Difference between revisions of "Vendor Selection Criteria"

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−	== Clinical Features the System Should Provide==	+	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>
−	*  Health Information & Data Management (Demographics, Problem list [CC, Conditions, Acute/Chronic, Worsening/Resolving, Injuries, Present Illness] with ICD-9 or ICD-10 numbering, Procedures, Diagnoses, Medications, Allergies, Familial history, Consultations,  Signs & Symptoms and Vitals, Progress Notes and Discharge Summaries, Appointments/Admissions/Visits, Advance Directives, Clinical Reminders [Immunizations, Screenings, Risks])	+	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>
−	** EHR that allows for the creation and maintenance of patient specific problem lists that are dated and organized by diagnosis, problem, and problem type and associates encounters, orders, medications and notes to one or more problems. Once a problem is resolved, the EHR provides an automated algorithm that closes that problem.	+
−	*  Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)	+
−	*  [[CPOE| Computerized Physician Order Entry (CPOE)]], [[Electronic prescribing| e-Prescribing]]	+
−	** 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 interoperability with all current and future systems and between clinics and providers.	+
−	*  Decision Support (Drug Interaction, Clinical Guidelines [Plans & Protocols], Prescription Support, Diagnosis Support, Risk Assessments, Clinical Checklists, Medical References)	+
−	*  Formulary Database Support	+
−	*  Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)	+
−	*  Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)	+
−	* Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)	+
−	* 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.	+
−	* Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.	+
−	*  Patient Portal for online personal health record access	+
−	*  Clinical policies and procedures guidelines	+
−	*  Produce visit summary and complete medical record printout and data export on demand for patient use.	+
−	==Possible Vendor Services==	+	==EHR Vendor Selection==
−	* EHR Software	+	===Preliminary selection criteria for EHR vendors===
−	* Privacy and Security services	+
−	* Readiness assessments	+
−	* Implementation services	+
−	* IT infrastructure support	+
−	* Practice redesign and optimization services	+
−	* Quality improvement and measures services	+
−	* Education and training	+
−	* Meaningful use gap analysis	+
−	* Direct Messaging services	+
−	(RI Regional Extension Center, 2011)	+
−	==Requirements by Category==	+	According to McDowell, et.al (2003), the primary and vital step for choosing vendors is to narrow your selection from over 400 to as few as 4 vendors based on the following key requirements. <ref name="McDowell"> McDowell, et.al. (2003). Journal of Healthcare Information Management. Herding Cats: The Challenges of EMR Vendor Selection. http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats-Challenges_of_EMR_Vendor_Selection.pdf.</ref>
−	=== Demonstrate Clinical Functionality (25%) ===	+	*Is the EHR up-to-date with technology?
−	* Does the system promote delivery of safe care?	+	*Are the core clinical components fully integrated in the EHR?
−	* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.	+
−	* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?	+
−	* 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) (http://www.americanehr.com/Home.aspx)	+
−	* 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. [1]	+
−	* The system restore functionality shall result in a fully operational and secure state. This state shall include the restoration of the application data, security credentials, and log/audit files to their previous state. [1]	+
−	* Can the system identify the chronic disease management subgroups?	+
−	* Can the system support future clinical models (i.e., Medical Home)?	+
−	* 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?	+
−	* Will the system allow staff administrators to create and manage users and user security profiles?	+
−	* Does the EMR have the capability to display data over time graphically, such as growth charts?	+
−	* The system shall provide the ability to query for a patient by more than one form of identification	+
−	* 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?	+
−	* Does the EHR store the identity of the user and associate the ID with the additions or changes made to the system?	+
−	* Can the EHR system be used to capture clinical trial data? How the clinical trial specific data is managed?	+
−	* Does the EHR system have the ability to import and export data (interact) in a standard format to EHR systems from other vendors?	+
−	* Does the vendor’s product provide the key functionality needed to achieve the organization vision?	+
−	* How does the system import data from personal health devices?	+
−	* Can patient data be directly imported from patient portals or personal health records?	+
−	* Does the system provide roadmaps for adherence to organizational policies (such as HIPAA)?	+
−	=== Acquisition and Implementation Cost (25%) ===	+	*Are the applications available for inpatient, ambulatory, and outreach settings?
−	* 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)?	+	*Does the vendor have a proven record of financial stability and management reliability?
−	* 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 – Kannry J et al: 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.  Journal of Healthcare Information Management — Vol. 20, No. 2, pg 84.	+
−	* Does the vendor factor the number of users as part of their implementation cost?	+
−	* 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.	+
−	--[[User:Sfjafari|Sfjafari]] 12:42, 13 September 2011 (CDT)	+
−	* Does the system minimize or ease the data input, so that doctors spend more time with their patient?	+
−	--[[User:Sfjafari|Sfjafari]] 12:42, 13 September 2011 (CDT)	+
−	* Does the vendor qualify under the organization acquisition policies?	+
−	* What kind of on-going training and support will be provided after implementation?  Is the  cost of post-implementation training and support clearly specified?	+
−	* How many hours of initial training is provided for administrators? For users?	+
−	* When is the initial training provided, during or after implementation?	+
−	* 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?	+
−	* Is there a dedicated support team?	+
−	* If implementation of the system fails, what steps is the EHR willing to take to make it successful?	+
−	=== Hardware Platform and Technical Requirements (20%) ===	+	*Does the vendor have a well-established familiarity with large healthcare providers like academic medical centers and tertiary care hospitals?
−	* 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)?	+	*Does the vendor offer an "exit strategy" if they, for unknown reasons, are unable to continue to support your system
−	* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?	+	--- Example will they allow you access to the source code---
−	* Will technical support remain active even if the Hospital is running a non-upgraded system? For how long?	+
−	* Does the system use [http://medical.nema.org/ DICOM] standards for the transmission of image data?	+
−	* How frequently does the vendor provide patch upgrades for the product?	+
−	*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…)	+
−	*How does the system handle multiple logins of the same user at different locations/instances?	+
−	*How does the system handle user inactivity? (auto-logout, discarding\saving changes, draft creation)	+
−	* 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.[1]	+
−	--[[User:Sfjafari|Sfjafari]] 12:44, 13 September 2011 (CDT)	+
−	* Can the system allow login remotely – off site transcription or home or other clinic?	+
−	--[[User:Sfjafari|Sfjafari]] 12:44, 13 September 2011 (CDT)	+
−	* 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?	+
−	* How well does the EMR work with antivirus, antispyware and other security software? What is the vendor’s history with cyber attacks?	+
−	* Does the vendor offer a Software as a Service (SaaS) solution, also know as an Application Service Provider (ASP), or a client-server solution?	+
−	* With existing systems, how tightly integrated will the new EHR system be and what prep work is required to make the integration possible?	+
−	* Does the system have modules for automatic update of knowledge sets at regular intervals, more like automatic update of antivirus definitions?	+
−	* Does the software allow generation of customized reports such that desired information can be extracted periodically for performance improvement projects or performance monitoring.	+
−	* Does the vendor utilize the desired technology?	+
−	* Is remote access available for mobile devices?	+
−	* Is remote access cross platform? The use of open standards (e.g. HTML5, XML) allows users on any platform, including smartphones and tablets, to have equivocal access to the system.	+
−	=== Implementability (15%) ===	+	===Assess EHR Requirements===
		+	Before diving into specific attributes needed for an EHR system, the general requirements of the EHR must be decided. General requirement decisions may be needed for the following:<ref name = HRSA HIT Vendor Select>How to Select a Certified EHR. http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref>
−	* How does the vendor compare in [http://www.klasresearch.com/ KLAS] rankings of similar systems and applications?	+	*Will the EHR be open source or off-the shelf commercial software?
−	* How long is the training that is required for each subgroup to fully implement the system?	+	*What EHR functions are needed, such as patient demographic and care management data on patient visits?
−	* What are the training requirements for the vendor? For the clinic/hospital?	+	*What kind of clinical decision support and reports are critical, important, and desired but not essential?
−	* What is the vendor's track record for successfully training a new system for your clinic/hospital size?	+	*What type of consents, authorizations, and directives are needed?
−	* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?	+	*What interfaces are required to exchange health information with other providers, laboratories, pharmacies, patients, and government disease registries?
−	* How will legacy patient record data be integrated into the new system?	+	*What type and scope of training is expected?
−	* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations?  [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)	+	**What levels of training will be needed?
−	*Make sure the vendors give accurate information for the Request for Proposal. So the stakeholders can make informed decisions on the comparison of vendors.	+	**How many people need to be trained by the vendor?
−	-Zoker 9/17/2011	+	*What availability for assistance will be necessary?
−	* 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?  [[User:MikeField|MikeField]] 20:47, 29 January 2010 (CST)	+	**How much will be needed for how long?
−	* Does the vendor have a List of Lessons Learned from previous implementations?	+
−	* 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]	+
−	* 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?	+
−	* 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]	+
−	* What is the vendor's rate for on time & under budget implementations?	+
−	* 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?	+
−	* Check whether the vendors EMR products are [http://www.cchit.org/ CCHIT] certified (http://www.cchit.org/products/cchit)	+
−	* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?	+
−	* What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/Home.aspx)	+
−	* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? (http://www.americanehr.com/Home.aspx)	+
−	* What is the company policy regarding data ownership for the ASP EHR?	+
−	* 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?	+
−	* Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/Home.aspx)	+
−	* 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).[1]	+
−	* The system shall include documented procedures for product installation, start-up and/or connection.[1]	+
−	* 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 HIPAA-mandated risk analysis and management, there will be a variety of implementation- specific organizational policies and operational limits.[1]	+
−	* What options does the EMR have for upfront abstraction and scanning? Are these costs included in the purchase of the EMR?	+
−	* Can the vendor support the organization desired implementation strategy?	+
−	* How can the EHR technology be useful for electronic exchange of clinical health information among providers and patient authorized entities? (http://en.wikipedia.org/wiki/Electronic_health_record#Quality)	+
−	=== Vendor Partnership and On-going viability (10%) ===	+	'''Vendor Assessment'''
−	*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).	+	Vendor assessment should be performed systematically in order to meet the goals of the given institution: <ref name= “Chin”> Chin, B. J., & Sakuda, C. M. (2012). Transforming and Improving Health Care through Meaningful Use of Health Information Technology. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347738/.</ref>
−	*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare	+	*Determine which EHR vendors are available in the locality.
		+	*Compile a pre-screen questionnaire and survey for local vendors.
		+	*Evaluate request for proposal (RFP) documents and provide vendors with details of any state-specific requirements.
		+	*Assemble a list of pre-qualified vendors based on survey response and RFP.
		+	*Provide a comprehensive request for information document to pre-qualified vendors.
−	*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?"	+	'''Steps to conducting an EHR Assessment'''
		+	*What is your facilities need for an EHR?
		+	*What are your goals for the EHR?
		+	*What could be the deal breakers
		+	*Start narrowing the field on the EHR selection <ref name = HealthIT>http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref>
−	*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?	+	=== Decide what paths and vendors you need to obtain your EHR===
		+	*Create a checklist with functionalities that your selected EHR must have, is good to have, and must avoid.
		+	*Conduct wide screen to map EHRs that meet all or most of your anticipated functionalities and rank them from high to low.
		+	*Request advice from organizations that you know or have collaboration about the process of acquiring and implementing EHRs or find potential organizations that you can collaborate with. <ref name=" HRSA"> HRSA. (n.d.). Organizations Safety Net Providers Can Collaborate With. Retrieved September 24, 2015, from http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/collaborate/collaborate_3.html. </ref>
		+	*Contact or work with your local Health IT offices and regional extension centers for further information and advice.
−	*What are the vendors’ contingency plans if technical glitches occur, post implementation?	+	===  Check out possible vendors through current users ===
		+	*Find EHR using organizations in your local area or collaborators for their experience and comments.
		+	*Ask questions related to EHRs’ core functionality and relevant information, including but not limited to timeline, cost, impact on interruption of productivity, vendor additional charges or hidden charges, evaluation about return on investment, feedback from clinicians, staff, or other users. <ref name=" HRSA"> </ref>
−	*Is technical support offered by the vendor 24 hours per day/ 7 days a week?	+	=== Interview certified EHR vendors ===
		+	*Select 4-5 top ranked certified EHR vendors based on your investigation through your previous screening and inquires.
		+	*Set up phone interview for asking questions as suggested by HRSA website. <ref name=" HRSA"> </ref> For example, type of organization (for-profit or not-for-profit), history or duration in EHR business, other users in local area, costs for different phases and upgrades, and supports.
−	* 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?	+	=== Arrange for vendor demonstrations ===
		+	*Select 2-3 best candidates from previous selection for onsite demonstrations.
		+	*Set up an environment that can mimic a real situation for using selected EHRs in your organization that can test how well each EHR can meet the needs of your organization.
		+	*Test each EHR if it can integrate with other providers or data systems such as public health interface, billing system, drug post market surveillance, CDSSs, and CPOE.
		+	*Cybersecurity protection function.
		+	*Quality control and report function.
		+	*Electronic reporting capability.
		+
		+	===Common Vendor Selection Mistakes===
−	*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?	+	*Not Enough/Too Much Time
		+	*Not Enough Research
		+	*RFP is a Surprise / Poor Quality / Scoring Unclear
		+	*No Plan for Demos
		+	*Insufficient Due Diligence
		+	*Insufficient Education and Buy-In
		+	*No Rules of Engagement
		+	*Fool Me Once…
		+	*Entering Negotiations Alone, Naked, and Cold<ref name="Miller 2010">Miller,D. Best Practices in Software Vendor Selection http://www.slideshare.net/advantiv/cfakepathbest-practices-in-vendor-selection-advantiv </ref>
−	* When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?	+	=== EMR Selection Tips From A CCRC ===
−	*In "EMR Vendor Selection" on Health Technology Review.com (http://www.healthtechnologyreview.com/emr-vendor-selection.php) 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.	+	Retirement community service providers are generally not considered a priority when the government is considering the purchasing and use of electronic medical record (EMR) systems. While acknowledging the benefits that a new EMR system can bring to their facility, the Jewish Association on Aging (JAA) would like to point out four main challenges it faced with the implementation of the government mandated EMR.
		+	But first they mentioned the positive: the benefits. These benefits included improved reliability of data, improved workflow, and increased quality of life (QOL) for their residents. The JAA is a non-profit continuing care retirement community (CCRC).  The impact of the required, updated EMR systems can pose a greater threat to the existence of these non-profit, smaller patient care entities.
		+	This facility would like to share four main challenges which it encounters while trying to update to the new government regulations for EMR regulations.
		+	# The first of these challenges was the large burden of financial funding.  In order for the JAA to overcome this they first informed their board of directors about what the upcoming mandated changes encompassed, and they stressed the positive benefits of the new EMR implementation.  With the support of their board of directors, and grants from local foundations, they were able to meet the first challenge.
		+	# The second challenge was to ensure adequate information technology (IT) support for their project.  In order to do this, the JAA hired an IT project manager and an EMR nurse clinician to help develop their specific EMR infrastructure.
		+	# The JAA realized they had to upgrade the CCRC's hardware and networking system.  This was the third challenge they faced in order to implement the demands of a new EMR system.
		+	# The fourth challenge was actually selecting the appropriate system to meet their specific needs as a CCRC.  In order to do this, the JAA utilized an EMR selection tool by the Leading Age Center for Aging Services Technologies (CAST).  This was reported as a major influence in helping them select the appropriate EMR system to meet their specific needs.  They also contracted an outside consulting company to aid in the selection process.
−	* Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?	+	Once the JAA had narrowed their choices down to two possible software candidates, they used a five year total cost of ownership (TCO) to make their final decision.  The consulting company was able to present a comprehensive image of what the TCO would entail.  With this process, the JAA was able to choose the HealthMEDX EMR system.  They found HealthMEDX to have evidence of a proven and successful implementation record for their EMR system.<ref name="Bowers 2015"> Bowers, Lois A.(2015). Secrets to EMR selection: a CCRC shares implementation and selection tips. Long-Term Living; 64(2): 34-37. http://ca3cx5qj7w.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Secrets+to+EMR+success%3A+a+CCRC+shares+implementation+and+selection+tips&rft.jtitle=Long-Term+Living&rft.au=Bowers%2C+Lois+A&rft.date=2015-03-01&rft.pub=Vendome+Group+LLC&rft.issn=1940-9958&rft.eissn=2168-4561&rft.volume=64&rft.issue=2&rft.spage=34&rft.externalDBID=IOF&rft.externalDocID=410137947&paramdict=en-US</ref>
−	*Does the vendor have local support personnel or will all issues be handled by a distant team?	+	== Planning and Implementation Approach==
		+	[[Vendor Selection Criteria: Planning and Implementation Approach]]
−	* 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?	+	== Planning and Implementation Approach==
		+	[[Vendor Selection Criteria: Planning and Implementation Approach]]
−	=== Future Vision (5%) ===	+	== Core clinical features ==
		+	[[Vendor Selection Criteria: Core clinical features]]
−	* Compared 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	+	There are 8 "Core Clinical Functions" That EHRs should have. With these core features the EHR should be usable in any (NON-specialized) clinic
−	* 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.[http://www.ama-assn.org 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.[1]	+
−	* 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.	+
−	* 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?	+
−	=== Extra Credit (optional) ===	+	1. Health information and data
−	* 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?	+	2. Results management
−	* 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.	+
−	* 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.	+
−	* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?	+
−	* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?	+
−	* 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	+
−	*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?	+
−	* 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?	+
−	* Is the vendor capable of integrating it's system with a personal health record and allowing more patient control?	+
−	* Can the company provide return on investment analysis?	+
−	* 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.	+
−	* Reduced pharmaceutical costs derived from having information available at the time it is needed	+
−	* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?	+
−	* Will the vendor be readily available to conduct training for all shift and service line?	+
−	* How much extra financially will it be to train outpatient clinics that are subset of the system?	+
−	* Does the EHR system provide with data mining capabilities to support clinical research?	+
−	===Other Criteria===	+	3. Orders management
−	*'''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.	+
−	* '''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.	+	4. Decision support
−	* '''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.	+	5. Electronic communications and connectivity
−	=== EHR Evaluation Resources ===	+	6. Patient support
−	* 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]	+
−	* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf EHR Demonstration Rating Form]	+
−	* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]	+
−	* 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]	+
−	* www.purchasing-procurement-center.com/selecting-a-vendor.html	+
−	==References==	+	7. Administrative processes
−	RI Regional Extension Center. 2011. Vendor members and applicants. Retrieved from http://www.docehrtalk.org/selecting-ehr/for-vendors	+	8. Reporting and population health management  <ref name= "core">http://www.mmafoundation.org/portals/mmaf/HIT_Toolkit/Printpages/select3.pdf</ref>
		+
		+	== Personal Health Records ==
		+
		+	'''Personal Health Records''' is a vendor selection criteria important for patients in order to have access to personal information through [[Electronic Health Records|(EHR)]]. [[Personal health records |(PHR)]] is an electronic system designed and integrated into the EHR system for patients to maintain and manage their own health information.
		+	* PHR will improve health care cost
		+	* PHR will improve quality and efficiency
		+	* With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet.
		+	* Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal and for instance will able to track their lab results from the past years. <ref name= "hit">http://www.healthit.gov/providers-professionals/patient-participation</ref>
		+
		+	According to Phillips, et al (2015 ) '''Strategic Suggestions for PHR''' are to fully integrate EHR and PHR and "improve patient and population health". <ref name= "family medicine and phi">A family medicine health technology strategy for achieving the Triple Aim for US health care,http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/2638212, Phillips, R. L., Bazemore, A. W., & DeVoe, J. E. (2015). </ref>
		+	* A shared primary care health IT center will be necessary for control, privacy and security.
		+	* Meaningful primary care quality measures and capacity to assess/report them.
		+	* Increased primary care technology research: to advance and constantly improve health care to patients.
		+	* A national family medicine registry, every patient should have a primary care provider.
		+	* Enhancement of family physicians' technology leadership
		+	* Championing patient-centered technology functionality. Phillips, et al (2015) <ref name= "family medicine and phi"></ref>
		+
		+	== IT and technical requirements ==
		+	[[Vendor Selection Criteria: IT and technical requirements]]
		+
		+	== Usability ==
		+	[[Vendor Selection Criteria: Usability]]
		+
		+	Previous studies demonstrated how usability measurements can be applied to the evaluation of EHR systems; however, most of these studies were conducted post implementation. If significant problems have been discovered with usability, at this point in the system development
		+	life cycle it is usually too late to make any major modifications to the EHR system. Therefore, it is important to consider the usability criteria in early stages of the EHR implementation, and particularly during the process of vendor and product selection.  <ref name="Saiku"> I. Saiku. Including usability in the procurement process of healthcare IT Systems. <http://www.soberit.hut.fi/T-121/shared/thesis/di-Inkeri-Saiku.pdf</ref>
		+
		+	== Interoperability ==
		+	[[Vendor Selection Criteria:  Interoperability]]
		+
		+
		+
		+	== Future relationship with vendor ==
		+	[[Vendor Selection Criteria: Future relationship with vendor]]
		+
		+	Purchasing an EMR is a long-term decision with many hidden costs to consider.
		+
		+	== Certification and meaningful use ==
		+	[[Vendor Selection Criteria: Certification and meaningful use]]
		+
		+	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. One must be able to confirm whether an EHR system is HIE certified or not.<ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref> In addition, meaningful use should be assessed.<ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref>
		+
		+	==Why need vendor certification==
		+	#certification assures certain level of quality of EHR.
		+	#provides sustainability and support by vendor.
		+	# CCHIT <ref name="CCHIT">CCHIT website.http://www.cchit.org </ref>-Certification Commission for Healthcare Information Technology is one of the well known certification process in the market now.
		+	#The goals of CCHIT mentioned by Handel et. al are
		+	*Lower the risks of investment in new EHR
		+	*Assure compatibility of EHRs
		+	*With improved quality, providing incentives for EHR adoption.
		+	*Protect patient privacy
		+
		+	== Vendor assessment ==
		+	[[Vendor Selection Criteria: Vendor assessment]]
		+
		+	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.
		+	# Vendors that may operate under one name, but offer several acquired products, including some custom programs.
		+	# Vendors that have been acquired/sold/merged as a means to stay more competitive.
		+
		+	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> However, selection of a vendor also depends on the size of the organization, and the list of services they need. A larger health care organization might need more services, hence the vendor they select must offer multiple products.
		+
		+
		+
		+	Goals
		+
		+	The setting of goals is a critical component of the assessment of EHRs.  It is suggested that the goals should be according to the following format
		+
		+	Specific – Achieving the goal would make a difference for our patients and our organization.
		+
		+	Measurable – We can quantify the current level and the target goal.
		+
		+	Attainable – Although the goal may be a stretch, we can achieve it.
		+
		+	Relevant – The goal is worth the effort.
		+
		+	Time bound – There are deadlines and opportunities to celebrate success
		+
		+	These are referred to as the "SMART" Goals <ref>SMART http://www.healthit.gov/providers-professionals/faqs/what-types-goals-should-i-set-during-readiness-assessment-process</ref>
		+
		+	===Vendor assessment plan===
		+	When vendors have been short listed, the following type of analysis should be included in the assessment process.  Each vendor should be assessed in a structured process with a ranking of 1-7 for each vendor and criteria:
		+	*Functionality Analysis - clinical criteria, workflow processes and outcomes functionality are some of the features that could be the focus
		+	*CPR attributes assessment - the vendor's claims of their product's ability to fulfill the computer based patient record attributes and sub-attributes could cross-references and used to contractually bind the vendor to deliver the actual functionality
		+	*Technology assessment - stakeholders from the IT architecture department should rank the vendor and product against their list of technical criteria
		+	*Cost of ownership - while it may to difficult to assess across vendors for this, initial cost can be divided into capital and operating cost to make this more possible
		+	*vendor comparison analysis - structure cross vendor comparison analysis should be conducted by the decision team
		+	* Risk Analysis - the specific risk should be objectively analyzed
		+
		+	The selection team should assess the vendors with ranking against the various criteria as this ensures the team focus on objective analysis of each of the vendors.<ref name ="Herding Cats"> Herding Cats: The Challenges of EMR Vendor Selection http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats -Challenges_of_EMR_Vendor_Selection.pdf</ref>
		+
		+	== Go live support ==
		+	[[Vendor Selection Criteria: Go live support]]
		+
		+	== Evaluation post implementation ==
		+	[[Vendor Selection Criteria: Evaluation post implementation]]
		+
		+	== References ==
		+	<references/>

---

Latest revision as of 04:57, 3 October 2015

Choosing an 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 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.^[1]

Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. ^[2]

EHR Vendor Selection

Preliminary selection criteria for EHR vendors

According to McDowell, et.al (2003), the primary and vital step for choosing vendors is to narrow your selection from over 400 to as few as 4 vendors based on the following key requirements. ^[3]

• Is the EHR up-to-date with technology?

• Are the core clinical components fully integrated in the EHR?

• Are the applications available for inpatient, ambulatory, and outreach settings?

• Does the vendor have a proven record of financial stability and management reliability?

• Does the vendor have a well-established familiarity with large healthcare providers like academic medical centers and tertiary care hospitals?

• Does the vendor offer an "exit strategy" if they, for unknown reasons, are unable to continue to support your system

   --- Example will they allow you access to the source code---

Assess EHR Requirements

Before diving into specific attributes needed for an EHR system, the general requirements of the EHR must be decided. General requirement decisions may be needed for the following:^[4]

• Will the EHR be open source or off-the shelf commercial software?
• What EHR functions are needed, such as patient demographic and care management data on patient visits?
• What kind of clinical decision support and reports are critical, important, and desired but not essential?
• What type of consents, authorizations, and directives are needed?
• What interfaces are required to exchange health information with other providers, laboratories, pharmacies, patients, and government disease registries?
• What type and scope of training is expected?
  • What levels of training will be needed?
  • How many people need to be trained by the vendor?
• What availability for assistance will be necessary?
  • How much will be needed for how long?

Vendor Assessment

Vendor assessment should be performed systematically in order to meet the goals of the given institution: ^[5]

• Determine which EHR vendors are available in the locality.
• Compile a pre-screen questionnaire and survey for local vendors.
• Evaluate request for proposal (RFP) documents and provide vendors with details of any state-specific requirements.
• Assemble a list of pre-qualified vendors based on survey response and RFP.
• Provide a comprehensive request for information document to pre-qualified vendors.

Steps to conducting an EHR Assessment

• What is your facilities need for an EHR?
• What are your goals for the EHR?
• What could be the deal breakers
• Start narrowing the field on the EHR selection ^[6]

Decide what paths and vendors you need to obtain your EHR

• Create a checklist with functionalities that your selected EHR must have, is good to have, and must avoid.
• Conduct wide screen to map EHRs that meet all or most of your anticipated functionalities and rank them from high to low.
• Request advice from organizations that you know or have collaboration about the process of acquiring and implementing EHRs or find potential organizations that you can collaborate with. ^[7]
• Contact or work with your local Health IT offices and regional extension centers for further information and advice.

Check out possible vendors through current users

• Find EHR using organizations in your local area or collaborators for their experience and comments.
• Ask questions related to EHRs’ core functionality and relevant information, including but not limited to timeline, cost, impact on interruption of productivity, vendor additional charges or hidden charges, evaluation about return on investment, feedback from clinicians, staff, or other users. ^[7]

Interview certified EHR vendors

• Select 4-5 top ranked certified EHR vendors based on your investigation through your previous screening and inquires.
• Set up phone interview for asking questions as suggested by HRSA website. ^[7] For example, type of organization (for-profit or not-for-profit), history or duration in EHR business, other users in local area, costs for different phases and upgrades, and supports.

Arrange for vendor demonstrations

• Select 2-3 best candidates from previous selection for onsite demonstrations.
• Set up an environment that can mimic a real situation for using selected EHRs in your organization that can test how well each EHR can meet the needs of your organization.
• Test each EHR if it can integrate with other providers or data systems such as public health interface, billing system, drug post market surveillance, CDSSs, and CPOE.
• Cybersecurity protection function.
• Quality control and report function.
• Electronic reporting capability.

Common Vendor Selection Mistakes

• Not Enough/Too Much Time
• Not Enough Research
• RFP is a Surprise / Poor Quality / Scoring Unclear
• No Plan for Demos
• Insufficient Due Diligence
• Insufficient Education and Buy-In
• No Rules of Engagement
• Fool Me Once…
• Entering Negotiations Alone, Naked, and Cold^[8]

EMR Selection Tips From A CCRC

Retirement community service providers are generally not considered a priority when the government is considering the purchasing and use of electronic medical record (EMR) systems. While acknowledging the benefits that a new EMR system can bring to their facility, the Jewish Association on Aging (JAA) would like to point out four main challenges it faced with the implementation of the government mandated EMR. But first they mentioned the positive: the benefits. These benefits included improved reliability of data, improved workflow, and increased quality of life (QOL) for their residents. The JAA is a non-profit continuing care retirement community (CCRC). The impact of the required, updated EMR systems can pose a greater threat to the existence of these non-profit, smaller patient care entities. This facility would like to share four main challenges which it encounters while trying to update to the new government regulations for EMR regulations.

1. The first of these challenges was the large burden of financial funding. In order for the JAA to overcome this they first informed their board of directors about what the upcoming mandated changes encompassed, and they stressed the positive benefits of the new EMR implementation. With the support of their board of directors, and grants from local foundations, they were able to meet the first challenge.
2. The second challenge was to ensure adequate information technology (IT) support for their project. In order to do this, the JAA hired an IT project manager and an EMR nurse clinician to help develop their specific EMR infrastructure.
3. The JAA realized they had to upgrade the CCRC's hardware and networking system. This was the third challenge they faced in order to implement the demands of a new EMR system.
4. The fourth challenge was actually selecting the appropriate system to meet their specific needs as a CCRC. In order to do this, the JAA utilized an EMR selection tool by the Leading Age Center for Aging Services Technologies (CAST). This was reported as a major influence in helping them select the appropriate EMR system to meet their specific needs. They also contracted an outside consulting company to aid in the selection process.

Once the JAA had narrowed their choices down to two possible software candidates, they used a five year total cost of ownership (TCO) to make their final decision. The consulting company was able to present a comprehensive image of what the TCO would entail. With this process, the JAA was able to choose the HealthMEDX EMR system. They found HealthMEDX to have evidence of a proven and successful implementation record for their EMR system.^[9]

Planning and Implementation Approach

Vendor Selection Criteria: Planning and Implementation Approach

Planning and Implementation Approach

Vendor Selection Criteria: Planning and Implementation Approach

Core clinical features

Vendor Selection Criteria: Core clinical features

There are 8 "Core Clinical Functions" That EHRs should have. With these core features the EHR should be usable in any (NON-specialized) clinic

1. Health information and data

2. Results management

3. Orders management

4. Decision support

5. Electronic communications and connectivity

6. Patient support

7. Administrative processes

8. Reporting and population health management ^[10]

Personal Health Records

Personal Health Records is a vendor selection criteria important for patients in order to have access to personal information through (EHR). (PHR) is an electronic system designed and integrated into the EHR system for patients to maintain and manage their own health information.

• PHR will improve health care cost
• PHR will improve quality and efficiency
• With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet.
• Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal and for instance will able to track their lab results from the past years. ^[11]

According to Phillips, et al (2015 ) Strategic Suggestions for PHR are to fully integrate EHR and PHR and "improve patient and population health". ^[12]

• A shared primary care health IT center will be necessary for control, privacy and security.
• Meaningful primary care quality measures and capacity to assess/report them.
• Increased primary care technology research: to advance and constantly improve health care to patients.
• A national family medicine registry, every patient should have a primary care provider.
• Enhancement of family physicians' technology leadership
• Championing patient-centered technology functionality. Phillips, et al (2015) ^[12]

IT and technical requirements

Vendor Selection Criteria: IT and technical requirements

Usability

Vendor Selection Criteria: Usability

Previous studies demonstrated how usability measurements can be applied to the evaluation of EHR systems; however, most of these studies were conducted post implementation. If significant problems have been discovered with usability, at this point in the system development life cycle it is usually too late to make any major modifications to the EHR system. Therefore, it is important to consider the usability criteria in early stages of the EHR implementation, and particularly during the process of vendor and product selection. ^[13]

Interoperability

Vendor Selection Criteria: Interoperability

Future relationship with vendor

Vendor Selection Criteria: Future relationship with vendor

Purchasing an EMR is a long-term decision with many hidden costs to consider.

Certification and meaningful use

Vendor Selection Criteria: Certification and meaningful use

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. One must be able to confirm whether an EHR system is HIE certified or not.^[14] In addition, meaningful use should be assessed.^[15]

Why need vendor certification

1. certification assures certain level of quality of EHR.
2. provides sustainability and support by vendor.
3. CCHIT ^[16]-Certification Commission for Healthcare Information Technology is one of the well known certification process in the market now.
4. The goals of CCHIT mentioned by Handel et. al are

• Lower the risks of investment in new EHR
• Assure compatibility of EHRs
• With improved quality, providing incentives for EHR adoption.
• Protect patient privacy

Vendor assessment

Vendor Selection Criteria: Vendor assessment

Most vendors typically fall into one of the three categories:

1. Vendors that develop their own software organically on a single source code, one database, single instance.
2. Vendors that may operate under one name, but offer several acquired products, including some custom programs.
3. Vendors that have been acquired/sold/merged as a means to stay more competitive.

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.^[17] However, selection of a vendor also depends on the size of the organization, and the list of services they need. A larger health care organization might need more services, hence the vendor they select must offer multiple products.

Goals

The setting of goals is a critical component of the assessment of EHRs. It is suggested that the goals should be according to the following format

Specific – Achieving the goal would make a difference for our patients and our organization.

Measurable – We can quantify the current level and the target goal.

Attainable – Although the goal may be a stretch, we can achieve it.

Relevant – The goal is worth the effort.

Time bound – There are deadlines and opportunities to celebrate success

These are referred to as the "SMART" Goals ^[18]

Vendor assessment plan

When vendors have been short listed, the following type of analysis should be included in the assessment process. Each vendor should be assessed in a structured process with a ranking of 1-7 for each vendor and criteria:

• Functionality Analysis - clinical criteria, workflow processes and outcomes functionality are some of the features that could be the focus
• CPR attributes assessment - the vendor's claims of their product's ability to fulfill the computer based patient record attributes and sub-attributes could cross-references and used to contractually bind the vendor to deliver the actual functionality
• Technology assessment - stakeholders from the IT architecture department should rank the vendor and product against their list of technical criteria
• Cost of ownership - while it may to difficult to assess across vendors for this, initial cost can be divided into capital and operating cost to make this more possible
• vendor comparison analysis - structure cross vendor comparison analysis should be conducted by the decision team
• Risk Analysis - the specific risk should be objectively analyzed

The selection team should assess the vendors with ranking against the various criteria as this ensures the team focus on objective analysis of each of the vendors.^[19]

Go live support

Vendor Selection Criteria: Go live support

Evaluation post implementation

Vendor Selection Criteria: Evaluation post implementation

References

1. ↑ Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf
2. ↑ What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor
3. ↑ McDowell, et.al. (2003). Journal of Healthcare Information Management. Herding Cats: The Challenges of EMR Vendor Selection. http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats-Challenges_of_EMR_Vendor_Selection.pdf.
4. ↑ How to Select a Certified EHR. http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html
5. ↑ Chin, B. J., & Sakuda, C. M. (2012). Transforming and Improving Health Care through Meaningful Use of Health Information Technology. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347738/.
6. ↑ http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor
7. ↑ ^{7.0 7.1 7.2} HRSA. (n.d.). Organizations Safety Net Providers Can Collaborate With. Retrieved September 24, 2015, from http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/collaborate/collaborate_3.html.
8. ↑ Miller,D. Best Practices in Software Vendor Selection http://www.slideshare.net/advantiv/cfakepathbest-practices-in-vendor-selection-advantiv
9. ↑ Bowers, Lois A.(2015). Secrets to EMR selection: a CCRC shares implementation and selection tips. Long-Term Living; 64(2): 34-37. http://ca3cx5qj7w.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Secrets+to+EMR+success%3A+a+CCRC+shares+implementation+and+selection+tips&rft.jtitle=Long-Term+Living&rft.au=Bowers%2C+Lois+A&rft.date=2015-03-01&rft.pub=Vendome+Group+LLC&rft.issn=1940-9958&rft.eissn=2168-4561&rft.volume=64&rft.issue=2&rft.spage=34&rft.externalDBID=IOF&rft.externalDocID=410137947&paramdict=en-US
10. ↑ http://www.mmafoundation.org/portals/mmaf/HIT_Toolkit/Printpages/select3.pdf
11. ↑ http://www.healthit.gov/providers-professionals/patient-participation
12. ↑ ^{12.0 12.1} A family medicine health technology strategy for achieving the Triple Aim for US health care,http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/2638212, Phillips, R. L., Bazemore, A. W., & DeVoe, J. E. (2015).
13. ↑ I. Saiku. Including usability in the procurement process of healthcare IT Systems. <http://www.soberit.hut.fi/T-121/shared/thesis/di-Inkeri-Saiku.pdf
14. ↑ EHR/HIE: Interoperability http://interopwg.org/certification.html/
15. ↑ Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
16. ↑ CCHIT website.http://www.cchit.org
17. ↑ Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf
18. ↑ SMART http://www.healthit.gov/providers-professionals/faqs/what-types-goals-should-i-set-during-readiness-assessment-process
19. ↑ Herding Cats: The Challenges of EMR Vendor Selection http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats -Challenges_of_EMR_Vendor_Selection.pdf