Vendor Selection Criteria: IT and technical requirements

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IT and Technical Requirements

  • 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)?
  • How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?
  • Will technical support remain active even if the Hospital is running a non-upgraded system? For how long?
  • Does the system use 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?
  • How frequently does the vendor provide patch upgrades for the product?
  • Do the upgrades come with a fee?
  • Is the vendor’s application (system) platform independent?
  • Is the system using standards such as Snomed, ICD 10; HL7 Version 2 or 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?
  • 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, 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?
  • Does the system have a spell check tool for notes (progress notes, letters, and H&P notes)?
  • What are the data back up options available in case of natural calamity?
  • Is the EHR system compatible with other systems in the event of termination or vendor's insolvency? [1]
  • Are scanning capabilities available and if so, is there a particular scanner make and model required?
  • Are scanning licenses needed? How much are the scanning licenses and are they needed per user or per pc?

Legacy systems

  • How does the vendor compare in KLAS rankings of similar systems and applications?
  • 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?[2]
  • How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations?
  • 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?
  • 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 AMA Current Procedural Terminology (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?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? 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 certified Health IT products through the Office of the National Coordinator (ONC) for HIT. Previously CCHIT provided a list of certified EMR but as of late 2014 is no longer in operation.
  • What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization?
  • 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?
  • How is documentation managed and preserved over time? How is documentation protected from being altered, in all parts of the system including the underlying databases?[3]
  • Does the vendor retain, ensure availability, and destroy health record information according to organizational standards? For instance, retaining all EHR data and clinical documents for the time period designated by policy or legal requirement; retaining inbound documents as originally received (unaltered); ensuring availability of information for the legally prescribed period of time; and provide the ability to destroy EHR data/records in a systematic way according to policy and after the legally prescribed retention period.[4]

Troubleshooting

  • Immediate trouble shooting ability
  • Once the problem is identified, the first step is to ascertain the scope[5]
  • If the scope of outage is large and the root cause is unknown, raise alarm bells early[5]
  • Bring visibility to the process by having hourly updates,and multiple eyes on the problem[5]
  • Over communicate with the users[5]
  • Do not let pride get in the way[5]
  • It is important to set deadlines in the response plan[5]
  • The simplest explanation is usually the correct one[5]
  • 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).
  • The system shall include documented procedures for product installation, start-up and/or connection.
  • 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 quality of EHR technology be useful for electronic exchange of clinical health information among providers and patient authorized entities?

EHR Disaster Recovery

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:

  • Does the EHR use internal hosting or an ASP model? [6]
  • 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?
  • What happens when small private EHR vendors go out of business for any reason? Will you have a backup of the source code when that happens? Are we able to access that source code for our use?
  • Is off-site back-up and recovery supported in the event of a natural disaster or other catastrophic event?
  • Is training available for catastrophic event recovery?
  • What safeguards does the software have to warn users/administrator of an impending major failure?
  • Does the software monitor the hardware that it runs on?
  • Is there a technical relationship between the EHR/EMR vendor and hardware vendors?

Some of the criteria I will like to see in an EHR system in the event that it crashes or during downtime*****

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

Because healthcare providers rarely use the same EHR system integration between providers in a state or region is being addressed by healthcare information exchange (HIEs). Patients will often see different providers from different groups. An exchange that provides one of more standards methods for integrating with it means that a provider needs to integrate just once, to the exchange, rather than dozens of times.[7]

  • Does it meet the following connectivity standards: HL7, HL7 CDA, CCR, HL7 CCD, ELINCS and Vendor software specifications? [8]
  • How flexible is there connection framework? Can it negotiate multiple standards?
  • How quickly can you build and implement an interface within the interface engine?
  • Can our facility support the space needed for the installation and implementation of an EHR?
  • Make sure wireless connection is accessible in all parts of the hospital is your facility is planning to use portable devices (tablets, computers on wheels, etc.) to access the system.
  • Is there a cost to connecting the EMR/EHR to an HIE? [9]
  • Does the vendor meet the certification requirements to allow patient data to go from different EHRs to meet Meaningful Use? [10]
  • Does the system support C-CDA? Can the system accept, parse, and integrate a CDA document as well as create and export a CDA document as specified in C-CDA?


Mobile Devices

One of the most logical reasons to have an EHR System linked up to a mobile device, such as a cell phone, is for the convenience aspect. “According to a 2012 Vitera Healthcare survey, a reported 91 percent of physicians are interested in a mobile EHR access, along with 66 percent of practice administrators.” [11]

Advantages: [11]

  • Accessibility is the greatest advantage derived from being able to view patient data. A physician can view necessary patient records whether he/she is at the clinic or at home.
  • Clinical documents can be virtually updated from anywhere, speeding up the healthcare process. Medical personnel will be able to avoid the necessity of having to fax or scan documents.
  • Patient perception of a physician speaking to him/her from a desktop has been identified as negative. With a mobile device, this barrier is dropped and the patient can feel more in control speaking face-to-face and viewing results on a screen.
  • The small size of a cell phone enables a physician or home health worker to avoid the bulkiness of carrying a tablet. The only necessary tool when walking into a consultation will be the mobile device. Hand written notes and large electronic devices will be a thing of the past.

Disadvantages: [11]

  • Sensitive nature of Patient Health Information
  • Providers will have to look into providing Mobile Device Management (MDM) in order to have data stored safely.
  • Lost or stolen devices will need to have the ability of having information completely wiped from a remote location
  • The durability of a mobile device is a concern for hospitals and clinics if they are going to issue out devices to employees. Many mobile devices are very fragile and tend to have an average life span of 2-3 years.


Hardware

Most physician practices will need to upgrade existing hardware (computers and servers) in order to run the EHR. Typically the vendor will give the organization a “shopping list” for hardware so that the organization will purchase equipment that is compatible with the EHR. [12]

  • Will the new hardware include tablets, laptops, desktops, servers, routers, printers, and scanners? [13]

Desktops

Advantages:[14]

  • Desktops are low-cost and available from a wide variety of vendors.
  • Because desktop PCs are standardized, it is relatively easy and inexpensive to find spare parts and support, or to replace a machine.
  • Desktops will run just about any software you need.
  • Additional devices such as microphones, speakers, and headsets are readily available at low cost.

Disadvantages:[14]

  • Because it's stationary, you need to buy a desktop PC for each room in which you need access to your EHR software.
  • Desktops typically take up more space than a laptop or tablet PC. While flat screen monitors and tower units save actual desktop space, the standard desktop computer requires more room than either a laptop or tablet PC.
  • You must purchase additional equipment to take full advantage of voice recognition and/or handwriting recognition programs.

Laptops

Advantages:[14]

  • A laptop has a smaller footprint and can easily be turned to allow patients to view information on the screen.
  • A laptop is less obtrusive during patient interviews.
  • Most have fairly long battery life and/or an A/C adaptor.
  • Laptops use standard PC inputs such as keyboard and mouse and/or touchpad.

Disadvantages:[14]

  • Although laptops are portable, they can be heavy to carry, typically weighing five to eight pounds.
  • Repairs and maintenance tend to be more expensive because laptops use non-standard or proprietary parts. You may have to send a laptop off-site for diagnosis and repair.

Tablet PCs

Advantages:[14]

  • Tablets are truly portable and lightweight, typically weighing three to four pounds.
  • It is as powerful as a PC, but it doesn't require a keyboard. Instead, you add information by writing on the screen with a digital pen or stylus, much like you do in a paper chart.
  • Handwriting recognition software developed for tablet PCs is excellent, even for very poor handwriting.
  • Tablet PCs have integrated dictation capability with voice recognition software that transcribes directly into the patient record.

Disadvantages:[14]

  • Writing with a stylus takes getting used to; there is a longer learning curve in adapting to a new way of using a computer.
  • Handwriting recognition dictionaries have not yet fully integrated medical terminology and acronyms, requiring more correction.
  • There is not as much standardized software yet available for tablets.
  • Screens are easily scratched and can become unusable without screen protectors purchased at additional cost.
  • Some EHRs/EMRs require a higher/lower resolution than others and won't work on a tablet. ex: Amazing Charts (AC) will not work on the Surface Pro 2 but will work on a Surface Pro 3.
  • Some EHRs/EMRs can work on a tablet but licenses/support will cost more. ex: To use Amazing Charts on an iPad will require the clinic to purchase their "Cloud Based" package. It is slightly more expensive since AC will host the data vs hosting the EMR on a server built by the clinic or hospital. Amazing charts charges $39 a month in addition to license and support fees, per user for their "cloud." When a clinic or hospital hosts AC on their own server, they only pay the license and annual support fees. [15]

Software

  • Identify and budget for required systems changes
    • Software changes
    • Increased system storage capacity
  • Know if the necessary upgrades are covered by current vendor contracts
  • Identify for what upgrade costs the practice will be responsible [16]

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References

  1. Neal, D. (2011). Choosing an Electronic Health Records System: Professional Liability Considerations. Innovations in Clinical Neuroscience, 8(6), pg. 45.
  2. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf
  3. Understanding Features & Functions of an EHR.http://www.aafp.org/practice-management/health-it/product/features-functions.html
  4. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 http://www.kevinmd.com/blog/2010/09/10-tips-troubleshooting-complex-ehr-infrastructure-problems.html
  5. EHR and Disaster Recovery. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=6469
  6. Healthcare Electronic Records Technology and Government Funding:Improving Patient Care.http://www.myemrstimulus.com/tag/ehr-application/
  7. What is Your EHR Connectivity Strategy? http://www.corepointhealth.com/sites/default/files/whitepapers/emr-connectivity-strategy-healthcare-interoperability.pdf
  8. How to implement EHRs? http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr
  9. How to connect Health Information Exchange (HIE) with Electronic Medical Records.http://www.practicefusion.com/blog/how-to-connect-health-information/
  10. 11.0 11.1 11.2 Mobile EHR Access http://www.hitechanswers.net/mobile-ehr-access-healthcares-next-big-thing/
  11. HEY, WHO DID THIS?Note: there needs to be something here
  12. How do I plan for hardware purchases? http://www.healthit.gov/providers-professionals/faqs/EHR-infrastructure-investment.
  13. 14.0 14.1 14.2 14.3 14.4 14.5 www.aafp.org/practice-management/health-it/product/hardware.html
  14. No Servers to set up. No software to install. http://amazingcharts.com/products/web-based-ehr/
  15. Is your practice ready? 5010 and ICD-10 vendor questions and guidelines. 20143. http://www.mgma.com/government-affairs/issues-overview/health-information-technology/icd-10/5010-and-icd-10-vendor-questions-and-guidelines