Difference between revisions of "Vendor Selection Criteria"

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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>
 
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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==EHR Vendor Selection==
  
=== Dr. Sittig's Overview of EMR Vendor Selection ===
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===Preliminary selection criteria for EHR vendors===
#Make The Plan
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##Identify Decision makers
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#Set Goals
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##Make a Checklist of what should the EMR accomplish
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##Map your Workflow
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##Do a thorough Scan of your environment
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#Prioritize needs
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##Make EHR Functionality Checklist
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#Develop a Request For Proposal (RFP)
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#Select RFP recipients
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##For example up to 5 vendors
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#Narrow the field
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##EHR Evaluation Form
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#EHR Vendor Demonstrations
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#Narrow the field
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##For example up to 3 vendors
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##Ask additional questions to vendors
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#Check references
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##Examples: consulting KLAS, Gartner etc
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#Rank the vendors
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##Functionality vs cost vs vendor characteristics
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###functionality can be the institution's most important function
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###cost can include the total amount from hardware, software, training, and support
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###vendor characteristics can be important traits that are aligned with the institution's core values <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref>
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##Vendor selection tools
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#Site visits
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#Select a finalist (between the last 2 competitors)
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#Verify Commitment
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##Determine approval of selection committees and discuss choice will all the key stakeholders.
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##If possible repeat the Demo to all the staffs
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##For uncovered concerns, verify all the references and repeat verification steps if necessary
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#Formal Contract Negotiation
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##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation
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##Ask vendor to put source code in escrow just in case Vendor go out of business
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##Before signing the software contracts,make sure you have familiar attorney to review
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#Follow all the above process
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##Know that the process takes time and do not rush because the end result can be expensive.
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##Follow the process without skipping any steps.
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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>
  
== Core clinical features ==
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*Is the EHR up-to-date with technology?
[[Vendor Selection Criteria: Core clinical features]]
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== IT and technical requirements ==
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*Are the core clinical components fully integrated in the EHR?
[[Vendor Selection Criteria: IT and technical requirements]]
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== Vendor Selection Criteria: Future relationship with vendor ==
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*Are the applications available for inpatient, ambulatory, and outreach settings?
[[Vendor Selection Criteria: Future relationship with vendor]]
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== Vendor Selection Criteria: Certification and meaningful use ==
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*Does the vendor have a proven record of financial stability and management reliability?
[[Vendor Selection Criteria: Certification and meaningful use]]
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== Vendor Selection Criteria: Vendor assessment ==
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*Does the vendor have a well-established familiarity with large healthcare providers like academic medical centers and tertiary care hospitals?
[[Vendor Selection Criteria: Vendor assessment]]
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== Go live support ==
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*Does the vendor offer an "exit strategy" if they, for unknown reasons, are unable to continue to support your system
[[Vendor Selection Criteria: Go live support]]
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    --- Example will they allow you access to the source code---
  
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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>
  
== Regional Selection Center EHR Selection Criteria ==
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*Will the EHR be open source or off-the shelf commercial software?
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*What EHR functions are needed, such as patient demographic and care management data on patient visits?
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*What kind of clinical decision support and reports are critical, important, and desired but not essential?
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*What type of consents, authorizations, and directives are needed?
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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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*What type and scope of training is expected?
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**What levels of training will be needed?
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**How many people need to be trained by the vendor?
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*What availability for assistance will be necessary?
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**How much will be needed for how long?
  
The Regional Selection Center suggests that medical practices compare EHR vendors using the following criteria before selecting a specific product. <ref name="RSC EHR Selection Criteria">Selecting or Upgrading to a Certified EHR.
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'''Vendor Assessment'''
http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref>
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*Will the vendor’s product accomplish key practice goals?
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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>
*Clarify EHR system start-up prices before selecting a vendor including costs associated with hardware, software, maintenance and upgrades, phase  payment options, lab and pharmacy interfaces, connection to health information exchange, and customized quality reports.  
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*What implementation support does the vendor offer?
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*What are the costs, roles, and responsibilities associate with the data migration strategy?
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*What are your sever options?
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*What is the products ability to integrate with other products?
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*What are the privacy and security capabilities of the product and what is the back-up plan?
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*How does the product link payments with EHR incentive rewards, which are necessary to meet the practices EHR implementation goals and milestones?
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*What is the vendor’s stability and market presence?
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*What is the cost to link the product to HIE?
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*What are the costs associated with legal counsel for contract review versus open sources through medical associations?
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== Basic EHR Criteria ==
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*Determine which EHR vendors are available in the locality.
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*Compile a pre-screen questionnaire and survey for local vendors.
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*Evaluate request for proposal (RFP) documents and provide vendors with details of any state-specific requirements.
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*Assemble a list of pre-qualified vendors based on survey response and RFP.
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*Provide a comprehensive request for information document to pre-qualified vendors.
  
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]
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'''Steps to conducting an EHR Assessment'''
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]
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*What is your facilities need for an EHR?
* Meaningful use reporting
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*What are your goals for the EHR?
**Stage 1 (2011-2012) Data Capture and Sharing
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*What could be the deal breakers
**Stage 2 (2014) Advance Clinical Processes
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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>
**Stage 3 (2016) Improved Outcomes
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* Ability to generate county, state, and federal reports
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* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]
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* Support Secure Sockets (SSL) digital certificate
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* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.
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http://www.hitecla.org/ehr_selection_tips</ref>
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== Analyzing EHR Business Requirements ==
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=== Decide what paths and vendors you need to obtain your EHR===
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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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*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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*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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*Contact or work with your local Health IT offices and regional extension centers for further information and advice.
  
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:
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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.
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*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>
  
* Assemble an Evaluation Team
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=== Interview certified EHR vendors ===
* Define the Product, Material or Service
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*Select 4-5 top ranked certified EHR vendors based on your investigation through your previous screening and inquires.
* Define the Technical and Business Requirements
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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.
* Define the Vendor Requirements
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* Publish a Requirements Document for Approval
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=== Arrange for vendor demonstrations ===
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*Select 2-3 best candidates from previous selection for onsite demonstrations.
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*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.
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*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. 
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*Cybersecurity protection function.
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*Quality control and report function.
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*Electronic reporting capability.
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===Common Vendor Selection Mistakes===
  
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*Not Enough/Too Much Time
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*Not Enough Research
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*RFP is a Surprise / Poor Quality / Scoring Unclear
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*No Plan for Demos
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*Insufficient Due Diligence
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*Insufficient Education and Buy-In
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*No Rules of Engagement
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*Fool Me Once…
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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>
  
== Product Requirements ==
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=== EMR Selection Tips From A CCRC ===
  
* Is the EHR system HIE certified? The organization might need an EHR system that meets the national interoperability standards; a system with the capability of transferring health information within and across organizational and state boundaries. Implementing an HIE certified system will eliminate the need to create a custom interface in the future that may be very costly to the organization. An HIE certified system will "reduce adoption barriers due to high interface costs, low reliability, and unknown development costs for the vendor". <ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref>
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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.
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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.
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This facility would like to share four main challenges which it encounters while trying to update to the new government regulations for EMR regulations.
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# 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.
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# 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.
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# 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.
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# 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.
  
* Does the EHR package come with a fully integrated Computer Practitioner Order Entry (CPOE) system?
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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>
* If you are a large academic teaching hospital, does the EHR meet the special It requirements? Specifically, does the EHR accommodate the numerous handoffs in care that are the result of resident education and regulatory requirements?<ref name="Kannry"> Kannry, J, Mukani, S & K Myers. Using an Evidence-based
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Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital, Journal of Healthcare Information Management — Vol. 20, No. 2</ref>
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* An EMR at an academic medical center must be evaluated on its ability to conduct large-scale research with data capture and retrieval, as well as attaining regulatory compliance regarding billing.<ref name="Kannry"> </ref>
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== Planning and Implementation Approach==
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[[Vendor Selection Criteria: Planning and Implementation Approach]]
  
=== Clinical Process Assessment and Improvement ===
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== Planning and Implementation Approach==
*The EMR vendor, in response to requirements defined in the [[Request for Proposal|request for proposal (RFP)]], should describe a plan for evaluation and assessment of the as-is clinical processes and workflows, identification of needed improvements and a proposal for implementing workflow optimizations necessary to launch the EMR. <ref name=”McDowell2003”>McDowell, S. W., Wahl, R., & Michelson, J. (2003). Herding cats: the challenges of EMR vendor selection. Journal of healthcare information management, 17(3), 63-71.</ref>
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[[Vendor Selection Criteria: Planning and Implementation Approach]]
  
==New Non Traditional Approach Overview==
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== Core clinical features ==
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[[Vendor Selection Criteria: Core clinical features]]
  
New adaptive methods to be considered regarding the successful HIT (Healthcare Information Technology) implementation:
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There are 8 "Core Clinical Functions" That EHRs should have. With these core features the EHR should be usable in any (NON-specialized) clinic
R.T.Blake et al., did an interesting case study about The Christ Hospital which underwent a world class successful HIT implementation.
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The Christ Hospital (TCH) is 555 bed nonprofit acute care hospital in Cincinnati, Ohio. It has successfully implemented HIT by firmly focusing to the goals set and following a strategic yet non-traditional methods in every area, and was exceptionally exemplary in collaboration with the different stakeholders.
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For more information on The Christ Hospital visit their website. <ref name="The Christ">The Christ Hospital http://www.thechristhospital.com/</ref>
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There are many adoptable methods for Healthcare Organizations (HCO) to be learnt from TCH HIT Implementation.
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*Stakeholder analysis
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*[[Formal Request for Proposal (RFP) vs Non Request for Proposal (Non RPF)]]
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*Separate vendors for each identified core IT implementation areas
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*Transparency in communication with stakeholders for collaboration
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* Personalization of HIT
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===Stakeholder Analysis===
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1. Health information and data
  
It is important to recognize the role of key Healthcare Organizations (HCO) Stakeholders.<ref name="Blake">Blake, R.T., Massey, A.P., Bala, H., Cummings,J., Zotos,A. (2010).Driving health IT implementation success: Insights from The Christ Hospital.53(2),131-138 http://www.sciencedirect.com/science/article/pii/S0007681309001530/</ref>
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2. Results management
Stakeholders in healthcare can be broadly divided into internal and external.
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Internal stakeholders consist mainly of physicians, nurse, hospital administrators while external comprise of IT providers, vendors, and consultants.
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Physicians and nurses have direct contact with patient, more so nurses with monitoring, administering medications and discharge/after care services. There are many healthcare workers under the supervision of registered or licensed practical nurses.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care.Hospital administrators have often challenging workforce, hospital missions, complex regulatory and day- to day operations which target directly or indirectly quality of patient care. <ref name="Blake"></ref>
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3. Orders management
  
===Separate vendors for each identified core IT implementation areas===
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4. Decision support
Identification of core areas which are in dire need of HIT have to be recognized before the HIT implementation. And each area identified should be supervised by a different vendor.This can best be adopted in time bound projects and could prove cost effective.<ref name="Blake"></ref>
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===Personalization of HIT===
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5. Electronic communications and connectivity
  
For the smooth work flow which is primarily patient centered, the HIT should focus on the user friendly for physicians and nurses who can handle them with ease, so they contribute to the successful patient’s outcomes.<ref name="Blake"></ref>
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6. Patient support
  
===Transparency in communication with stakeholders for collaboration===
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7. Administrative processes
  
This is essential as there are various stakeholders involved, always giving scope for power struggles and may fail the implementation as well as integration and may eventually face resistance from end users.Enterprise governance with good leader even from non IT can work successfully if utilized from the start. Also, this will enable the focus on patient care rather than technology.Starting from vendor selection to discuss with them, the criteria upon which they were selected and capability to contribute as per needs, also prior feedback from end users, all stakeholders perspectives and opinions before, during and  after implementation can build a strong interpersonal relationships  with primary target of patient centered care environment.<ref name="Blake"></ref>
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8. Reporting and population health management <ref name= "core">http://www.mmafoundation.org/portals/mmaf/HIT_Toolkit/Printpages/select3.pdf</ref>
  
The ability to have an openness for the reporting of problems in a particular level to the advisory committee/ any  which can resolve them within hours rather than dragging them for days and weeks. These problems with solutions can be circulated among all the stakeholders.<ref name="Blake"></ref>
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== Personal Health Records ==
  
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'''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.
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* PHR will improve health care cost
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* PHR will improve quality and efficiency
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* 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.
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* 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>
  
== Research Functionality ==
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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>
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* A shared primary care health IT center will be necessary for control, privacy and security.
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* Meaningful primary care quality measures and capacity to assess/report them.
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* Increased primary care technology research: to advance and constantly improve health care to patients.
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* A national family medicine registry, every patient should have a primary care provider.
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* Enhancement of family physicians' technology leadership
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* Championing patient-centered technology functionality. Phillips, et al (2015) <ref name= "family medicine and phi"></ref>
  
* Does the vendor bid include the product's ability to be used as a tool for research.  If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="Kannry"> </ref>
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== IT and technical requirements ==
* Does the EMR have informed consent alerts and documentation systems for clinical research?
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[[Vendor Selection Criteria: IT and technical requirements]]
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?
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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? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref>
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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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== Usability ==
* 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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[[Vendor Selection Criteria: Usability]]
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:
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#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged.
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#Literature search:
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** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.
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** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.
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=== Patient Quality Improvement ===
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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
* 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.
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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>
* 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 ?
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* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?
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* Are vendor-provided and supported order sets available?
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* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?
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* 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?
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* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?
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* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?
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* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.
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* 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?
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=== Public Health Research ===
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== Interoperability ==
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?
+
[[Vendor Selection Criteria:  Interoperability]]
* 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
+
  
  
== Cost and Budget ==
 
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.
 
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> 
 
  
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref>
+
== Future relationship with vendor ==
 +
[[Vendor Selection Criteria: Future relationship with vendor]]
  
 +
Purchasing an EMR is a long-term decision with many hidden costs to consider.
  
 +
== Certification and meaningful use ==
 +
[[Vendor Selection Criteria: Certification and meaningful use]]
  
 +
Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. One must be able to confirm whether an EHR system is HIE certified or not.<ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref> In addition, meaningful use should be assessed.<ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref>
  
 +
==Why need vendor certification==
 +
#certification assures certain level of quality of EHR.
 +
#provides sustainability and support by vendor.
 +
# CCHIT <ref name="CCHIT">CCHIT website.http://www.cchit.org </ref>-Certification Commission for Healthcare Information Technology is one of the well known certification process in the market now.
 +
#The goals of CCHIT mentioned by Handel et. al are
 +
*Lower the risks of investment in new EHR
 +
*Assure compatibility of EHRs
 +
*With improved quality, providing incentives for EHR adoption.
 +
*Protect patient privacy
  
== Misc considerations ==
+
== Vendor assessment ==
 +
[[Vendor Selection Criteria: Vendor assessment]]
  
* 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?
+
Most vendors typically fall into one of the three categories:
* 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 vendor 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"></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>
+
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref>
+
  
*'''Attend Demonstrations with a rating form''' this will help you write down the important parts of what you '''DID''' and '''DID NOT''' like and help you make the best EHR decision for your practice. Sales people are awesome and so are the demonstrators but it's important to stay focused on what will work for you.<ref name="adler,k.">HEY, WHO DID THIS? Note: there needs to be something here</ref>
+
# Vendors that develop their own software organically on a single source code, one database, single instance.
 +
# Vendors that may operate under one name, but offer several acquired products, including some custom programs.
 +
# Vendors that have been acquired/sold/merged as a means to stay more competitive.
  
 +
The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref> However, selection of a vendor also depends on the size of the organization, and the list of services they need. A larger health care organization might need more services, hence the vendor they select must offer multiple products.
  
=== Hospital Inpatient Quality Reporting Program (IQR)===
 
  
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.
 
  
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.
+
Goals
  
=== Physician Quality Reporting System (PQRS) ===
+
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
  
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).
+
Specific – Achieving the goal would make a difference for our patients and our organization.
+
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref>
+
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.
+
  
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:
+
Measurable – We can quantify the current level and the target goal.
  
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li>
+
Attainable – Although the goal may be a stretch, we can achieve it.
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li>
+
  
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.
+
Relevant – The goal is worth the effort.
  
== EHR Evaluation Resources ==
+
Time bound – There are deadlines and opportunities to celebrate success
 +
 
 +
These are referred to as the "SMART" Goals <ref>SMART http://www.healthit.gov/providers-professionals/faqs/what-types-goals-should-i-set-during-readiness-assessment-process</ref>
 +
 
 +
===Vendor assessment plan===
 +
When vendors have been short listed, the following type of analysis should be included in the assessment process.  Each vendor should be assessed in a structured process with a ranking of 1-7 for each vendor and criteria:
 +
*Functionality Analysis - clinical criteria, workflow processes and outcomes functionality are some of the features that could be the focus
 +
*CPR attributes assessment - the vendor's claims of their product's ability to fulfill the computer based patient record attributes and sub-attributes could cross-references and used to contractually bind the vendor to deliver the actual functionality
 +
*Technology assessment - stakeholders from the IT architecture department should rank the vendor and product against their list of technical criteria
 +
*Cost of ownership - while it may to difficult to assess across vendors for this, initial cost can be divided into capital and operating cost to make this more possible
 +
*vendor comparison analysis - structure cross vendor comparison analysis should be conducted by the decision team
 +
* Risk Analysis - the specific risk should be objectively analyzed
 +
 
 +
The selection team should assess the vendors with ranking against the various criteria as this ensures the team focus on objective analysis of each of the vendors.<ref name ="Herding Cats"> Herding Cats: The Challenges of EMR Vendor Selection http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats -Challenges_of_EMR_Vendor_Selection.pdf</ref>
 +
 
 +
== Go live support ==
 +
[[Vendor Selection Criteria: Go live support]]
  
* 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]
+
== Evaluation post implementation ==
* 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]
+
[[Vendor Selection Criteria: Evaluation post implementation]]
* 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>
+
*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]
+
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement <ref name="himss-ama-pms"> </ref>
+
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration </ref>
+
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]
+
  
 
== 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