Difference between revisions of "Vendor Selection Criteria"

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−	== Example Vendor Evaluation Criteria ==	+	Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref>
−		+
−	=== Demonstrate Clinical Functionality (25%) ===	+	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>
−	* How well is the vendor able to demonstrate the clinical functionality required by [your organization]?	+	==EHR Vendor Selection==
−	* Is the software flexible enough to meet our current needs and allow for future changes?	+
−	* Can a demonstration of the software successfully handle a scenario you have prepared?	+
−	* Does the software have functions of supporting clinical decisions?	+
−	* Does the software have functions of assisting nurses in documentations?	+
−	* Is the vendor able to create interfaces for physicians' office EMRs to allow viewing and sharing of clinical, financial (insurance) and other data?	+
−	* How easily and quickly can the embedded clinical decision support be modified when new published guidelines or evidence-based medicine studies are published? Will they be responsible for these updates (and at what cost) or will that be our responsibility?	+
−	* Is the vendor software compliant with the Certification Commission of Healthcare Information Technology (CCHIT) criteria?	+
−	* Can the company categorize users according to their characteristic and provide user-centered usability design? Old physicians usually have vision problem and do not like to use keyboard.	+
−	* Can the company provide different levels of decision support based on user working experience? For resident, attending physician, the decision support should be different.	+
−	* What capabilities does the application provide for patients with psychiatric, psychological, or severe behavioral disorders?	+
−	* If your organization's mission includes clinical research, does the software include decision support and data query function sto support research?	+
−	* Can the medical records be easily transferred to another clinic with patient approval?	+
−	* With what other HIT software systems have you established successful interfaces? (organization may use a variety of systems for BCMA, clinical documentation, laboratory data, business functions that need to have data interchange)	+
−	* What capability does the application demonstrate to produce information for patient education?	+
−	* Does the system provide capability for patient portals (web access)?	+
−	* What wireless functions has the system supported?	+
−	* Does the system satisfy security requirements (access control and logging)?	+
−	* Does the system provide configurable workflow options?	+
−	* Does the system provide integration options with other service providers’ systems (hospitals, insurance companies, labs, …)	+
−	=== Acquisition and Implementation Cost (25%) ===	+	===Preliminary selection criteria for EHR vendors===
−	* What is the total financial investment required to acquire and fully implement the proposed solution?  Break out costs for the following and detail any time or resource constraints for each item. If additional resources or time are required, what are the additional costs per unit?	+	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>
−	** Application	+
−	** Per-user licenses (and tier pricing, if offered)	+
−	** Database (if treated as a separate item)	+
−	** Application documentation	+
−	** Annual maintenance agreement	+
−	** Training	+
−	*** End-user	+
−	*** System administrators	+
−	*** In-house developers	+
−	** Professional services:	+
−	*** Project management	+
−	*** Software development or customizations	+
−	*** Technical support	+
−	* What is the estimated time that it will take for the investment of the vendor to pay for itself based on projected savings?	+
−	=== Hardware Platform and Technical Requirements (20%) ===	+	*Is the EHR up-to-date with technology?
−	*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation	+	*Are the core clinical components fully integrated in the EHR?
−	* How well is the vendor able to meet our technical requirements ?	+	*Are the applications available for inpatient, ambulatory, and outreach settings?
−	* How flexible is the vendor to change requirements and what are the cost?	+
−	* How hard is to implement new modules within the system?	+
−	* How well is the vendor able to create and maintain interfaces to our existing systems?	+
−	* How well is the vendor able to migrate our data from actual system to the new, if it is neccesary?	+
−	* Is the vendors's software created with the most adequate developing technology? Platform? Language? Databases?	+
−	* Will we do periodic updates, or will the vendor do this as part of the contract? How often are they released?	+
−	* Do we plan on-site or remote hosting for the system?	+
−	* If we plan to utilize remote hosting, how safe, sound, and accessible are these data?	+
−	* Is the hardware user friendly in all departments? (i.e. nursing, pharmacy, pulmonary,..etc.)	+
−	* Will the vendor provide a mock system for testing?	+
−	* What is the responding duration of each entry and information extraction? Is there any delay?	+
−	* How the data structure for storing data? Is it expandable? Is it easy to be extracted for future analysis?	+
−	*How often does the system need to be updated or serviced?	+
−	*As the technology is changing and the hospital decides to upgrade their hardware, will your system be able to handles these changes or will we have to buy a new program?	+
−	=== Implementability (15%) ===	+	*Does the vendor have a proven record of financial stability and management reliability?
−	* How much time, effort, and resources will be required to successfully implement?	+	*Does the vendor have a well-established familiarity with large healthcare providers like academic medical centers and tertiary care hospitals?
−	* What is the vendors track record for successfully implementing its system in similar settings?	+
−	* Do the vendors provide detailed plan for implementation, training and quality control?	+
−	* Will the vendor supply on site support when we "go-live" and how long will they be available?	+
−	* Do they have a backup or alternative plan if the system or partial of the system is not working? The situation could be out of energy or computer virus attack.	+
−	* How long is the training that is required for each subgroup to fully implement the system?	+
−	* What are the training requirements for the vendor? For the clinic/hospital?	+
−	* What is the vendor's track record for successfully training a new system for your clinic/hospital size?	+
−	* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?	+
−	* Will the implementation require a consulting "team" and how much will this cost?	+
−	* Is the vendor sufficiently well known that most health care consulting firms have familiarity with the system?	+
−	=== Vendor Partnership and On-going viability (10%) ===	+	*Does the vendor offer an "exit strategy" if they, for unknown reasons, are unable to continue to support your system
−	*Create a list of vendor selection criteria, and evaluate the vendors and software: review responses to the RFP; schedule demonstrations; check references; and, use proven tools/templates for assessing and consistently comparing vendors.	+	--- Example will they allow you access to the source code---
−	*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and, prepare a Request for Proposals (RFP).	+	===Assess EHR Requirements===
		+	Before diving into specific attributes needed for an EHR system, the general requirements of the EHR must be decided. General requirement decisions may be needed for the following:<ref name = HRSA HIT Vendor Select>How to Select a Certified EHR. http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref>
−	* What type of long-term relationship do we think we can expect from the vendor?	+	*Will the EHR be open source or off-the shelf commercial software?
−	* How stable vs risky is the company?	+	*What EHR functions are needed, such as patient demographic and care management data on patient visits?
−	** Request that the software source code be put in escrow with specific provisions established under which it could be accessed.	+	*What kind of clinical decision support and reports are critical, important, and desired but not essential?
−	** How long has the company been in business?	+	*What type of consents, authorizations, and directives are needed?
−	** How large is the company?	+	*What interfaces are required to exchange health information with other providers, laboratories, pharmacies, patients, and government disease registries?
−	*** How much money did they bring in last quarter? year? 3-years?	+	*What type and scope of training is expected?
−	*** Are they a private or a public company?	+	**What levels of training will be needed?
−	*** How many employees?	+	**How many people need to be trained by the vendor?
−	* How many contracts have they should to Health Care Systems like yours?	+	*What availability for assistance will be necessary?
−	** Can you contact and/or visit a few representative samples?	+	**How much will be needed for how long?
−	* How many new contracts have they signed in the past year?	+
−	* How many uninstall's have been done the last year?	+
−	* Does word of mouth support that the company believes in service after the sale?	+
−	* What is the vendor's cost per year after implementation?	+
−	* How the vendor provides technical support? On site or remote? Package or individual project based?	+
−	* What provisions exist in the contract for termination and/or penalties if the application does not perform as specified or if the vendor fails to provide any services that are agreed to?	+
−	** Ensure that all application specifications that can be measured or quantified are incorporated into the contract.	+
−	** Ensure that all services verbally offered by the vendor are incorporated into the contract.	+
−	** Does the vendor have service level agreements (SLAs) with appropriate penalties for technical support of the application?	+
−	=== Future Vision (5%) ===	+	'''Vendor Assessment'''
−	* What is the vendor's five-year strategic plan?	+	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>
−	* What percentage of revenue is being re-invested into R&D?	+
−	* How does the company capture/communicate client concerns for re-engineering? i.e. Is this a learning company?	+
−	* What "game changers" are on the drawing board?  Are these related to one of our organization's core goals?	+
−	*Compared retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation	+	*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 <ref name = HealthIT>http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref>
−	=== Extra Credit (optional) ===	+	=== Decide what paths and vendors you need to obtain your EHR===
		+	*Create a checklist with functionalities that your selected EHR must have, is good to have, and must avoid.
		+	*Conduct wide screen to map EHRs that meet all or most of your anticipated functionalities and rank them from high to low.
		+	*Request advice from organizations that you know or have collaboration about the process of acquiring and implementing EHRs or find potential organizations that you can collaborate with. <ref name=" HRSA"> HRSA. (n.d.). Organizations Safety Net Providers Can Collaborate With. Retrieved September 24, 2015, from http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/collaborate/collaborate_3.html. </ref>
		+	*Contact or work with your local Health IT offices and regional extension centers for further information and advice.
−	* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?	+	===  Check out possible vendors through current users ===
−	* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?	+	*Find EHR using organizations in your local area or collaborators for their experience and comments.
−	* 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	+	*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>
−	*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?	+
−	[[Category:EMR]]	+	=== Interview certified EHR vendors ===
		+	*Select 4-5 top ranked certified EHR vendors based on your investigation through your previous screening and inquires.
		+	*Set up phone interview for asking questions as suggested by HRSA website. <ref name=" HRSA"> </ref> For example, type of organization (for-profit or not-for-profit), history or duration in EHR business, other users in local area, costs for different phases and upgrades, and supports.
		+
		+	=== 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<ref name="Miller 2010">Miller,D. Best Practices in Software Vendor Selection http://www.slideshare.net/advantiv/cfakepathbest-practices-in-vendor-selection-advantiv </ref>
		+
		+	=== 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.
		+	# The first of these challenges was the large burden of financial funding.  In order for the JAA to overcome this they first informed their board of directors about what the upcoming mandated changes encompassed, and they stressed the positive benefits of the new EMR implementation.  With the support of their board of directors, and grants from local foundations, they were able to meet the first challenge.
		+	# The second challenge was to ensure adequate information technology (IT) support for their project.  In order to do this, the JAA hired an IT project manager and an EMR nurse clinician to help develop their specific EMR infrastructure.
		+	# The JAA realized they had to upgrade the CCRC's hardware and networking system.  This was the third challenge they faced in order to implement the demands of a new EMR system.
		+	# The fourth challenge was actually selecting the appropriate system to meet their specific needs as a CCRC.  In order to do this, the JAA utilized an EMR selection tool by the Leading Age Center for Aging Services Technologies (CAST).  This was reported as a major influence in helping them select the appropriate EMR system to meet their specific needs.  They also contracted an outside consulting company to aid in the selection process.
		+
		+	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>
		+
		+	== 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  <ref name= "core">http://www.mmafoundation.org/portals/mmaf/HIT_Toolkit/Printpages/select3.pdf</ref>
		+
		+	== Personal Health Records ==
		+
		+	'''Personal Health Records''' is a vendor selection criteria important for patients in order to have access to personal information through [[Electronic Health Records|(EHR)]]. [[Personal health records |(PHR)]] is an electronic system designed and integrated into the EHR system for patients to maintain and manage their own health information.
		+	* PHR will improve health care cost
		+	* PHR will improve quality and efficiency
		+	* With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet.
		+	* Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal and for instance will able to track their lab results from the past years. <ref name= "hit">http://www.healthit.gov/providers-professionals/patient-participation</ref>
		+
		+	According to Phillips, et al (2015 ) '''Strategic Suggestions for PHR''' are to fully integrate EHR and PHR and "improve patient and population health". <ref name= "family medicine and phi">A family medicine health technology strategy for achieving the Triple Aim for US health care,http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/2638212, Phillips, R. L., Bazemore, A. W., & DeVoe, J. E. (2015). </ref>
		+	* A shared primary care health IT center will be necessary for control, privacy and security.
		+	* Meaningful primary care quality measures and capacity to assess/report them.
		+	* Increased primary care technology research: to advance and constantly improve health care to patients.
		+	* A national family medicine registry, every patient should have a primary care provider.
		+	* Enhancement of family physicians' technology leadership
		+	* Championing patient-centered technology functionality. Phillips, et al (2015) <ref name= "family medicine and phi"></ref>
		+
		+	== IT and technical requirements ==
		+	[[Vendor Selection Criteria: IT and technical requirements]]
		+
		+	== Usability ==
		+	[[Vendor Selection Criteria: Usability]]
		+
		+	Previous studies demonstrated how usability measurements can be applied to the evaluation of EHR systems; however, most of these studies were conducted post implementation. If significant problems have been discovered with usability, at this point in the system development
		+	life cycle it is usually too late to make any major modifications to the EHR system. Therefore, it is important to consider the usability criteria in early stages of the EHR implementation, and particularly during the process of vendor and product selection.  <ref name="Saiku"> I. Saiku. Including usability in the procurement process of healthcare IT Systems. <http://www.soberit.hut.fi/T-121/shared/thesis/di-Inkeri-Saiku.pdf</ref>
		+
		+	== Interoperability ==
		+	[[Vendor Selection Criteria:  Interoperability]]
		+
		+
		+
		+	== Future relationship with vendor ==
		+	[[Vendor Selection Criteria: Future relationship with vendor]]
		+
		+	Purchasing an EMR is a long-term decision with many hidden costs to consider.
		+
		+	== Certification and meaningful use ==
		+	[[Vendor Selection Criteria: Certification and meaningful use]]
		+
		+	Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. One must be able to confirm whether an EHR system is HIE certified or not.<ref name="EHR/HIE Interoperability Workgroup">EHR/HIE: Interoperability http://interopwg.org/certification.html/</ref> In addition, meaningful use should be assessed.<ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref>
		+
		+	==Why need vendor certification==
		+	#certification assures certain level of quality of EHR.
		+	#provides sustainability and support by vendor.
		+	# CCHIT <ref name="CCHIT">CCHIT website.http://www.cchit.org </ref>-Certification Commission for Healthcare Information Technology is one of the well known certification process in the market now.
		+	#The goals of CCHIT mentioned by Handel et. al are
		+	*Lower the risks of investment in new EHR
		+	*Assure compatibility of EHRs
		+	*With improved quality, providing incentives for EHR adoption.
		+	*Protect patient privacy
		+
		+	== Vendor assessment ==
		+	[[Vendor Selection Criteria: Vendor assessment]]
		+
		+	Most vendors typically fall into one of the three categories:
		+
		+	# Vendors that develop their own software organically on a single source code, one database, single instance.
		+	# Vendors that may operate under one name, but offer several acquired products, including some custom programs.
		+	# Vendors that have been acquired/sold/merged as a means to stay more competitive.
		+
		+	The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.<ref>Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf</ref> However, selection of a vendor also depends on the size of the organization, and the list of services they need. A larger health care organization might need more services, hence the vendor they select must offer multiple products.
		+
		+
		+
		+	Goals
		+
		+	The setting of goals is a critical component of the assessment of EHRs.  It is suggested that the goals should be according to the following format
		+
		+	Specific – Achieving the goal would make a difference for our patients and our organization.
		+
		+	Measurable – We can quantify the current level and the target goal.
		+
		+	Attainable – Although the goal may be a stretch, we can achieve it.
		+
		+	Relevant – The goal is worth the effort.
		+
		+	Time bound – There are deadlines and opportunities to celebrate success
		+
		+	These are referred to as the "SMART" Goals <ref>SMART http://www.healthit.gov/providers-professionals/faqs/what-types-goals-should-i-set-during-readiness-assessment-process</ref>
		+
		+	===Vendor assessment plan===
		+	When vendors have been short listed, the following type of analysis should be included in the assessment process.  Each vendor should be assessed in a structured process with a ranking of 1-7 for each vendor and criteria:
		+	*Functionality Analysis - clinical criteria, workflow processes and outcomes functionality are some of the features that could be the focus
		+	*CPR attributes assessment - the vendor's claims of their product's ability to fulfill the computer based patient record attributes and sub-attributes could cross-references and used to contractually bind the vendor to deliver the actual functionality
		+	*Technology assessment - stakeholders from the IT architecture department should rank the vendor and product against their list of technical criteria
		+	*Cost of ownership - while it may to difficult to assess across vendors for this, initial cost can be divided into capital and operating cost to make this more possible
		+	*vendor comparison analysis - structure cross vendor comparison analysis should be conducted by the decision team
		+	* Risk Analysis - the specific risk should be objectively analyzed
		+
		+	The selection team should assess the vendors with ranking against the various criteria as this ensures the team focus on objective analysis of each of the vendors.<ref name ="Herding Cats"> Herding Cats: The Challenges of EMR Vendor Selection http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats -Challenges_of_EMR_Vendor_Selection.pdf</ref>
		+
		+	== Go live support ==
		+	[[Vendor Selection Criteria: Go live support]]
		+
		+	== Evaluation post implementation ==
		+	[[Vendor Selection Criteria: Evaluation post implementation]]
		+
		+	== References ==
		+	<references/>

---

Latest revision as of 04:57, 3 October 2015

Choosing an electronic medical record (EMR) vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a paper-based system could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.^[1]

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

EHR Vendor Selection

Preliminary selection criteria for EHR vendors

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

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

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

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

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

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

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

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

Assess EHR Requirements

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

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

Vendor Assessment

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

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

Steps to conducting an EHR Assessment

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

Decide what paths and vendors you need to obtain your EHR

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

Check out possible vendors through current users

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

Interview certified EHR vendors

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

Arrange for vendor demonstrations

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

Common Vendor Selection Mistakes

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

EMR Selection Tips From A CCRC

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

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

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

Planning and Implementation Approach

Vendor Selection Criteria: Planning and Implementation Approach

Planning and Implementation Approach

Vendor Selection Criteria: Planning and Implementation Approach

Core clinical features

Vendor Selection Criteria: Core clinical features

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

1. Health information and data

2. Results management

3. Orders management

4. Decision support

5. Electronic communications and connectivity

6. Patient support

7. Administrative processes

8. Reporting and population health management ^[10]

Personal Health Records

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

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

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

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

IT and technical requirements

Vendor Selection Criteria: IT and technical requirements

Usability

Vendor Selection Criteria: Usability

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

Interoperability

Vendor Selection Criteria: Interoperability

Future relationship with vendor

Vendor Selection Criteria: Future relationship with vendor

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

Certification and meaningful use

Vendor Selection Criteria: Certification and meaningful use

Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. One must be able to confirm whether an EHR system is HIE certified or not.^[14] In addition, meaningful use should be assessed.^[15]

Why need vendor certification

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

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

Vendor assessment

Vendor Selection Criteria: Vendor assessment

Most vendors typically fall into one of the three categories:

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

The first category of vendor is less likely to run into major market conflicts to keep its software modern and compliant with regulations. Vendors that operate on a single source code have far less difficultly staying current and/or responding to rapid changes in the market and mandated IT standards.^[17] However, selection of a vendor also depends on the size of the organization, and the list of services they need. A larger health care organization might need more services, hence the vendor they select must offer multiple products.

Goals

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

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

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

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

Relevant – The goal is worth the effort.

Time bound – There are deadlines and opportunities to celebrate success

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

Vendor assessment plan

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

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

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

Go live support

Vendor Selection Criteria: Go live support

Evaluation post implementation

Vendor Selection Criteria: Evaluation post implementation

References

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