Vendor Selection Criteria: Future relationship with vendor
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 sure to also contact some vendor customers independently, as the vendors tend to only provide contacts to their most satisfied customers.
- 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).
- 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 here. 
- An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare
- 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?"
- 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?
- What are the vendors’ contingency plans if technical glitches occur, post implementation?
- Is technical support offered by the vendor 24 hours per day/ 7 days a week?
- In the event of need for support from the vendor, what is the approximate response time to calls that vendor the projects?
- What is the cost of providing this technical support per hour?
- 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?
- 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?
- When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?
- In "EMR Vendor Selection" on 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.
- Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?
- 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.
- Does the vendor have local support personnel or will all issues be handled by a distant team?
- 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?
- Is there going to be a vendor-institution confidentiality agreement or can the vendor share institutional information and dealings with other establishments?
* 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.
- Does the vendor share the organization's vision for the EHR?
- Does the product provided by the vendor has all the key functions needed to fulfill the vision of the organization?
- Is the vendor utilizing the desired technology?
- Is the vendor stable and does it has presence in the region where the system will be implemented?
- Is the system capable of integrating with other product such as billing systems, practice management software and public health interfaces?
- 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
- Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?
- 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.American Medical Association
- Ability to have HIE compatibility
- Improved billing accuracy and charge capture
- Electronic replacement for traditional reportable disease notifications to health departments, may become part of biosurveillance in the future.
- Is it possible to virtualize or 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.
- 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?
- 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?
- Provision of EHR systems that support the capture of public health data from Clinical Information Systems.
- Does the system can combine with EHR in long term health care area as a reminder of senior people?
- 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. 
- 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?
- 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.
- Does the vendor require hiring of outside consultants for training?
- 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?
- 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?
- 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?
- Does the system offers privacy and security capabilities?
- The contract should include the vendor's response for proposal (RFP) or request for information (RFI) 
- Project Payments
- Contract Terms 
- All costs, current and future, associated with the implementation
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.  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.
- Does the vendor have any hidden fees?
- Time commitment from vendor with regard to implementation and training
- Penalties for delays in implementation
- Code escrow - be sure code will be available if vendor goes out of business
- Indemnification and hold harmless clauses
- Confidentiality and nondisclosure agreements
- Warranties and disclaimers
- Limits on liability
- Dispute resolution
- Termination and wind down
- Intellectual property disputes: For instance, it is important to consider who will own the data that enters the EHR once the EHR is in place 
- IT support agreement
- Training Contract
- Proficient requirement of the implementation team (certification requirement and the associated costs)?
- Applied area contract
- User and vender liability
- Disputation judgment
- Attorney of vender and clients
- User License - The person who has access to data using a user ID and password. Pricing structures vary according to the definition of user.
- 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). 
- 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
- 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.
- Third Party Software Contracts – Software includes encryption, speech-recognition, password management, Microsoft™ suite, anti-virus, golden image, bar-coding or webcams.
- 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.
Support and Maintenance
- What is the facility agreement for the Vendor support?
- What is the cost for support fees each year?
back to home, Vendor Selection criteria
Maintenance of facility systems is provided by system updates. The frequency of these updates must be taken into consideration along with the duration of each update. Long or overly frequent updates may have negative effects of productivity of facilities. This could in turn even negate the benefits of the system in place.
- AHIMA http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959
- Upgrade to a Certified EHR http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr
- (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
- Transmitting Data Using the Direct Protocol. (2013, February 4). Retrieved February 3, 2015, from http://bluebuttonplus.org/transmit-using-direct.html
- 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
- 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
- Carolyn Hartley - signing an EHR contract http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx
- What are important items to include in a vendor contract? http://www.healthit.gov/providers-professionals/faqs/what-are-important-items-include-vendor-contract
- Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.
- Signing an EHR contract. Tips to control costs. http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx
- Weber, M. (2008, January 8). Selecting an EHR, Now What???? Lecture, Grand Ledge.