Vendor Selection Criteria: Go live support
Go Live Support
Determine what type of support your institution will need is an important part of choosing an EMR vendor. Questions to ask include: 
- What support will I receive during and after implementation? 
- Is the vendor support unlimited? Is it free? 
- Do they offer support from live people? 
- If I have an issue, how will the vendor help me resolve it? 
- What is your resolution plan and support structures when problems arise during go live? 
The Electronic Health Record (EHR) Implementation Go-Live Planning Checklist published by the National Learning Consortium documents the following items on the plan for "Day of Go-Live": 
- The practice
- Backups and Downtime
- Connectivity. 
Meeting Organizational Needs
When selecting an EMR for your institution, one size does not fit all. Here are five questions to answer before selecting an EMR: 
- Decide whether you want to purchase an Application Service Provider (ASP) module or a locally hosted EHR solution. 
- Review the organization’s current goals and objectives to determine the EHR benefits to be achieved. 
- Compare EHR Vendor Products-what may work for a urban organization may not work for a rural hospital. 
- Develop a written RFP (Request For Proposal) based upon these requirements-Don't forget to include IT support and upgrades, if applicable. 
- Vendor Selection and Contract Negotiation-Request demos of the products and ask about maintenance. 
- Ability to integrate with other products (e.g., practice management software, billing systems, and public health interfaces, ADT). One of the biggest headaches with systems are the inability to exchange information between third party applications. These could cause a lot of issues down the road.
- Implementation Project Manager – A project manager is necessary to bring vendor experience and guidance to the implementation process and should hand off the implementation to your internal team within 12 to 15 months.
- While vendors often assign resources designated as “project managers”, and this may be important for vendor-side work, it is in the best interest of the customer to obtain a project manager accountable to the executive sponsor for the success of the overall implementation (which often has a scope beyond that of the EHR itself).
- Will the vendor be readily available to conduct training for all shift and service line?
- Service Agreement - A service agreement identifies what the EMR vendor will do to maintain the software, including software maintenance, technical support, and upgrades.
- IT Support Agreement - Hardware installations are your responsibility, not the EHR vendor. However, if you do not have onsite IT support, request an estimate for the following:
- Installation charges for electrical requirements, cable and phone connections for the system
- Monthly fees to provide access to patient data on a remote server
- Networking design and administration charges related to the set-up and service of client's network
- Hardware onsite installation and maintenance
- Third-party software maintenance for products not provided by the vendor
- Correcting errors that result from changes you or a third-party made to the software. This applies primarily to client-server agreements
- Backup capabilities. This applies primarily to client-server agreements.
- Terms and Conditions - Irrespective of the contract length, ask about penalties for withdrawing your data. Any vendor interested in preserving its reputation will provide you with data in a common format able to be transitioned to another system, but there is a withdrawal fee. 
- How long is does it take for a typical install, troubleshooting and go-live of the EHR?
- The significance of a multidisciplinary group with dedication to common aims and objectives for the task of EMR implementation cannot be overstated. 
- Does the vendor factor the number of users as part of their implementation cost?
- Does the system provide pre built records or allow the import of pre built from a third party (i.e. Specialty order set, Medi-Span Medication records, SNOMED Clinical Terms)? Or do all of these records need to be built again
- Does the vendor provide their own hardware or use a third-party company for their hardware needs? Based on the practice size and niche, is a well-established vendor with all software and hardware in-house preferable?
- If you have an existing system, what kind of difficulties will the vendor encounter? Will it be possible to transfer existing data to the new system?
- In calculating the Total Cost of Ownership (TCO), the break out costs should include who pays for the additional costs due to delays in implementation, especially those due to the Vendor. In fairness, the Vendor's rate for successful, on-time and under-budget implementation should be discussed as well.
- Does the TCO include lifecycle costs that include milestone payment scheduling to back up promises made by EHR implementation? 
- Does the system minimize or ease the data input, so that doctors spend more time with their patient?
- Does the vendor qualify under the organization acquisition policies?
- How will current policies and procedures change once implementation takes place?
- Is there a dedicated support team?
- If implementation of the system fails, what steps is the EHR willing to take to make it successful?
- Will the license cost for updated versions of the EHR be borne solely by the purchasing institution or will there be cost sharing between the institution and the vendor for updates?
- How often the possibility of system break out?
- Does the fee include pre-training and post-training?
- How long and including of the warranty of infrastructure and system? Do we pay for accident damage for system or hardware?
- What system configurations are available? How does the vendor involve the client in the configuration of the system?
A significant predictor or implementation difficulty is lack of adequate end-user training and support. Depending on your organization and its staff, training may need to address the entire spectrum of computer usage from basic use of a mouse to specific use of that mouse to navigate your EHR.
- How many hours of initial training is provided for administrators? For users?
- Is an onsite advisor there to assist with training and problems after the system has been implemented? If so, for how long?
- When is the initial training provided, during or after implementation?
- How large a virtual environment will be required to provide training for staff, and how much time should be allocated.
- What are the time requirements to train the trainers?
- Is the initial training included in the costs of the tool?
- If additional training is required post-implementation, how is it priced – lump sum or hourly rate?
- How many hours of post-implementation support is included?* Will the vendor provide technical training to the IT Department of the purchasing institution to handle minor non-critical hardware problems?
- How long is the training that is required for each subgroup to fully implement the system?
- What are the training requirements for the vendor? For the clinic/hospital?
- What is the vendor's track record for successfully training a new system for your clinic/hospital size?
- What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?
- What training mechanisms are used by the EHR Vendor? 
- Does the vendor provides training instructors at beginning?
- Are the training staff familiar with both the technical aspects of the product and the clinical needs of the department of interest? (i.e. subject matter specialist, clinical informatics specialist)
- Does the vendor has well-organized and reliable training courses?
- Training Contract - Training should be included in the licensing and service agreement, but some vendors provide separate online and onsite training contracts.
- Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) 
- Are training materials provided by the vendor or is the organization responsible for producing in-house? If the training material will be developed in-house, does the vendor stipulate specific training requirements (i.e. classroom-based vs. web-based, mandatory competency examinations)?
- What kind of on-going training and support will be provided after implementation? Is the cost of post-implementation training and support clearly specified?
- What type of training is given for upgrades to the system. Does the vendor offer any online education material to assist?
- If there are major updates to the system, will the vendor provide ample support and training for the users? And how much will this additional training cost?
- Does the EHR/EMR vendor offer the option to have their staff available to be present at the hospital/clinic/facility during training and then "go-live" implementation? This would allow the EHR/EMR staff to offer hands-on support for any obstacles that come up during training and "go live" implementation.
- Does the product have a functional academic version that can be used to train physicians and nursing staff , to allow them to adapt to the installed EHR quickly and easily?
* Spell out pricing before selecting and Electronic Medical Record (EMR/Electronic Health Record (EHR) system such as hardware, software, maintenance, upgrade costs, lab and pharmacies interfaces, customized quality reports, expenditure to connect to health information exchange (HIE)
Doing Go Live for the initial run of an EHR system is tough work and requires several steps to accomplish. The same can be said for updating an EHR system. Robin Gomez, Chief Nursing Officer of Paradise Valley Hospital has written the following steps that she believes will make the transition easier, particularly during the "go live" stage. Some of these steps could also be useful in an initial go live scenario. 
- Develop project plan
- Scrutinize workflow and documentation practices
- Set a go-live date
- Schedule weekly calls with vendor
- Prepare and get word out early
- Schedule software upload
- Allocate sufficient hardware resources
- Station super users on the floors
- Conduct post-implementation action analysis
back to home, Vendor Selection criteria
- Shay, Ryan(July 2015). Choosing the best EHR: Five questions to ask http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/
- Medical Cost http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings
- Electronic Health Record (EHR) Implementation Go-Live Planning Checklist https://www.healthit.gov/sites/default/files/tools/nlc-ehr-implementation-go-live-planning-checklist.docx
- Khuu, T.(2011, May). EHR Vendor Selection: The 5-Step Guide. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=3852
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- Holbrook, A., Keshavjee, K., Langton, K., Troyan, S., Millar, S., Olantunji, S., Pray, M., Tytus, R. & Ford, P.T. (2001). A critical pathway for electronic medical record selection. Proceedings of the AMIA Symposium; Pages 264–268. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2243608/
- Healthcare Standards. http://www.emrandehr.com/tag/healthcare-standards/
- Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23(42), 1-4.
- Planning Your EHR System:guidelines for Executive Management.http://www.satva.org/white-papers/MHCA-SATVA-PlanningYourEHRSystem.pdf
- Gomez, R. (2010). EHR upgrade considerations. Nursing Management, 41(12), 35-37. doi: 10.1097/01.NUMA.0000390464.11624.d6