided training packets and educational materials for end users to study to prepare for unscheduled downtime of the EHR?<br />
* Will the EHR notify users immediately when system failure occurs and provide information about the breadth of the failure and the time anticipated before the EHR will be restored?<br />
* What happens when small private EHR vendors go out of business for any reason? Will you have a backup of the source code when that happens? Are we able to access that source code for our use?<br />
* Is off-site back-up and recovery supported in the event of a natural disaster or other catastrophic event?<br />
* Is training available for catastrophic event recovery?<br />
* What safeguards does the software have to warn users/administrator of an impending major failure?<br />
* Does the software monitor the hardware that it runs on? <br />
* Is there a technical relationship between the EHR/EMR vendor and hardware vendors?<br />
<br />
Some of the criteria I will like to see in an EHR system in the event that it crashes or during downtime*****<br />
<br />
1. What backup system does it have in place during such an event so that patient care continues without reverting to a paper system? <br />
<br />
2. How is data updated into the system when it is back up and running again?<br />
<br />
3. Where is the data stored so that in the event of a catastrophic crash historical data is not lost?<br />
<br />
=== Health information exchange, connectivity, and standards ===<br />
Because healthcare providers rarely use the same EHR system integration between providers in a state or region is being addressed by healthcare information exchange (HIEs). Patients will often see different providers from different groups. An exchange that provides one of more standards methods for integrating with it means that a provider needs to integrate just once, to the exchange, rather than dozens of times.<ref name="Healthcare Electronic REcords TEchnology and Government Funding">Healthcare Electronic Records Technology and Government Funding:Improving Patient Care.http://www.myemrstimulus.com/tag/ehr-application/</ref><br />
<br />
* Does it meet the following connectivity standards: [[HL7]], HL7 CDA, CCR, HL7 CCD, ELINCS and Vendor software specifications? <ref name="whitepaper emr connectivity">What is Your EHR Connectivity Strategy? http://www.corepointhealth.com/sites/default/files/whitepapers/emr-connectivity-strategy-healthcare-interoperability.pdf </ref><br />
* How flexible is there connection framework? Can it negotiate multiple standards?<br />
* How quickly can you build and implement an interface within the interface engine?<br />
* Can our facility support the space needed for the installation and implementation of an EHR? <br />
* Make sure wireless connection is accessible in all parts of the hospital is your facility is planning to use portable devices (tablets, computers on wheels, etc.) to access the system.<br />
* Is there a cost to connecting the EMR/EHR to an HIE? <ref name="HIE"> How to implement EHRs? http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
* Does the vendor meet the certification requirements to allow patient data to go from different EHRs to meet Meaningful Use? <ref name= "Health Information Exchange"> How to connect Health Information Exchange (HIE) with Electronic Medical Records.http://www.practicefusion.com/blog/how-to-connect-health-information/</ref><br />
* Does the system support C-CDA? Can the system accept, parse, and integrate a CDA document as well as create and export a CDA document as specified in C-CDA?<br />
<br />
<br />
<br />
=== Mobile Devices ===<br />
One of the most logical reasons to have an EHR System linked up to a mobile device, such as a cell phone, is for the convenience aspect. “According to a 2012 Vitera Healthcare survey, a reported 91 percent of physicians are interested in a mobile EHR access, along with 66 percent of practice administrators.” <ref name="Mobile EHR Access">Mobile EHR Access http://www.hitechanswers.net/mobile-ehr-access-healthcares-next-big-thing/</ref><br />
<br />
Advantages: <ref name="Mobile EHR Access"></ref><br />
* Accessibility is the greatest advantage derived from being able to view patient data. A physician can view necessary patient records whether he/she is at the clinic or at home.<br />
* Clinical documents can be virtually updated from anywhere, speeding up the healthcare process. Medical personnel will be able to avoid the necessity of having to fax or scan documents.<br />
* Patient perception of a physician speaking to him/her from a desktop has been identified as negative. With a mobile device, this barrier is dropped and the patient can feel more in control speaking face-to-face and viewing results on a screen.<br />
* The small size of a cell phone enables a physician or home health worker to avoid the bulkiness of carrying a tablet. The only necessary tool when walking into a consultation will be the mobile device. Hand written notes and large electronic devices will be a thing of the past.<br />
<br />
Disadvantages: <ref name="Mobile EHR Access"></ref><br />
* Sensitive nature of Patient Health Information<br />
* Providers will have to look into providing Mobile Device Management (MDM) in order to have data stored safely.<br />
* Lost or stolen devices will need to have the ability of having information completely wiped from a remote location<br />
* The durability of a mobile device is a concern for hospitals and clinics if they are going to issue out devices to employees. Many mobile devices are very fragile and tend to have an average life span of 2-3 years.<br />
<br />
<br />
<br />
=== Hardware ===<br />
Most physician practices will need to upgrade existing hardware (computers and servers) in order to run the EHR. Typically the vendor will give the organization a “shopping list” for hardware so that the organization will purchase equipment that is compatible with the EHR. <ref name="Selecting a vendor">HEY, WHO DID THIS?Note: there needs to be something here</ref><br />
*Will the new hardware include tablets, laptops, desktops, servers, routers, printers, and scanners? <ref name=”hadware”> How do I plan for hardware purchases? http://www.healthit.gov/providers-professionals/faqs/EHR-infrastructure-investment. </ref><br />
<br />
==== Desktops ====<br />
Advantages:<ref name="Hardware">www.aafp.org/practice-management/health-it/product/hardware.html</ref><br />
* Desktops are low-cost and available from a wide variety of vendors.<br />
* Because desktop PCs are standardized, it is relatively easy and inexpensive to find spare parts and support, or to replace a machine.<br />
* Desktops will run just about any software you need.<br />
* Additional devices such as microphones, speakers, and headsets are readily available at low cost.<br />
<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Because it's stationary, you need to buy a desktop PC for each room in which you need access to your EHR software.<br />
* Desktops typically take up more space than a laptop or tablet PC. While flat screen monitors and tower units save actual desktop space, the standard desktop computer requires more room than either a laptop or tablet PC.<br />
* You must purchase additional equipment to take full advantage of voice recognition and/or handwriting recognition programs.<br />
<br />
==== Laptops ====<br />
<br />
Advantages:<ref name="Hardware"></ref><br />
* A laptop has a smaller footprint and can easily be turned to allow patients to view information on the screen.<br />
* A laptop is less obtrusive during patient interviews.<br />
* Most have fairly long battery life and/or an A/C adaptor.<br />
* Laptops use standard PC inputs such as keyboard and mouse and/or touchpad.<br />
<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Although laptops are portable, they can be heavy to carry, typically weighing five to eight pounds.<br />
* Repairs and maintenance tend to be more expensive because laptops use non-standard or proprietary parts. You may have to send a laptop off-site for diagnosis and repair.<br />
<br />
==== Tablet PCs ====<br />
<br />
Advantages:<ref name="Hardware"></ref><br />
* Tablets are truly portable and lightweight, typically weighing three to four pounds.<br />
* It is as powerful as a PC, but it doesn't require a keyboard. Instead, you add information by writing on the screen with a digital pen or stylus, much like you do in a paper chart.<br />
* Handwriting recognition software developed for tablet PCs is excellent, even for very poor handwriting.<br />
* Tablet PCs have integrated dictation capability with voice recognition software that transcribes directly into the patient record.<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Writing with a stylus takes getting used to; there is a longer learning curve in adapting to a new way of using a computer.<br />
* Handwriting recognition dictionaries have not yet fully integrated medical terminology and acronyms, requiring more correction.<br />
* There is not as much standardized software yet available for tablets.<br />
* Screens are easily scratched and can become unusable without screen protectors purchased at additional cost.<br />
* Some EHRs/EMRs require a higher/lower resolution than others and won't work on a tablet. ex: Amazing Charts (AC) will not work on the Surface Pro 2 but will work on a Surface Pro 3.<br />
* Some EHRs/EMRs can work on a tablet but licenses/support will cost more. ex: To use Amazing Charts on an iPad will require the clinic to purchase their "Cloud Based" package. It is slightly more expensive since AC will host the data vs hosting the EMR on a server built by the clinic or hospital. Amazing charts charges $39 a month in addition to license and support fees, per user for their "cloud." When a clinic or hospital hosts AC on their own server, they only pay the license and annual support fees. <ref name="AC">No Servers to set up. No software to install. http://amazingcharts.com/products/web-based-ehr/</ref><br />
<br />
=== Software ===<br />
*Identify and budget for required systems changes<br />
** Software changes<br />
** Increased system storage capacity<br />
*Know if the necessary upgrades are covered by current vendor contracts<br />
*Identify for what upgrade costs the practice will be responsible <ref name="mgma"> Is your practice ready? 5010 and ICD-10 vendor questions and guidelines. 20143. http://www.mgma.com/government-affairs/issues-overview/health-information-technology/icd-10/5010-and-icd-10-vendor-questions-and-guidelines </ref><br />
<br />
back to [[Vendor Selection Criteria|home, Vendor Selection criteria]]<br />
<br />
<br />
== References ==<br />
<references/></div>Annathehybridhttp://clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-09-18T19:45:10Z<p>Annathehybrid: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
<br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
<br />
<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
<br />
== Core clinical features ==<br />
[[Vendor Selection Criteria: Core clinical features]]<br />
<br />
== IT and technical requirements ==<br />
[[Vendor Selection Criteria: IT and technical requirements]]<br />
<br />
== Regional Selection Center EHR Selection Criteria ==<br />
<br />
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.<br />
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
*Will the vendor’s product accomplish key practice goals? <br />
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports. <br />
*What implementation support does the vendor offer?<br />
*What are the costs, roles, and responsibilities associate with the data migration strategy?<br />
*What are your sever options?<br />
*What is the products ability to integrate with other products?<br />
*What are the privacy and security capabilities of the product and what is the back-up plan?<br />
*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones? <br />
*What is the vendor’s stability and market presence?<br />
*What is the cost to link the product to HIE?<br />
*What are the costs associated with legal counsel for contract review versus open sources through medical associations?<br />
<br />
== Basic EHR Criteria ==<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
**Stage 1 (2011-2012) Data Capture and Sharing<br />
**Stage 2 (2014) Advance Clinical Processes<br />
**Stage 3 (2016) Improved Outcomes<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
<br />
== Go live support ==<br />
[[Vendor Selection Criteria: Go live support]]<br />
<br />
== Vendor Assessment ==<br />
Most vendors typically fall into one of the three categories:<br />
<br />
# Vendors that develop their own software organically on a single source code, one database, single instance.<br />
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.<br />
# Vendors that have been acquired/sold/merged as a means to stay more competitive.<br />
<br />
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref><br />
<br />
*Vendor viability must be checked. Will the vendor be around in nine years (the average life span of a significant IT investment)? If not, can the organisation live without them? Evaluations by neutral third-party analysts like Gartner, Chilmark, KLAS, and The Advisory Board must be considered to see what these analysts are saying about the vendor’s prospects in the market. Questions about vendors viability must be considered such as: Is the vendor in solid financial shape? What’s their monthly burn rate vs. income? How many days cash-on-hand do they maintain? What does their sales pipeline look like? Does the vendor’s executive leadership team have a track record for jumping from one company to another or do they have a track record of longevity and success? How much is the vendor spending on sales staff in comparison to engineering and product development staff? The best products are supported by a very lean sales staff. That’s because great products sell themselves.<ref>vendor viability https://www.healthcatalyst.com/How-to-Evaluate-a-Clinical-Analytics-Vendor/2/</ref><br />
<br />
*EHR Goals must be set. Goals should be specific, measurable, attainable, relevant, and time bound.<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
*Key Decisions should be made by making a list of potential deal-breakers such as deciding whether EHR data should reside in-office, a vendor server, or in web-based storage (“cloud storage”). To help form a list of potential deal-breakers, vendor websites should be researched. Making key decisions up-front will enable a practice to effectively narrow the field..<ref name="assessing vendor">Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref> <br />
<br />
* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"></ref><br />
<br />
* Online form from HRSA available for establishing EHR specifications to help in vendor section. The form's name is 2011 EHR Selection Guidelines for Health Centers and can be downloaded from www.HRSA.gov <ref name=" HRSA"> - http://search.hhs.gov/search?q=EHR+evaluation+form&site=hrsa&client=hrsa&proxystylesheet=hrsa&btnG=Search&lr=lang_en&output=xml_no_dtd&sort=date%3AD%3AL%3Ad1&ie=UTF-8&ud=1&oe=UTF-8</ref><br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"></ref><br />
<br />
* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
<br />
* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
<br />
* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
<br />
*Which category do you fall under should be one of the first questions you ask. Are you a small practice 1-15providers, a medium practice 15-100providers, or a large practice greater than 100providers ?<ref name="adler,k"> Kenneth G. Adler, MD, MMM Fam Pract Manag. 2005 Feb;12(2):55-62How to Select an Electronic Health Record System http://www.aafp.org/fpm/2005/0200/p55.html</ref> Once size of practice has been determined including the potential to reach the size should help you narrow down as to which vendors might best suit your needs.<br />
<br />
*Percentage of research and development reinvested into the company.<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Life cycle state or maturity of EHR system products should be asked(i.e., the occurrence of software obsolescence)..<ref name= "vendor selection"> Vendor Selection Criteria http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Frequency of software product updates..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Customer support availability..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref> <br />
<br />
*Certification status of the EHR..<ref name= "vendor selection"> Vendor Selection http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047961.hcsp?dDocName=bok1_047961</ref><br />
<br />
*Setting goals before selecting an EHR. The goals should be specific, measureable, attainable, relevant, and time bound. Having these goals will guarantee that your organization benefits from the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Make a rundown of potential issues and choose where you wish to have your EHR data to reside. Whether you need your EHR information to reside in a live in-office, a vendor server, or web-based storage. Making this list before selecting an EHR will help your practice to narrow the field. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*Plan site visits. Ask vendors for a list of practices that have successfully implemented the EHR. At site visits it is important to have a list of questions for the practice during, before, and after implementation of the EHR. <ref name= "vendor selection"> Vendor Selection http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor </ref><br />
<br />
*No vendor can offer all possible services and products. Therefore, it is important to assess if an ecosystem of partners exist for the selected vendor. Is there active developer program? Does the vendor use an open strategy or single a source strategy? <ref> Enterprise EHR Vendor Evaluation https://www.advisory.com/Research/Health-Care-IT-Advisor/ATC/research-notes/2013/enterprise-ehr-vendor-evaluation </ref><br />
<br />
*A good vendor should have a healthy management team that keeps it growing and improving. Does the vendor have stable, visionary and efficient management team? <br />
<br />
*We certainly do not wish to select a vendor that may bankrupt in the near future. Does the vendor have resources to compete in the market and likely to win in the future?<br />
<br />
== Product Requirements ==<br />
<br />
* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref><br />
<br />
* Does the EHR system employ current technology and have all the core clinical functionality, including a fully integrated pharmacy/medication management interface? <br />
<br />
* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system? <br />
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based<br />
Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref><br />
<br />
* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref><br />
<br />
== Vendor Proposal (Request) ==<br />
*Requesting a proposal is just as important as selecting the type of medication that will be used in your practice. When you ask for a proposal it is important that as a practice you are clear and concise as to what you and your practice will need. This process, though very monotonous is absolutely crucial to the flow and efficiency of your practice. It also gives you an inside knowledge to the various EHRs that are available and will give you the ability for good comparison to what is on the market <ref name="adler,k"></ref><br />
<br />
* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
=== Clinical Process Assessment and Improvement ===<br />
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref><br />
<br />
== Privacy and Security ==<br />
* Does the system provide roadmaps for adherence to organizational policies (such as HIPAA)?<br />
* Does the vendor’s EMR source code comply with the Patient Safety & Quality Improvement Act of 2005 (PSQIA)?<br />
* The system shall allow an authorized administrator to enable or disable auditing for events or groups of related events to properly collect evidence of compliance with implementation-specific policies. Note: In response to a [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA-mandated risk analysis]] and management, there will be a variety of implementation- specific organizational policies and operational limits.<br />
* Internet Connectivity and Redundancy Contract - There are three main types of connections for clinical data connections: business class digital subscriber line (DSL), business class cable, and T1 connection. Redundant back up systems and procedures to ensure your data will be backed up in multiple locations and securely stored off-site. <br />
* Will the system allow staff administrators to create and manage users and [[Data security|user security profiles]]?<br />
* The system restore functionality shall result in a fully operational and secure state. This state shall include the restoration of the application data, [[Security|security credentials]], and log/audit files to their previous state.<br />
* If the system includes hardware, the system shall include documentation that covers the expected physical environment necessary for proper secure and reliable operation of the system including: electrical, HVAC, sterilization, and work area.<br />
* How well does the EMR work with antivirus, antispyware and other security software?<br />
* What is the vendor’s history with cyber attacks? <ref name="mit cybersecurity">MIT Geospactial Data Center: Protecting EMR Data (1 of 2) http://cybersecurity.mit.edu/2012/11/protecting-emr-data-1-of-2/</ref><br />
* Does the system allow for off-site access to files/data and how does the technology protect against external breech or diversion of patient information?<br />
* Does the system have role based permission and access? Different job roles should only be able to access what is required of their job. <ref name="Ensuring Security of High Risk Information in EHRs">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_039956.hcsp?dDocName=bok1_039956</ref><br />
* Are all messaging capabilities within the EMR encrypted? <ref name="Electronic Health Records: Privacy, Confidentiality, and Security">http://journalofethics.ama-assn.org/2012/09/stas1-1209.html </ref><br />
* Does the system have the ability to audit / monitor user activity if needed?<ref name="Electronic Health Records: Privacy, Confidentiality, and Security">http://journalofethics.ama-assn.org/2012/09/stas1-1209.html </ref><br />
* Does the system have time-stamp functionality (name, date, & time)? <ref name="Security Risk Analysis Tipsheet: Protecting Patients’ Health Information">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf</ref><br />
* Is the system in compliance with the organization’s HIPPA policy?<br />
* How will the decrease the unauthorized disclosure of information?<br />
* What procedures does the vendor have to handle disaster recovery and high availability issues?<br />
* Does the vendor offer policy and procedures in regards to disposal of Protected Health Information?<ref name="FAQs About the Disposal of PHI">http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/disposalfaqs.pdf</ref><br />
* How often do users have to update password information and credentials?<br />
* What does the vendor offer in regards to data backup procedures to ensure privacy and security integrity?<br />
* How often are user ID’s audits performed for inactive users?<ref name="information security">Information security policy template. (2011). Retrieved from http://www.healthit.gov/sites/default/files/info_security_policy_template_v1_0.docx.</ref><br />
<br />
=== Results Management Requirements ===<br />
Results management is an important clinical activity that requires a structured approach in order to be effective. Results management is in accord with the precepts of Meaningful Use. Incorporation of clinical lab results into the EHR as structured data is an ongoing MU objective. <ref name="results Mgt"> Carter, J. A New Look at Results Management. 2012. http://www.americanehr.com/blog/2012/07/a-new-look-at-results-management/ </ref><br />
* Lab Results<br />
** Will the system send the lab request electronically?<br />
** Will lab results populate electronically into the EHR with flags for abnormal result?<br />
** Will Physicians be able to review and publish lab results as well result notes to patients electronically?<ref>Patient Results. https://www.labcorp.com/wps/portal/patient/results</ref><br />
** Will the system suggest follow up test depending of test done and results obtained?<br />
* LOINC Codes<br />
** Will the EHR accept LOINC-mapped electronic lab results if available from the source lab <ref name="functional"></ref>?<br />
*Radiology Results<br />
** Will the system accept radiology results and reports electronically from imaging centers or through the HIE? <ref name="functional"></ref><br />
** Does the EHR support the direct viewing of DICOM medical images without having to log into the separate PACS system?<ref>Radiology Today. http://www.radiologytoday.net/archive/rt0513p18.shtml </ref><br />
** Does the EHR has time tracking of performed or to be performed procedures that are happening in the imaging in the form of “in progress”, “completed” or “discontinued”?<br />
** Does the EHR consist critical result notification application?<br />
** Does the EHR allow insurance authorization upon imaging order?<ref name=“ IT REference Guide for the Practicing Radiologist “> Kevin W. McEney MD. Radiology Information Systems and Electronic Medical Records http://www.acr.org/~/media/ACR/Documents/PDF/Advocacy/IT%20Reference%20Guide/IT%20Ref%20Guide%20RISEMR.pdf</ref><br />
* Reminder of next test due<br />
** Will the system set a reminder for recommended time frame for next lab test <ref name="functional"></ref>?<br />
<br />
===Specialty Needs (Pediatrics)===<br />
EHRs in pediatric care may increase patient safety through standardization of care and reducing error and variability in the entry and communication of patient data.4-9 While EHRs may improve safety, implementation of general EHR systems that do not meet pediatric functionality and workflow demands could be potentially dangerous.Healthcare organization have to be careful to select prospective EMR vendor to determine if they have incorporated a variety of Pediatric specific workflows into their system. <br />
For instance,<br />
*Are EHR provide child'a age in years or EHR have the ability to determine ages in hours, days, weeks and months in addition to years?<br />
*Are dosing models consistent with taking care of a pediatric patient population?<br />
*are they provide pediatric specific EHR features such as Intake forms,Demographics that support various family structures,Well child / Preventative,Immunization administration and management,Growth Charts,Genetic information, maintenance, and reporting,School Physical,Sports Physical,Camp Physical,Daycare Physical,Reportable Communicable Disease management,Child abuse reporting forms,Referral entry and tracking,VIS (Vaccine Information Sheet),CDC link,Flack Pain scale,Behavioral tools,ADD/HD tools,Age Specific,Birth Data,Instrumentation integration (vital signs, EKG, spirometry, etc,Pediatric protocols for pediatric triage,Patient Portals,Pediatric Specific templates?<br />
<br />
=== Specialty Needs (OBGYN) ===<br />
There are unique requirements from electronic medical records systems for obstetrics and gynecology, and rooting out vendors that provide the ability to support those requirements can be challenging.Unfortunately, until CCHIT adds OB/GYN as a specialty endorsement (not slated until 2012),there are no externally validated organizations that assure the prospective purchaser that the product meets all of the required needs. Of course, should one be in a sub-specialty practice (MFM, REI), there are even fewer assurances offered on suitability; it will be up to the individual/organization to sift through the vendors and product capabilities to match with the stipulated needs.<ref>http://www.acog.org/About-ACOG/ACOG-Departments/Health-Information-Technology/EMR-Vendor-Selection-Process</ref><br />
<br />
===Specialty Needs (Anesthesiology)===<br />
<br />
Anesthesiology is a unique medical specialty, as it is a field of acute care for medicine. Due to the fast-paced nature of emergency situations, critical pieces of information to make decisions are necessary to determine a good or bad outcome. Elements such as body weight, drug metabolism, drug interactivity and allergies are emphasized. The communication of the anesthesia provider during the case is more profound between him/herself and the operating room staff (surgeon, circulating nurse, scrub technician) than with the patient. <br />
<br />
====EMR Requirements====<br />
<br />
Anesthesiology-specific workflow templates reduce errors by automatically populating patient data and supporting treatment.<br />
<br />
* '''Vital Signs Device Integration''' - Capture physiologic data—including ECG, oxygen saturation, heart rate, blood pressure, end-tidal CO2, temperature and respiration—from anesthesia machine to ensure appropriate levels of anesthetization. <br />
* '''Interaction with Current System EMR''' - After capturing the physiologic data from operating room specific devices, the EMR should integrate it automatically into the patient's chart to be part of the permanent medical record.<br />
* '''Alarms''' - Due to the potent nature of anesthetic drugs, alarms should be available to monitor drug-drug interactions and vital signs should have trend monitors to predict the possibility of impending cardiopulmonary arrest.<br />
* '''Timers''' - Medicines given in this specialty are very time-sensitive in their time of onset and duration of action. Having the capability of tracking the last dosage and time since the last dosage or due time of the next dosage would be extremely beneficial.<br />
* '''Graphing Capabilities''' - With continuous fluctuations in vital signs, the ability to graph these allows the care provider to quickly and easily view changes over time and treat any issue immediately and appropriately.<br />
* '''Medication Pump Integration''' -Anesthetic gases, such as sevoflurane and isoflurane, and pain medications, such as remifentanyl, are given continuously in some surgical cases, and with the interoperability of the EMR with these pumps, allows for accurate recording of quantities and doses administered to the patient as well as time-sensitive recordings.<br />
* '''Unique user sign-ons''' -With the capability of having unique user sign-ons, it allows the ability to track all anesthetic personnel associated with the record and who administered the medications or completed an activity.<br />
* '''Narrative Capability''' - By allowing the ability to also include narratives, in addition to automatically sync information, it allows the clinician to provide as much detail as deemed appropriate regarding a situation or case.<br />
<br />
=== Other Clinical Functionality ===<br />
<br />
* Does the system promote delivery of safe care?<br />
* The system shall require documentation of the audit support functionality in the vendor provided user guides and other support documentation, including how to identify and retrospectively reconstruct all data elements in the audit log including date, time.<br />
* Can the system identify the chronic disease management subgroups?<br />
* Is the EHR scalable to different medical specialties and practice demographics (i.e., Neurology vs. Cardiology, small satellite practice vs. intensive care unit) <br />
* Can the system support future clinical models (i.e., Medical Home)?<br />
* Does the EHR system support accurate, consistent and effective clinical documentation by appropriately balancing data auto-population, structured data entry, and unrestricted physician entry of natural-language narrative?<br />
* Does the EMR have the capability to display data over time graphically, such as growth charts?<br />
* The system shall provide the ability to query for a patient by more than one form of identification<br />
* Can it integrate with external knowledge sources such as links to journal references or other knowledge base systems (such as [http://www.hopkinsguides.com/ John Hopkins Guidelines System]) to provide more academic information and update on particular patient problem?<br />
* Does the EHR store the identity of the user and associate the ID with the additions or changes made to the system?<br />
* Can the EHR system be used to capture clinical trial data? How the clinical trial specific data is managed?<br />
* Does the EHR system have the ability to import and export data (interact) in a standard format to EHR systems from other vendors?<br />
*In outpatient departments, does the EHR have a patient-to-physician email and/or web access abilities for the outpatient department to communicate directly with the patient in case more information is needed or the office needs the patient to take some action?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the vendor’s product provide the key functionality needed to achieve the organization vision?<br />
* Does the EHR provide outcomes data in terms of key metrics (cost savings, medication error reduction, disease management) in line with the vision of the organization?<br />
* How does the system import data from personal health devices?<br />
* Can patient data be directly imported from patient portals or [[PHR|personal health records]]?<br />
* Does the vendor provide an EHR system that can be integrated with and is interoperable with other systems?<br />
* Can the vendor provide an EHR system with standard terminology that is cross platform with other EHR systems?<br />
* Does the vendor provide safe log in for patients and clients?<br />
* Does the EMR could provide appropriate information on screen without cramming too much information?<br />
* If the EMR/EHR system allows users to access through mobile devices (through the web or an app), is the mobile version similar to the computer-based version? Is it user-friendly? Will mobile access require additional training, or will user feel comfortable with it after training on the computer-based version?<br />
* What type of system is built into the EHR for clinicians, staff and any other users to provide feedback?<br />
* Does the EMR/EHR integrate with off the shelf software currently in use? (i.e. Microsoft products, adobe, etc.) and will new software/upgrades need to be purchased to enable inter-operability?<br />
* Is the EMR capable of sending a Virtual Consultation Summary to another Physician via HIE?<br />
<br />
==== Continuity of Care: Outpatient vs Inpatient EMR ====<br />
If there is no communication between the ambulatory (outpatient) and the inpatient (hospital admissions) EMR services, the clinical information does not get accurately or completely transmitted between transitions of care. This need for continuity of care must be addressed by the EMR vendors by looking at the integration between their outpatient and inpatient clinical systems. The level of integration can be-<br />
#at the user interface level (for example, separate inpatient and outpatient applications, minimal data sharing with separate databases, viewable in same shell)<br />
#at the database level (such as having two separate applications and one database, with the ability to manually transfer data between applications)<br />
#at the workflow level (with one application and one database, with data displays in the context of care setting and full accommodation for workflow) <br />
A discharge note writer is needed to generate a transition of care document (discharge summary) so that the patient can be handed off from one setting of care to another. According to JCAHO (Joint Commission) ''medication reconciliation'' must be done at every transition of care. There is very little literature that addresses the direct financial ROI for an ambulatory EMR, as opposed to the inpatient arena, where more evidence exists.<ref name="Continuity of Care">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref><br />
#Cerner Ambulatory and Cerner Inpatient<br />
Cerner has recently deployed their “Cerner Integrated” platform that does “speak” to inpatient Cerner. Cerner deployed this to "improve the quality and accessibility of clinical documentation across the inpatient and outpatient venues of care while reducing costs of transcription and document scanning." Jim Shave, President of Cerner in Canada, stated “This integration between inpatient and outpatient systems will provide a seamless experience for patients and clinicians, particularly with the large volume of Ontario residents who use outpatient hospital care.” It is still fairly new and not a lot of hospitals and outpatient clinics have had the opportunity to experience the flow of this integrated platform but this is a step in the right direction for continuity of care. <ref name="Cerner">Cerner Hospital Information System in Extended to Ambulatory Clinics in Three Ontario Hospitals. http://www.cerner.com/Cerner_Hospital_Information_System_is_Extended_to_Ambulatory_Clinics_in_Three_Ontario_Hospitals/</ref><br />
<br />
=== Management and Reporting Requirements ===<br />
<br />
The [[Request for Proposal|request for proposal (RFP)]] should include requirement of a risk management plan which includes risk identification, risk analysis and risk mitigation. Status of the risk management plan should be included in project status reports. <ref name=”CMTP”> Texas Comptroller of Public Accounts (2014). Texas government project management. Contract Management Training and Certification. http://www.comptroller.texas.gov/procurement/prog/training-cert/cmt/</ref><br />
<br />
==New Non Traditional Approach Overview==<br />
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:<br />
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation. <br />
The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.<br />
For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref><br />
There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.<br />
*Stakeholder analysis<br />
*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]<br />
*Separate vendors for each identified core IT implementation areas<br />
*Transparency in communication with stakeholders for collaboration<br />
* Personalization of HIT<br />
<br />
===Stakeholder Analysis===<br />
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref> <br />
Stakeholders in healthcare can be broadly divided into internal and external.<br />
Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.<br />
Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref><br />
<br />
===Separate vendors for each identified core IT implementation areas===<br />
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref><br />
<br />
===Personalization of HIT===<br />
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref> <br />
===Transparency in communication with stakeholders for collaboration===<br />
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and after implementation can build a strong interpersonal relationships with primary target of patient centered care environment.<ref name="Blake"></ref><br />
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref><br />
<br />
<br />
=== Nursing Functionality ===<br />
# Supporting eMAR: supporting real-time electronic medication administration record and [http://www.ncbi.nlm.nih.gov/pubmed/20445181 bar code medication administration technology].<br />
## Does the system track refusal of medications? <ref name="ELECTRONIC MEDICATION ADMINISTRATION RECORD (EMAR)">http://www.healthsecure-emr.com/jail-emr-emar</ref><br />
## Does the eMar have the ability to send encrypted messages directly to the pharmacy? <br />
# Supporting bedside automation in medication delivery: Support data interface and real-time monitoring of [http://www.ncbi.nlm.nih.gov/pubmed/15753744 smart infusion pumps] and home infusion pumps <br />
# Ease of use of Nursing flow sheets: Rows in the EHR to be filled by nurses for consistent patient care processes.<ref name="ICU Accept">Carayon, P. Cartmill, R. Blosky, M. Brown, R. Hackenberg, M. Hoonakker, P. Hundt, A. Norfolk, E. Wetterneck, T. Walker, J. (2011).ICU nurses’ acceptance of electronic health records. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197984/pdf/amiajnl-2010-000018.pdf </ref><br />
# Ease of access and usability of EHR for nursing administration and clinical documentation for nurses. <ref name="Disputes Risks">Raasikh, . What the others haven't told you: lessons learned to avoid disputes and risks in EHR implementation.http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?action=interpret&id=GALE%7CA365889941&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&authCount=1</ref><br />
# Clinical decision support and risk assessment tools for issues related to nurse care delivery, such as falls, medication delivery, skin ulcers etc. <ref name="Impact Nurse">Dowding,D. Turley, M. and Garrido, T. (2012). The impact of an electronic health record on nurse<br />
sensitive patient outcomes: an interrupted time<br />
series analysis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384108/pdf/amiajnl-2011-000504.pdf</ref><br />
<br />
=== Pharmacy Operation ===<br />
Hospitals and physician practices need to keep their patients safe and well managed by using a pharmacy information system also called a medication management system. The system must have several core functions including in and outpatient order entry, dispensing, and inventory and purchasing management. The system must also be able to connect to other systems within the enterprise, including an EMR, computerized physician order entry (CPOE), barcode technology, and smart IV infusion pumps.<ref name="Pharmacy Information Systems">10 Popular Pharmacy Information Systems".http://www.informationweek.com/healthcare/clinical-information-systems/10-popular-pharmacy-information-systems/d/d-id/1104805?</ref><br />
<br />
# Connect to other systems within the enterprise including EMRs<br />
# Computerized physician order entry (CPOE)<br />
# Barcode technology<br />
# Smart IV infusion pumps<br />
<br />
<br />
==== Formulary Management ====<br />
<br />
# Data repository for formulary information, maintain real time update of medication information with national drug information database<br />
# Support periodic update of formulary, restricted formulary, and nonformulary medications<br />
# Cross reference patient’s insurance formulary list to allow for generic medications to be selected when e-prescribing.<br />
<br />
==== Drug dispense and delivery ====<br />
<br />
# Support outpatient pharmacy operation functionality: <br />
## Maintain outpatient prescription data<br />
## Management of prescription fill, refill and dispense activities<br />
## Support billing protocols with governmental and private insurance<br />
# Support inpatient pharmacy operation functionality<br />
## Maintain inpatient medication ordering data<br />
## Real-time monitoring of IV and oral medication compounding and delivery<br />
## Support real-time data interface with automatic dispensing cabinet<br />
<br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
<br />
== Vendor Financin g==<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name="Kannry”> </ref><br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
*Usability Testing - Realization of EMR benefits depends largely upon usability. Usability testing with representative end users validates “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use” (p. 331). <ref name=”Harrington2011”>Harrington, L., Porch, L., Acosta, K., & Wilkens, K. (2011). Realizing electronic medical record benefits: An easy-to-do usability study. Journal of Nursing Administration, 41(7/8), 331-335.</ref><br />
<br />
==== Face the Interfaces ==== <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
<br />
===== Interface History ===== <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
<br />
*Which vendors (and which of their applications) have they interfaced with?<br />
<br />
*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
<br />
*How many interfaces were built, and what is the maximum the system can support?<br />
<br />
*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
<br />
*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89)<ref name="Kannry"> </ref> it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> </ref><br />
<br />
== Future Relationships: Vendor Partnership ==<br />
<br />
* Talk to vendor's existing customers, making sure to also contact some vendor customers independently, as the vendors tend to only provide contacts to their most satisfied customers.<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and prepare a Request for Proposals (RFP). <br />
*Composing the RFP can be a daunting task. AHIMA has created a guidelines for a template that may be used to write the RFP. The guidelines are extensive and include several particular components that must be included. It can be found [http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959 here]. <ref name="RFI/RFP Template (Updated)">AHIMA http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959</ref><br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
*Ensure there will be well-laid out contractual agreement regards the 'source code' that will satisfy/cover necessary conditions: "When does the company get the 'source code?, How does the company get the source code?"<br />
*If there are workflow changes within the organization, after the product is implemented, is the product flexible enough to allow for changes without major outages or disruptions to daily activity?<br />
*What are the vendors’ contingency plans if technical glitches occur, post implementation?<br />
*Is technical support offered by the vendor 24 hours per day/ 7 days a week?<br />
*In the event of need for support from the vendor, what is the approximate response time to calls that vendor the projects?<br />
* What is the cost of providing this technical support per hour?<br />
* What size, in terms of employees, is the EHR vendor? Do they have the staff to fully address the support needs of their current client base and, can they accommodate the added support load of your institution?<br />
*In terms of clinical decision support, how often are drug list and drug interaction list updated? Once updated, how long will it take for the changes to be accessible by the end users?<br />
* When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?<br />
*In "EMR Vendor Selection" on [http://www.healthtechnologyreview.com/emr-vendor-selection.php Health Technology Review website], it states an old adage in the Software industry that consumers will buy a product based on features, but will leave the vendor based on a lack of support. Therefore, it is important to check references for the vendor related to post-implementation technical support satisfaction.<br />
* Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?<br />
* Will the source code be placed in escrow so that the system could be maintained and modified by internal IT staff in the event that the vendor ceases operation.<br />
* Does the vendor have local support personnel or will all issues be handled by a distant team?<br />
* What is an average time for installing and testing upgrades to the system? If an upgrade is missed or skipped, does the subsequent upgrade(s) have all prior changes included or just the current fix or feature for that version?<br />
* Is there going to be a vendor-institution confidentiality agreement or can the vendor share institutional information and dealings with other establishments?<br />
<br />
'''* Does the vendor's produce meet our needs and goals for our practice? Carryout a test drive of our specific needs with the vendor's product and provide the vendor with patient and office scenarios or mock trial that they may use to customize their produce demonstration.'''<br />
<br />
=== Upgrades ===<br />
<br />
* Does the vendor share the organization's '''vision''' for the EHR?<br />
* Does the product provided by the vendor has all the '''key functions''' needed to fulfill the vision of the organization?<br />
* Is the vendor utilizing the desired technology?<br />
*Is the vendor stable and does it has presence in the region where the system will be implemented?<ref name="Upgrade EHR">Upgrade to a Certified EHR http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
*Is the system capable of integrating with other product such as billing systems, practice management software and public health interfaces?<ref name="Upgrade EHR"></ref><br />
* Compare retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
* Electronic replacement for traditional reportable disease notifications to health departments, may become part of biosurveillance in the future.<br />
* Is it possible to virtualize or [http://en.wikipedia.org/wiki/Sandbox_(software_development) sandbox] the system to test updates? This functionality would allow site specific testing of new features and systems with less risk of corruption of the current system. It would also allow testing of new features functionality and allow easy rollback if features end up being unwanted.<br />
* Does the system allow outreach/growth to affiliates as a "subset" of the existing clinical provider group? Does that outreach include full or limited functionality? How does that data interface with the existing clinical record?<br />
*How does the system scale? Is the vendor able to provide support and functionality as a practice grows or can they provide functionality to a small, regional branch?<br />
* Provision of EHR systems that support the capture of public health data from Clinical Information Systems.<br />
* Does the system can combine with EHR in long term health care area as a reminder of senior people?<br />
* Ensure that your vendor will be around when you need help. While specific vendor qualifications vary, generally information to be considered in the vendor vetting process, besides functional and technical details, includes vendor reputation, staff experience and qualifications, and financial solvency. <ref name="Chao"> (Chao, C., & Goldbort, J. (2012). Lessons Learned from Implementation of a Perinatal Documentation System. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(5), 599-608. doi:10.1111/j.1552-6909.2012.01378.x </ref><br />
*Does the vendor allow discrete data capture and easy reporting of critical data that needs to be submitted for reimbursement by the national and state policies on healthcare?<br />
*Is the vendor at the forefront of research in healthcare and does the software offer clinical dashboards and predictive models for easy tracking and analysis of patient data and efficient decision making by clinicians.<br />
*Does the vendor require hiring of outside consultants for training?<br />
* Does the vendor, as part of their 18-24 month roadmap, include Direct-Trust (commonly referred to as Blue Button) to facilitate a more automated Provider to Provider data exchange as a replacement for FAX machine?<ref>Transmitting Data Using the Direct Protocol. (2013, February 4). Retrieved February 3, 2015, from http://bluebuttonplus.org/transmit-using-direct.html</ref><br />
<br />
* Does the vendor, as part of their 18-24 month roadmap, include Fast Healthcare Interoperability Resource (FHIR) protocol as well as Human APIs implementation to facilitate bi-directional data exchange between Provider and Patient?<ref>HL7 Fast Healthcare Interoperability Resources Specification (FHIR™), Release 1. (n.d.). Retrieved February 5, 2015, from http://www.hl7.org/implement/standards/product_brief.cfm?product_id=343</ref><br />
<br />
* Does the vendor, as part of their 18-24 month roadmap, include not only Member Eligibility data but History data, Formulary data as well as Drug Utilization Review (DUR) data in their ePrescription Hub?<ref>Pennell, U. (2013, August 21). What is E-prescribing and What are the benefits? - EMRConsultant. Retrieved February 7, 2015, from http://www.emrconsultant.com/emr-education-center/emr-selection-and-implementation/what-is-e-prescribing-and-what-are-the-benefits/?s=dur</ref><br />
<br />
*Does the system offers privacy and security capabilities?<ref name="Upgrade EHR"></ref><br />
<br />
== Contracts ==<br />
<br />
Contracts are as much a business tool as they are a purchasing agreement. <ref name="ehr contract">Carolyn Hartley - signing an EHR contract http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
<br />
* Project Payments<br />
* Contract Terms [http://calhipso.org/documents/ehr_contracting_terms_final_508_compliant.pdf]<br />
* All costs, current and future, associated with the implementation<br />
Details of the total cost incurred by the institution also called total cost of ownership (TCO) is an important consideration in the selection process. It helps to predict the longevity of the program. The request for proposal to vendors should include a request for information about vendor license and implementation costs. Vendors should deliniate the assumptions made when preparing the TCO so the decision committee is able to verify that they are parallel to the goals and objectives of the insitutions. If the same assumptions are encorporated in all request for proposals one can better compare the applications. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref><br />
Institutions must also consider the intangible return on their investments such as reduced adverse events, decreased hospital stay, accurate and timely billing and improved management of supplies.<br />
* Does the vendor have any hidden fees?<br />
* Time commitment from vendor with regard to implementation and training<br />
* Penalties for delays in implementation<br />
* Code escrow - be sure code will be available if vendor goes out of business<br />
* Indemnification and hold harmless clauses <br />
* Confidentiality and nondisclosure agreements <br />
* Warranties and disclaimers <br />
* Limits on liability <br />
* Dispute resolution <br />
* Termination and wind down<br />
* Intellectual property disputes <br />
* IT support agreement<br />
* Training Contract<br />
* Applied area contract<br />
* User and vender liability<br />
* Disputation judgment <br />
* Attorney of vender and clients<br />
* User License - The person who has access to data using a user ID and password. Pricing structures vary according to the definition of user.<br />
* Consider variation of user licenses according to the needs: one price per MD, tiered price (MD, nurse or administrator), site license (25+ providers in the same facility), and enterprise license (multiple users in multiple departments). <ref name="user license">Signing an EHR contract. Tips to control costs. http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
* Interface - The EHR vendor's contract includes the cost of interfaces. These include interfaces such as those with your scanner or fax machine; and more complex interfaces such <br />
* Hardware Contract - Review the EHR vendor's hardware quote, but research may lower costs. Check the vendor's website for hardware specifications the vendor supports. Hardware includes servers, high-speed scanners, computers, handhelds, computer on wheels (COW), wall mounts, etc. Hardware installation to a wholesaler means assembling the server and software to make it work at their location prior to delivering it to you. It usually does NOT mean the installation at your location, a difference that will create a significant budget surprise. Clarify the term "installation" with any hardware wholesaler before making the purchase.<br />
* Third Party Software Contracts – Software includes encryption, speech-recognition, password management, Microsoft™ suite, anti-virus, golden image, bar-coding or webcams.<br />
* Business Associate Agreement - To be HIPAA-compliant you will need a business associate agreement with the vendor, and must ensure the vendor meets HIPAA security and privacy requirements.<ref name="HIMSS-AMA-BAA">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
<br />
=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-pms"> </ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
<br />
*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
<br />
*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor"></ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
<br />
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref><br />
<br />
== Regulatory Compliance ==<br />
<br />
Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:<br />
<br />
=== Meaningful Use (MU) === <br />
<br />
Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. <ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref> A gap analysis can be performed:<br />
<br />
==== Meaningful Use Gap Analysis ====<br />
<br />
* Is it ONC Certified? [http://oncchpl.force.com/ehrcert?q=chpl]<br />
* Does it meet all Meaningful Use objectives?<br />
* Does it provide automated MU & Clinical Quality Measure Reports?<br />
* Does the vendor provide MU Training Guides/Resources?<br />
* Does the system facilitate easy MU Data capture such as required data fields?<br />
* Does it provide audit logs, usage monitoring, etc?<br />
* Does it allow/include data migration from previous EMR?<br />
* Does it contain CDS Rules to improve performance on high priority health conditions?<br />
* Does it have capability to electronically submit Clinical Quality Measures to CMS?<br />
* Does it have Public/Cancer Registry Reporting Capabilities? <br />
* Does it provide 24/7 technical support?<br />
* Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? <ref name="CMS.gov">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html</ref><br />
* Is the ONC certification current or does the product require inherited certification/ gap certification?<ref name="healthIT.gov">http://healthit.gov/sites/default/files/final2015certedfactsheet.022114.pdf</ref><br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref> <br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
== References ==<br />
<references/></div>Annathehybrid