Difference between revisions of "Vendor Selection Criteria"

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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>
 
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>
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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"></ref>
 
  
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== Core Clinical Features ==
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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>
  
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In 2003, the DHHS asked the IOM to provide guidance on the basic functionalities of electronic health records systems.  The committee concluded that the core functionalities should address the following areas:
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==EHR Vendor Selection==
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* Improvement of patient safety
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* Support delivery of effective patient care
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* Facilitate management of chronic conditions
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* Improve efficiency
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* Feasibility of implementation and
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* Integration of hospital services
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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. (8) 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 worng 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.
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Based on these areas, the IOM committee identified eight categories of core functionalities, including: <ref name="johnson 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>
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===Preliminary selection criteria for EHR vendors===
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* Health information and data
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* Results management
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* [[CPOE|Order entry/management]]
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* [[CDS|Decision support]]
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* Electronic communication and connectivity
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* Patient support; administrative processes
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* Reporting and population health management
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== Analyzing Business(EHR) requirements ==
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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>
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* Assemble an Evaluation Team
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The Evaluation team or decision Team should consist of clinicl healthcare professionals including house staff, tech support professionals, administrators, and financers from all areas of the institution.  Each person brings to the table a differnt perspective of usage from their daily job responsibilites. Insitution-wide involvement creates awareness and knowledge of EMRs and their benefits. AS well as, an understanding of the upcoming modifications in work flows.  
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* Define the Product, Material or Service
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* Define the Technical and Business Requirements
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* Define the Vendor Requirements
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* Publish a Requirements Document for Approval
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=== EMR software ===
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*Is the EHR up-to-date with technology?
  
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* Health Information & Data Management (Demographics, Problem list [CC, Conditions, Acute/Chronic, Worsening/Resolving, Injuries, Present Illness] with [[ICD|ICD-9 or ICD-10 numbering]], Procedures, Diagnoses, Medications, Allergies, Family medical history, Consultations,  Signs & Symptoms and Vitals, Progress Notes and Discharge Summaries, Appointments/Admissions/Visits, Advance Directives, Clinical Reminders [Immunizations, Screenings, Risks])
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*Are the core clinical components fully integrated in the EHR?
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** 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.
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*  Is the Software configuration flexible to customize for future needs.
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*  Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)
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** Review and search results easily by sorting test types, test time, test administers, test results and so on
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** Choose one or several test types, such as HGB, and/or WBC, and/or blood sugar and chart on their results for showing trends.
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*  The proposed EMR software should bring minimal to no new limitations to the institution.  Selectors must be certain that the EMR system meets all required operational tasks.
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*  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?
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*  Ensure that the EMR software is tested prior to finalizing the vendor contract.
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*  Proposed EHR should allow for expandability to mobile devices, mobile medical applications and upcoming mobile technology.
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* Does the EHR have integrated practice management to avoid having to interface with a 3rd part practice management system?<ref name"himss-ama-pms">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref>
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* Does the software provide a tool for workflow mapping/charting?
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* Can the software be easily configured/adapted to changing workflows?
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* 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.)
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=== Privacy and Security ===
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*Are the applications available for inpatient, ambulatory, and outreach settings?
  
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* Does the system provide roadmaps for adherence to organizational policies (such as HIPAA)?
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*Does the vendor have a proven record of financial stability and management reliability?
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* 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.[1]
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* 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.
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* Will the system allow staff administrators to create and manage users and [[Data security|user security profiles]]?
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* 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. [1]
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* 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.
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* How well does the EMR work with antivirus, antispyware and other security software?
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* 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>
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* 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?
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=== CPOE ===
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*Does the vendor have a well-established familiarity with large healthcare providers like academic medical centers and tertiary care hospitals?
  
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* [[CPOE| Computerized Physician Order Entry (CPOE)]], [[Electronic prescribing| e-Prescribing]]
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*Does the vendor offer an "exit strategy" if they, for unknown reasons, are unable to continue to support your system
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* 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.
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    --- Example will they allow you access to the source code---
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* 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>.
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* 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>.
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* 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.
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* 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>.
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=== Clinical decision support (CDS) ===
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===Assess EHR Requirements===
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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>
  
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* [[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)
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*Will the EHR be open source or off-the shelf commercial software?
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* Formulary Database Support
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*What EHR functions are needed, such as patient demographic and care management data on patient visits?
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*  Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)
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*What kind of clinical decision support and reports are critical, important, and desired but not essential?
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*  Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)
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*What type of consents, authorizations, and directives are needed?
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* Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)
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*What interfaces are required to exchange health information with other providers, laboratories, pharmacies, patients, and government disease registries?
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* Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.
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*What type and scope of training is expected?
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*  [[PHR|Patient Portal for online personal health record access]]
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**What levels of training will be needed?
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*  Clinical policies and procedures guidelines
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**How many people need to be trained by the vendor?
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*  Produce visit summary and complete medical record printout and data export on demand for patient use.
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*What availability for assistance will be necessary?
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* 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 [2]. 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 [2].
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**How much will be needed for how long?
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** 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.
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** 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.
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* 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>.
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*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>.
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* 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?
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=== Data storage and retrieval ===
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'''Vendor Assessment'''
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*  EHR systems should be capable of capturing, storing, indexing, retrieving and displaying externally created documents [2]. Indexing of captured documents should include not only patient identifiers and descriptive information, but also date/time stamps and document type [2].
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*  EHR systems should be capable of retaining all system data until such data is archived or intentionally purged from the system [2].
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*  The system should load patient records in a timely manner to not interrupt workflow.
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*  This system should present chronological data of patients like medicine history, progress of diseases.
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*  Also, system provides gene information or drug allergies of patients to avoid [[Adverse drug event|ADE]].
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*  System should be compatible with old system to reduce re-entry time.
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*  System should update regularly.
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*  system should be able to have Patient prescription plan eligibility, prescription product formulary and external medication history.
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*  System should be able to have insurance retrieval capabilities (i.e. insurance firms, sum insured, premium dues, etc.).[11]
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* Capability to integrate with other products such as practice management software, billing systems and public health interfaces.
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=== Other Clinical Functionality  ===
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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>
  
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* Does the system promote delivery of safe care?
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*Determine which EHR vendors are available in the locality.
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* 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]
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*Compile a pre-screen questionnaire and survey for local vendors.
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* Can the system identify the chronic disease management subgroups?
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*Evaluate request for proposal (RFP) documents and provide vendors with details of any state-specific requirements.
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* Is the EHR scalable to different medical specialties and practice demographics (i.e., Neurology vs. Cardiology, small satellite practice vs. intensive care unit)
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*Assemble a list of pre-qualified vendors based on survey response and RFP.
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* Can the system support future clinical models (i.e., Medical Home)?
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*Provide a comprehensive request for information document to pre-qualified vendors.
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* 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?
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* Does the EMR have the capability to display data over time graphically, such as growth charts?
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* The system shall provide the ability to query for a patient by more than one form of identification
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* 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?
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* Does the EHR store the identity of the user and associate the ID with the additions or changes made to the system?
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* Can the EHR system be used to capture clinical trial data? How the clinical trial specific data is managed?
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* Does the EHR system have the ability to import and export data (interact) in a standard format to EHR systems from other vendors?
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*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>.
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* Does the vendor’s product provide the key functionality needed to achieve the organization vision?
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* 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?
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* How does the system import data from personal health devices?
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* Can patient data be directly imported from patient portals or [[PHR|personal health records]]?
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* Does the vendor provide an EHR system that can be integrated with and is interoperable with other systems?
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* Can the vendor provide an EHR system with standard terminology that is cross platform with other EHR systems?
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* Does the vendor provide safe log in for patients and clients?
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* Does the EMR could provide appropriate information on screen without cramming too much information?
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* 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?
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=== Nursing Functionality ===
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'''Steps to conducting an EHR Assessment'''
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# Supporting eMAR: supporting real-time electronic medication administration record and bar code medication administration technology [http://www.ncbi.nlm.nih.gov/pubmed/20445181[Link to reference]]
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*What is your facilities need for an EHR?
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# Supporting bedside automation in medication delivery: Support data interface and real-time monitoring of smart pumps and home infusion pumps [http://www.ncbi.nlm.nih.gov/pubmed/15753744[Link to reference]]
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*What are your goals for the EHR?
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=== Pharmacy operation ===
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*What could be the deal breakers
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====Formulary management====
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*Start narrowing the field on the EHR selection <ref name = HealthIT>http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref>
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# Data repository for formulary information, maintain real time update of medication information with national drug information database
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# Support periodic update of formulary, restricted formulary, and nonformulary medications
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# Cross reference patient’s insurance formulary list to allow for generic medications to be selected when e-prescribing.
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====Drug dispense and delivery====
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=== Decide what paths and vendors you need to obtain your EHR===
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# Support outpatient pharmacy operation functionality:
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*Create a checklist with functionalities that your selected EHR must have, is good to have, and must avoid.
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## Maintain outpatient prescription data
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*Conduct wide screen to map EHRs that meet all or most of your anticipated functionalities and rank them from high to low.
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## Management of prescription fill, refill and dispense activities
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*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>
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## Support billing protocols with governmental and private insurance
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*Contact or work with your local Health IT offices and regional extension centers for further information and advice.
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# Support inpatient pharmacy operation functionality
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## Maintain inpatient medication ordering data
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## Real-time monitoring of IV and oral medication compounding and delivery
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## Support real-time data interface with automatic dispensing cabinet
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== Research Functionality ==
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=== Check out possible vendors through current users ===
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*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>
  
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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 2006">Kannry J 2006: 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>
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=== Interview certified EHR vendors ===
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* Does the EMR have informed consent alerts and documentation systems for clinical research?
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*Select 4-5 top ranked certified EHR vendors based on your investigation through your previous screening and inquires.
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* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?
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*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.
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* How is research achieved?
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* How are reports produced?
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* How is data exported from the production system?
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* Which database is used for reporting? For research?  Vendor or other?
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* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?
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* Support for research billing including research orders (6)
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* Does the EHR system provide data mining capabilities to support clinical research?
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** Are there limits on the fields that researchers can use?
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** How difficult is it to interface with the database?
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** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.
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** Does the vendor assist in research endeavors, or is it left up to the institution?
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* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? [9]
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* 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?
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* Does the EMR system provide functionality to identify clinical related concepts?
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* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?
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* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose?
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* 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 
+
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.</ref>
+
  
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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>
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=== Arrange for vendor demonstrations ===
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* 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>
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*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.
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*Quality control and report function.
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*Electronic reporting capability.
 +
 
 +
===Common Vendor Selection Mistakes===
  
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=== Meaningful use gap analysis ===
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*Not Enough/Too Much Time
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* The ONC’s Regional Extension Centers (RECs), located in every region of the country, serve as a support and resource center to assist providers in EHR implementation and HealthIT needs. As trusted advisors, RECs “bridge the technology gap” by helping providers navigate the EHR adoption process from vendor selection and workflow analysis to implementation and meaningful use. <ref name="regional extension center">Regional Extension Centers (RECs) http://www.healthit.gov/providers-professionals/regional-extension-centers-recs </ref>
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*Not Enough Research
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* Does the system provide relevant reports for data for compliance with meaningful use of the EHR.[11]
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*RFP is a Surprise / Poor Quality / Scoring Unclear
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* Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/Home.aspx)
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*No Plan for Demos
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*Does the vendor support data documentation and capture of future government mandated measures such as Meaningful Use, ACO measures, CMS measures for Patient Quality, population health etc?
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*Insufficient Due Diligence
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* Make sure the vendor's product is able to document the [[meaningful use]] <ref name="factors selecting vendor"></ref>
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*Insufficient Education and Buy-In
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* Is the EMR CCHIT Certified?
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*No Rules of Engagement
−
* Is there a way for the organization to monitor the usage of EMR components?
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*Fool Me Once…
−
* Will the EMR user potentially qualify for the [[ARRA|American Recovery Health and Reinvestment Act]] or [[ARRA|Health Information Technology for Economic & Clinical Health Act]] funding opportunities?
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*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>
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* Be certain that the organization has a way to transfer pertinent data from the current EMR to proposed EMR.  Create a plan that is not only financially safe, but also allows the organization enough time for implementation.
+
−
* Does the vendor provide training and resources specific to Meaningful Use compliance?
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* Does the vendor provide any consulting services to assist with workflow modifications and attestation for Meaningful Use?
+
  
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******Will the EHR help the hospital to meet the following requirement of Meaningful Use:
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=== EMR Selection Tips From A CCRC ===
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1. Use CPOE for medication, laboratory, radiology ordering by licensed professionals
+
−
2. Automatically track medications from order to administration using assistive technologies such as bar coding in conjunction with an electronic medication administration record (eMAR)
+
−
3. Generate and transmit permissible prescriptions electronically (eRX)
+
−
4. Protect electronic health information created or maintained by the CEHRT through the implementation of appropriate technical capabilities.
+
−
5. Implement drug-drug, drug-allergy checking.
+
−
6. Maintain up-to-date problem/diagnosis list.
+
−
7. E-Prescribing
+
−
8. Maintain active medication list and medication allergy list
+
−
9. Record demographics: Gender, Race, Date of Birth, Ethnicity, Preferred Language
+
−
10. Record and chart changes in vital signs: Height, Weight, Blood Pressure, Calculate and Display, BMI, Plot and display growth charts for children 2-20 years, including BMI
+
  
−
=== Patient quality improvement ===
+
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.
−
* 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.
+
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.
−
* 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 ?
+
This facility would like to share four main challenges which it encounters while trying to update to the new government regulations for EMR regulations.
−
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?
+
# 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.
−
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?
+
# 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.
−
* 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?
+
# 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.
−
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?
+
# 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.
−
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?
+
−
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.
+
−
* 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?
+
  
−
=== Public Health research ===
+
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 support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?
+
−
* 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)?
+
−
* 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?
+
−
* Does the vendor have the ability to report to the State, CDC Registry and external sources
+
  
−
== IT and Technical Requirements ==
+
== Planning and Implementation Approach==
 +
[[Vendor Selection Criteria: Planning and Implementation Approach]]
  
−
* 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)?
+
== Planning and Implementation Approach==
−
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?
+
[[Vendor Selection Criteria: Planning and Implementation Approach]]
−
* 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?
+
−
* Does the system provide an imaging database or allow customized program attachments of imaging needs of specific departments in the hospital?
+
−
* What are the hardware requirements? [1]
+
−
* 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)
+
−
* Is the software capable of using biometric data for rapid login by providers who are mobile between patients/sites?
+
−
* 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?
+
−
* Can the system allow login remotely – off site transcription or home or other clinic?
+
−
* 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?
+
−
* 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?
+
−
* How often does the software need to be upgraded? [1]
+
−
* 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 this web-access or a dedicated app?
+
−
** In what way is this mobile access limited?  Does it have access to all functionality?
+
−
** What devices can access the mobile apps? (e.g. iPad, iPhone, Android, etc.)
+
−
* 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.
+
−
* Does the system support web-based working environment?
+
−
* Does the system provide extension package or software for IT engineers or users?
+
−
* Does the system comply with HIMMS standard?
+
−
* Can the system be installed on Windows or IOS operating systems?
+
−
* 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?
+
−
* What hardware technology (Server) does the database support? And does the supported hardware provide built-in high availability?
+
−
* Does the system’s application (not database) support virtual environments? Will it run on a virtual server?
+
−
* Is your ticketing system capable of interfacing with [name of ITSM software utilized by your institution]?
+
−
* 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.
+
−
* Can the system be hosted and supported remotely by the vendor? 
+
−
* 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)
+
−
* Does the system support dictation function?
+
−
* Does the system support speech recognition?
+
  
−
=== Legacy systems ===
+
== Core clinical features ==
 +
[[Vendor Selection Criteria: Core clinical features]]
  
−
* How does the vendor compare in [http://www.klasresearch.com/ KLAS] rankings of similar systems and applications?
+
There are 8 "Core Clinical Functions" That EHRs should have. With these core features the EHR should be usable in any (NON-specialized) clinic
−
* How will legacy patient record data be integrated into the new system?
+
−
* 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>
+
−
* 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)
+
−
*Make sure the vendors give accurate information for the Request for Proposal. So the stakeholders can make informed decisions on the comparison of vendors.
+
−
-Zoker 9/17/2011
+
−
* 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)
+
−
* 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)
+
−
* 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?
+
  
−
=== Troubleshooting ===
+
1. Health information and data
  
−
* Immediate trouble shooting ability.
+
2. Results management
−
* Regular connect with customers about their problems
+
−
* 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]
+
−
* 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)
+
−
* Is implementation of the new EHR system going to be in stages or at once based on the size and complexity of the purchasing institution?
+
  
−
=== EHR Disaster Recovery ===
+
3. Orders management
  
−
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:
+
4. Decision support
−
+
−
* 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>
+
−
* 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?
+
−
* Has the EHR provided users with a detailed disaster plan during implementation of the EHR that includes how to cope with unexpected system failure?
+
−
* Has the EHR provided training packets and educational materials for end users to study to prepare for unscheduled downtime of the EHR?
+
−
* 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?
+
  
−
**** Some of the criteria I will like to see in an EHR system in the event that it crashes or during downtime*****
+
5. Electronic communications and connectivity
−
1. What backup system does it have in place during such an event so that patient care continues without reverting to a paper system?
+
−
2. How is data updated into the system when it is back up and running again?
+
−
3. Where is the data stored so that in the event of a catastrophic crash historical data is not lost?
+
  
−
=== Health information exchange, connectivity, and standards ===
+
6. Patient support
  
−
* 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>
+
7. Administrative processes
−
* How flexible is there connection framework?  Can it negotiate multiple standards?
+
−
* How quickly can you build and implement an interface within the interface engine?
+
  
−
== Implementation ==
+
8. Reporting and population health management  <ref name= "core">http://www.mmafoundation.org/portals/mmaf/HIT_Toolkit/Printpages/select3.pdf</ref>
  
−
* 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.
+
== Personal Health Records ==
−
* 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. [13]
+
  
−
=== Configuration ===
+
'''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.
−
* Does the vendor factor the number of users as part of their implementation cost?
+
* PHR will improve health care 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?
+
* PHR will improve quality and efficiency
−
* 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? 
+
* 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.
−
*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.
+
* 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>
−
•Does the TCO include lifecycle costs that include milestone payment scheduling to back up promises made by EHR implementation? [8]
+
−
* 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?
+
  
−
=== Training of users ===
+
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>
−
* How many hours of initial training is provided for administrators? For users?
+
* A shared primary care health IT center will be necessary for control, privacy and security.  
−
* When is the initial training provided, during or after implementation?
+
* Meaningful primary care quality measures and capacity to assess/report them.
−
* How large a virtual environment will be required to provide training for staff, and how much time should be allocated.
+
* Increased primary care technology research: to advance and constantly improve health care to patients.  
−
* What are the time requirements to train the trainers?
+
* A national family medicine registry, every patient should have a primary care provider.  
−
* Is the initial training included in the costs of the tool?
+
* Enhancement of family physicians' technology leadership
−
* If additional training is required post-implementation, how is it priced – lump sum or hourly rate?
+
* Championing patient-centered technology functionality. Phillips, et al (2015) <ref name= "family medicine and phi"></ref>
−
* 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? (http://www.americanehr.com/Home.aspx)
+
−
* 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 informatic 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) (http://www.americanehr.com/Home.aspx)
+
−
* 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?
+
−
* 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.
+
  
 +
== IT and technical requirements ==
 +
[[Vendor Selection Criteria: IT and technical requirements]]
  
 +
== Usability ==
 +
[[Vendor Selection Criteria: Usability]]
  
−
'''* 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)Bold text'''== Future relationships: vendor partnership ==
+
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>
  
−
* 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.
+
== Interoperability ==
−
*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 Selection Criteria: Interoperability]]
−
*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.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.
+
−
* 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.Bold text'''=== Upgrades ===
 
  
−
* 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?
 
−
* 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.[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?
 
−
* 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. (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)
 
−
*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?
 
  
−
== Contracts ==
+
== Future relationship with vendor ==
 +
[[Vendor Selection Criteria: Future relationship with vendor]]
  
−
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>
+
Purchasing an EMR is a long-term decision with many hidden costs to consider.
  
−
* Project Payments
+
== Certification and meaningful use ==
−
* Contract Terms [http://calhipso.org/documents/ehr_contracting_terms_final_508_compliant.pdf]
+
[[Vendor Selection Criteria: Certification and meaningful use]]
−
* 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.(8)
+
−
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.
+
−
* 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
+
−
* IT support agreement
+
−
* Training Contract
+
−
* 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). <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>
+
−
* 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.<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>
+
  
−
=== Check Vendor References ===
+
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>
  
−
*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.
+
==Why need vendor certification==
−
* Vendor provided references may be considered 'happy customers' with biased viewpoints.
+
#certification assures certain level of quality of EHR.
−
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?
+
#provides sustainability and support by 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
+
# 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.
−
* 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.
+
#The goals of CCHIT mentioned by Handel et. al are
−
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.
+
*Lower the risks of investment in new EHR
−
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint
+
*Assure compatibility of EHRs
−
* Must use list serves, internet searches and networking to identify other users to interview to get more objective viewpoint.
+
*With improved quality, providing incentives for EHR adoption.
−
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.
+
*Protect patient privacy
−
* Notes must be recorded by each interviewer for each customer interviewed.
+
−
* These notes should be made part of the overall evaluation process, ideally kept by the project manager [7].
+
−
* Is the vendor currently involved in or have a history of any litigation with customers?<ref name="himss-ama-litigation">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref>
+
  
−
=== Transparency ===
+
== Vendor assessment ==
 +
[[Vendor Selection Criteria: Vendor assessment]]
  
−
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:
+
Most vendors typically fall into one of the three categories:
  
−
* 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.
+
# 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.
  
−
*Disclosure of information that has been independently developed by the disclosing party
+
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.
−
+
−
*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement.  
+
  
−
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>
 
  
−
== Misc considerations ==
 
  
−
* 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?
+
Goals
−
* 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 its 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?
+
−
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?
+
−
* Does the vender return loss money if their system can not complete established goal in scheduled time?
+
−
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?
+
−
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?
+
−
* 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>
+
−
* 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>
+
−
* Will the vendor be supporting the organization's desired implementation strategy?
+
−
* Check the track record of vendor for operations and maintenance support?
+
−
* Will the vendor sell or monetize of our clinical data for research or any other purposes? 
+
−
* Is Application Support provided by on-shore resources? 
+
−
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref>
+
−
* Does the Vendor demonstrate financial and management stability?
+
−
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?
+
−
* Conduct a site visit <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>
+
−
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting
+
−
*'''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.
+
−
* '''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.
+
−
* 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>
+
  
−
== EHR Evaluation Resources ==
+
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
  
−
* 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]
+
Specific – Achieving the goal would make a difference for our patients and our organization.
−
* 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
+
−
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]
+
−
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]
+
−
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]
+
−
* 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
+
−
* 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>
+
  
 +
Measurable – We can quantify the current level and the target goal.
  
−
*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]
+
Attainable – Although the goal may be a stretch, we can achieve it.
−
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement<ref name"AMA-HIMSS-15Questions">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref>
+
  
−
'''Select/upgrade to a certified electronic health record vendor
+
Relevant – The goal is worth the effort.
−
Retrieved from http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr
+
−
text'''==References (old, to edit) ==
+
  
−
# RI Regional Extension Center. 2011. Vendor members and applicants. Retrieved from http://www.docehrtalk.org/selecting-ehr/for-vendors
+
Time bound – There are deadlines and opportunities to celebrate success
−
# The Certification Commission for Healthcare Information Technology (CCHIT). CCHIT Certified 2011 Ambulatory EHR Certification Criteria. May 17, 2011. Available at: https://www.cchit.org/documents/18/158304/CCHIT+Certified+2011+Ambulatory+EHR+Criteria.pdf.
+
 
−
#http://mhcc.dhmh.maryland.gov/hit/ehr/Documents/sp.mhcc.maryland.gov/ehr/cmsdemo/februarycmsehrdemonstrationarticle.pdf
+
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>
−
#McDowell SW, Wahl R, Michelson J. Herding Cats: The Challenges of EMR Vendor Selection. Journal of Healthcare Information Management. 2003; 17(3):17.
+
 
−
# Weber, M. (January 2008). "Selecting an EHR, Now What????" wwww.healthconsultingstrategies.com
+
===Vendor assessment plan===
−
# Eastaugh, S. R. (2013). Electronic Health Records Lifecycle Cost. J Health Care Finance, 39(4), 36-43.
+
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:
−
# http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/
+
*Functionality Analysis - clinical criteria, workflow processes and outcomes functionality are some of the features that could be the focus
−
# Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23(42), 1-4.
+
*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
−
# Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24
+
*Technology assessment - stakeholders from the IT architecture department should rank the vendor and product against their list of technical criteria
−
# Hoyt, R. (2014). Health Informatics: Practical Guide for Healthcare and Information Technology Professionals. Informatics Education
+
*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 ==
 
<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
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