Vendor Selection Criteria
From Clinfowiki
Clinical Features the System Should Provide
- Health Information & Data Management (Demographics, Problem list [CC, Conditions, Acute/Chronic, Worsening/Resolving, Injuries, Present Illness], Procedures, Diagnoses, Medications, Allergies, Immunization, Consultations, Familial history, Signs & Symptoms, Progress Notes)
- Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)
- Physician Order Entry (CPOE)
- Decision Support (Drug Interaction, Clinical Guidelines [Plans & Protocols], Prescription Support, Diagnosis Support, Risk Assessments, Clinical Checklists, Medical References)
- Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications)
- Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing)
- Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Stat…], External Accountability Reporting)
- Education (Health Provider Education, Patient Education, Home Monitoring)
Requirements by Category
Demonstrate Clinical Functionality (25%)
- Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.
- Can the system pull from clinical documentation for billing and patient safety reporting?
- Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) (http://www.americanehr.com/Home.aspx)
- The system shall require documentation of the audit support functionality in the vendor provided user guides and other support documentation, including how to identify and retrospectively reconstruct all data elements in the audit log including date, time. [1]
- The system restore functionality shall result in a fully operational and secure state. This state shall include the restoration of the application data, security credentials, and log/audit files to their previous state. [1] --Sfjafari 12:41, 13 September 2011 (CDT)
- Can system identify the chronic disease sufferer’s subgroups? --Sfjafari 12:41, 13 September 2011 (CDT)
- Does the EHR system support accurate, consistent and effective clinical documentation by appropriately balancing data auto-population, structured data entry, and unrestricted physician entry of natural-language narrative?
- Will the system allow on staff administrators to create and manage users and user security profiles?
- Does the EMR have the capability to display data over time graphically, such as growth charts?
- The system shall provide the ability to query for a patient by more than one form of identification
- Can it integrate with external knowledge sources such as links to journal references or other knowledge base systems (such as John Hopkins Guidelines System )to provide more academic information and update on particular patient problem?
- Does the EHR store the identity of the user and associate the ID with the additions or changes made to the system?
- Can the EHR system be used to capture clinical trial data? How the clinical trial specific data is managed?
- Does the EHR system will have ability to import and export data (interact) in a standard format to EHR systems from other vendors?
Acquisition and Implementation Cost (25%)
- Are training materials provided by the vendor or is the organization responsible for producing in-house? If the training material will be developed in-house, does the vendor stipulate specific training requirements (i.e. classroom-based vs. web-based, mandatory competency examinations)?
- Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. Ref – Kannry J et al: Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital. Journal of Healthcare Information Management — Vol. 20, No. 2, pg 84.
- Does the vendor factor the number of users as part of their implementation cost?
- Does the vendor provide their own hardware or use a third-party company for their hardware needs?
- If you have an existing system, what kind of difficulties will the vendor encounter? Will existing data be able to be transferred?
- In calculating the Total Cost of Ownership (TCO), the Break out costs should include who pays for the additional costs due to delays in implementation, especially those due to the Vendor. In fairness, the Vendor's rate for successful, on-time and under-budget implementation should be discussed as well.
--Sfjafari 12:42, 13 September 2011 (CDT)
- Does system minimizes or ease the data input, so that doctor spend more time with patient?
--Sfjafari 12:42, 13 September 2011 (CDT)
Hardware Platform and Technical Requirements (20%)
- 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 upgrade system? For how long?
- Does the system use DICOM standards for the transmission of image data?
- How frequently does the vendor provide patch upgrades for the product?
- Is the system using standards such as Snomed, 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)
- If the system includes hardware, the system shall include documentation that covers the expected physical environment necessary for proper secure and reliable operation of the system including: electrical, HVAC, sterilization, and work area.[1]
--Sfjafari 12:44, 13 September 2011 (CDT)
- Can system allow login remotely – off site transcription or home or other clinic?
--Sfjafari 12:44, 13 September 2011 (CDT)
- Does the system provide the ability to identify all users who have accessed an individual's chart over a given time period, including date and time of access?
- How well does the EMR work with antivirus, antispyware and other security software? What is the vendor’s history with cyber attacks?
- Does the vendor offer a Software as a Service (SaaS) solution, also know as an Application Service Provider (ASP), or a client-server solution?
- With existing systems, how tightly integrated will the new EHR system be and what prep work is required to make the integration possible?
- Does the system has modules for automatic update of knowledge sets at regular intervals , more like automatic update of antivirus definitions?
- Does the software allows generation of customized reports such that desired information can be extracted periodically for performance improvement projects or performance monitoring.
Implementability (15%)
- How does the vendor compare in KLAS rankings of similar systems and applications?
- 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?
- How will legacy patient record data be integrated into the new system?
- How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? MikeField 20:47, 29 January 2010 (CST)
- Make sure the vendors give accurate information for the Request for Proposal. So the stakeholders can make informed decisions on the comparison of vendors.
-Zoker 9/17/2011
- What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems? MikeField 20:47, 29 January 2010 (CST)
- Does the vendor have a List of Lessons Learned from previous implementations?
- Does the vendor have a legal license to essential code sets, such as the AMA Current Procedural Terminology (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?American Medical Association
- 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 CCHIT certified (http://www.cchit.org/products/cchit)
- What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/Home.aspx)
- What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? (http://www.americanehr.com/Home.aspx)
- What is the company policy regarding data ownership for the ASP EHR?
- Does the EHR vendor provide any guarantees regarding the ability of a practice to meet meaningful use requirements? (http://www.americanehr.com/Home.aspx)
- The system shall include documentation that describes the patch (hot-fix) handling process the vendor will use for EHR, operating system and underlying tools (e.g. a specific web site for notification of new patches, an approved patch list, special instructions for installation, and post-installation test).[1]
- The system shall include documented procedures for product installation, start-up and/or connection.[1]
- The system shall allow an authorized administrator to enable or disable auditing for events or groups of related events to properly collect evidence of compliance with implementation-specific policies. Note: In response to a HIPAA-mandated risk analysis and management, there will be a variety of implementation- specific organizational policies and operational limits.[1]
- What options does the EMR have for upfront abstraction and scanning? Are these costs included in the purchase of the EMR?
Vendor Partnership and On-going viability (10%)
- 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).
- An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare
- Ensure there will be well-laid out contractual agreement regards the 'source code' that will satisfy/cover necessary conditions: "When does the company get the 'source code?, How does the company get the source code?"
- If there are workflow changes within the organization, after the product is implemented, is the product flexible enough to allow for changes without major outages or disruptions to daily activity?
- What are the vendors’ contingency plans if technical glitches occur, post implementation?
- In terms of clinical decision support, how often are drug list and drug interaction list updated? Once updated, how long will it take for the changes to be accessible by the end users?
- In "EMR Vendor Selection" on Health Technology Review.com (http://www.healthtechnologyreview.com/emr-vendor-selection.php) it states an old adage in the Software industry that consumers will buy a product based on features, but will leave the vendor based on a lack of support. Therefore, it is important to check references for the vendor related to post-implementation technical support satisfaction.
- Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?
- Does the vendor have local support personnel or will all issues be handled by a distant team?
- What is an average time for installing and testing upgrades to the system? If an upgrade is missed or skipped, does the subsequent upgrade(s) have all prior changes included or just the current fix or feature for that version?
Future Vision (5%)
- 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
- Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?
- Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.American Medical Association
- Ability to have HIE compatibility
- Improved billing accuracy and charge capture
- Electronic replacement for traditional reportable disease notifications to health departments, may become part of biosurveillance in the future.[1]
- Is it possible to virtualize or sandbox the system to test updates? This functionality would allow site specific testing of new features and systems with less risk of corruption of the current system. It would also allow testing of new features functionality and allow easy rollback if features end up being unwanted.
- 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.
Extra Credit (optional)
- 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?
- A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.
- An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.
- Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?
- Is the vendor willing to contract to go "at risk" for any part(s) of the contract?
- What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing
- Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?
- Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?
- Is the vendor capable of integrating it's system with a personal health record and allowing more patient control?
- Can the company provide return on investment analysis?
- Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.
- Reduced pharmaceutical costs derived from having information available at the time it is needed
- How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?
- Will the vendor be readily available to conduct training for all shift and service line?
- How much extra financially will it be to train outpatient clinics that are subset of the system?
- Does the EHR system provide with data mining capabilities to support clinical research?
EHR Evaluation Resources
- American Academy of Family Physicians Vendor Rating Tool
- American Academy of Family Physicians EHR Demonstration Rating Form
- American College of Physicians EHR Feature Checklist
- Doctor's Office Quality - Information Technology Guidelines for Evaluating EHR Vendors
