Vendor Selection Criteria

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Key Selection Criteria

  • Does the vendor share the organization's vision for the EHR?
  • Does the product provided by the vendor has all the key functions needed to fulfill the vision of the organization?
  • Is the vendor utilizing the desired technology?
  • Does the vendor qualify the organization's acquisition policies? Is the vendor CCHIT certified?
  • Certification can be verified at http://onc-chpl.force.com/ehrcert.[10]
  • Will the vendor be supporting the organization's desired implementation strategy?
  • Check the track record of vendor for operations and maintenance support?
  • Clarify the roles, responsibilities and costs for data migration if desired.[1]
  • 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?
  • Make sure the vendor's product is able to document the meaningful use. [2]
  • Conduct a site visit. [3]
  • Talk to vendor's existing customers, making sure to also contact some vendor customers independently, as the vendors tend to only provide contacts to their most satisfied customers.

Check Vendor References

  • Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.
  • Vendor provided references must be considered 'happy customers' with biased viewpoints.
  • Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion
  • Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.
  • Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.
  • Research references the vendor did not mention, visit facility to get an unbiased viewpoint
  • Must use list serves, internet searches and networking to identify other users to interview to get more objective viewpoint.
  • All interviewers should utilize the same questionnaire approved by the project manager or steering team.
  • Notes must be recorded by each interviewer for each customer interviewed.
  • These notes should be made part of the overall evaluation process, ideally kept by the project manager [7].

Clinical Features the System Should Provide

  • Health Information & Data Management (Demographics, Problem list [CC, Conditions, Acute/Chronic, Worsening/Resolving, Injuries, Present Illness] with ICD-9 or ICD-10 numbering, Procedures, Diagnoses, Medications, Allergies, Family medical history, Consultations, Signs & Symptoms and Vitals, Progress Notes and Discharge Summaries, Appointments/Admissions/Visits, Advance Directives, Clinical Reminders [Immunizations, Screenings, Risks])
    • EHR that allows for the creation and maintenance of patient specific problem lists that are dated and organized by diagnosis, problem, and problem type and associates encounters, orders, medications and notes to one or more problems. Once a problem is resolved, the EHR provides an automated algorithm that closes that problem.
  • Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)
    • Review and search results easily by sorting test types, test time, test administers, test results and so on
    • Choose one or several test types, such as HGB, and/or WBC, and/or blood sugar and chart on their results for showing trends.
    • Provide direct decision support explanation link to evidence based knowledge (through such as "infobutton",etc) about needed test information, such as purpose and methods of conducting that test, normal range of that test, clinical indications when abnormal results occurred and suggestions what to do, etc.
    • Provide abnormal alerts to providers and/or patients through various ways, such as online display, cell phone text messages, etc if the patients/doctors register for this service.
  • Computerized Physician Order Entry (CPOE), e-Prescribing
    • Computerized Physician Order Entry system that integrates and provides for two-way communication with the Pharmacy, Laboratory, Registration systems, and that allows for scanning and downloading of health information as needed. The EHR system should have a completely understood interface and provide for interoperability with all current and future systems and between clinics and providers.
  • Decision Support (Drug Interaction, Drug information and other Prescription Supports, Clinical Guidelines [Plans & Protocols] and disease information, Diagnosis and differential diagnosis Support, Risk Assessments, Clinical Checklists, Medical References, etc)
  • Formulary Database Support
  • Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)
  • Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)
  • Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)
  • 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.
  • Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.
  • Patient Portal for online personal health record access
  • Clinical policies and procedures guidelines
  • Produce visit summary and complete medical record printout and data export on demand for patient use.
  • Electronic Health Record (EHR) systems should be capable of accommodating multiple users working concurrently within the system and within the same patient file or document [2]. EHR systems should also be capable of protecting the integrity of data in the system so that no data loss occurs when multiple users are working concurrently with the same patient file or document [2].
  • EHR systems should be capable of capturing, storing, indexing, retrieving and displaying externally created documents [2]. Indexing of captured documents should include not only patient identifiers and descriptive information, but also date/time stamps and document type [2].
  • EHR systems should be capable of retaining all system data until such data is archived or intentionally purged from the system [2].
  • This system should present chronological data of patients like medicine history, progress of diseases.
  • Also, system provides gene information or drug allergies of patients to avoid ADE.
  • System should be compatible with old system to reduce re-entry time.
  • System should update regularly.
  • system should be able to have Patient prescription plan eligibility, prescription product formulary and external medication history.
  • System should be able to have insurance retrieval capabilities (i.e. insurance firms, sum insured, premium dues, etc.).[11]

In 2003, the DHHS asked the IOM to provide guidance on the basic functionalities of electronic health records systems. The committee concluded that the core functionalities should address the following areas: • Improvement of patient safety • Support delivery of effective patient care • Facilitate management of chronic conditions • Improve efficiency • Feasibility of implementation. Based on these areas, the IOM committee identified eight categories of core functionalities, including: • Health information and data • Results management • Order entry/management • Decision support • Electronic communication and connectivity • Patient support; administrative processes • Reporting and population health management (Johnson, E. (2006). Selecting an electronic medical record system for the physician practice. Retrieved from AHIMA HIM Body of Knowledge: http://library.ahima.org

Possible Vendor Services

  • EHR Software
  • Privacy and Security services
  • Readiness assessments
  • Implementation services
  • IT infrastructure support
  • Practice redesign and optimization services
  • Quality improvement and measures services
  • Education and training
  • Meaningful use gap analysis
  • Direct Messaging services

(RI Regional Extension Center, 2011)

  • Immediate trouble shooting ability.
  • Regular connect with customers about their problems
  • Installation, Configuration services and upgrades.

Requirements by Category

Demonstrate Clinical Functionality (25%)

  • Does the system promote delivery of safe care?
  • 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, quality reporting 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]
  • Can the system identify the chronic disease management subgroups?
  • Is the EHR scalable to different medical specialties and practice demographics (i.e., Neurology vs. Cardiology, small satellite practice vs. intensive care unit)
  • Can the system support future clinical models (i.e., Medical Home)?
  • 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 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 have the ability to import and export data (interact) in a standard format to EHR systems from other vendors?
  • Does the vendor’s product provide the key functionality needed to achieve the organization vision?
  • Does the EHR provide outcomes data in terms of key metrics (cost savings, medication error reduction, disease management) in line with the vision of the organization?
  • How does the system import data from personal health devices?
  • Can patient data be directly imported from patient portals or personal health records?
  • Does the system provide roadmaps for adherence to organizational policies (such as HIPAA)?
  • Does the vendor provide an EHR system that can be integrated with and is interoperable with other systems?
  • Can the vendor provide an EHR system with standard terminology that is cross platform with other EHR systems?
  • Does the vendor provide safe log in for patients and clients?
  • Does the vendor provide natural language processing for entry data or document?
  • Does the EMR could provide appropriate information on screen without cramming too much information?

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? Based on the practice size and niche, is a well-established vendor with all software and hardware in-house preferable?
  • If you have an existing system, what kind of difficulties will the vendor encounter? Will it be possible to transfer existing data to the new system?
  • 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.

•Does the TCO include lifecycle costs that include milestone payment scheduling to back up promises made by EHR implementation? [8] --Sfjafari 12:42, 13 September 2011 (CDT)

  • Does the system minimize or ease the data input, so that doctors spend more time with their patient?

--Sfjafari 12:42, 13 September 2011 (CDT)

  • Does the vendor qualify under the organization acquisition policies?
  • How will current policies and procedures change once implementation takes place?
  • What kind of on-going training and support will be provided after implementation? Is the cost of post-implementation training and support clearly specified?
  • How many hours of initial training is provided for administrators? For users?
  • When is the initial training provided, during or after implementation?
  • How large a virtual environment will be required to provide training for staff, and how much time should be allocated.
  • What are the time requirements to train the trainers?
  • Is the initial training included in the costs of the tool?
  • If additional training is required post-implementation, how is it priced – lump sum or hourly rate?
  • How many hours of post-implementation support is included?
  • Is there a dedicated support team?
  • If implementation of the system fails, what steps is the EHR willing to take to make it successful?
  • Will the license cost for updated versions of the EHR be borne solely by the purchasing institution or will there be cost sharing between the institution and the vendor for updates?
  • How often the possibility of system break out?
  • Does the fee include pre-training and post-training?
  • How long and including of the warranty of infrastructure and system? Do we pay for accident damage for system or hardware?
  • If there are major updates to the system, will the vendor provide ample support and training for the users? And how much will this additional training cost?


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-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?
  • 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)
  • 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?
  • 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 the 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 have modules for automatic update of knowledge sets at regular intervals, more like automatic update of antivirus definitions?
  • 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?
  • 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.
  • Will the vendor provide technical training to the IT Department of the purchasing institution to handle minor non-critical hardware problems?
  • 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?
  • Does the system provide relevant reports for data for compliance with meaningful use of the EHR.[11]
Connectivity Capability and Standards [4]
  • Does it meet the following connectivity standards: HL7, HL7 CDA, CCR, HL7 CCD, ELINCS and Vendor software specifications?
  • How flexible is there connection framework? Can it negotiate multiple standards?
  • How quickly can you build and implement an interface within the interface engine?

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
  • 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 CCHIT certified (http://www.cchit.org/products/cchit)
  • How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?
  • 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?
  • 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?
  • 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?
  • Can the vendor support the organization desired implementation strategy?
  • How can the EHR technology be useful for electronic exchange of clinical health information among providers and patient authorized entities? (http://en.wikipedia.org/wiki/Electronic_health_record#Quality)
  • Is implementation of the new EHR system going to be in stages or at once based on the size and complexity of the purchasing institution?
  • Does the vendor provides training instructors at beginning?
  • Does the vendor has well-organized and reliable training courses?


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?
  • Is technical support offered by the vendor 24 hours per day/ 7 days a week?
  • In the event of need for support from the vendor, what is the approximate response time to calls that vendor the projects?
  • What is the cost of providing this technical support per hour?
  • What size, in terms of employees, is the EHR vendor? Do they have the staff to fully address the support needs of their current client base and, can they accommodate the added support load of your institution?
  • In terms of clinical decision support, how often are drug list and drug interaction list updated? Once updated, how long will it take for the changes to be accessible by the end users?
  • When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?
  • In "EMR Vendor Selection" on Health Technology Review.com (http://www.healthtechnologyreview.com/emr-vendor-selection.php) it states an old adage in the Software industry that consumers will buy a product based on features, but will leave the vendor based on a lack of support. Therefore, it is important to check references for the vendor related to post-implementation technical support satisfaction.
  • Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?
  • Will the source code be placed in escrow so that the system could be maintained and modified by internal IT staff in the event that the vendor ceases operation.
  • Does the vendor have local support personnel or will all issues be handled by a distant team?
  • What is an average time for installing and testing upgrades to the system? If an upgrade is missed or skipped, does the subsequent upgrade(s) have all prior changes included or just the current fix or feature for that version?
  • Is there going to be a vendor-institution confidentiality agreement or can the vendor share institutional information and dealings with other establishments?

Future Vision (5%)

  • Compare retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation
  • Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?
  • Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.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.
  • Does the system allow outreach/growth to affiliates as a "subset" of the existing clinical provider group? Does that outreach include full or limited functionality? How does that data interface with the existing clinical record?
  • How does the system scale? Is the vendor able to provide support and functionality as a practice grows or can they provide functionality to a small, regional branch?
  • Provision of EHR systems that support the capture of public health data from Clinical Information Systems.
  • Does the system can combine with EHR in long term health care area as a reminder of senior people?
  • Ensure that your vendor will be around when you need help. While specific vendor qualifications vary, generally information to be considered in the vendor vetting process, besides functional and technical details, includes vendor reputation, staff experience and qualifications, and financial solvency. (Chao, C., & Goldbort, J. (2012). Lessons Learned from Implementation of a Perinatal Documentation System. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(5), 599-608. doi:10.1111/j.1552-6909.2012.01378.x)
  • Does the vendor support data documentation and capture of future government mandated measures such as Meaningful Use, ACO measures, CMS measures for Patient Quality, population health etc?
  • Does the vendor allow discrete data capture and easy reporting of critical data that needs to be submitted for reimbursement by the national and state policies on healthcare?
  • Is the vendor at the forefront of research in healthcare and does the software offer clinical dashboards and predictive models for easy tracking and analysis of patient data and efficient decision making by clinicians.

Contract Information

  • Project Payments
  • Contract Terms [5]
    • All costs, current and future, associated with the implementation
    • Time commitment from vendor with regard to implementation and training
    • Penalties for delays in implementation
    • Code escrow - be sure code will be available if vendor goes out of business
    • Indemnification and hold harmless clauses
    • Confidentiality and nondisclosure agreements
    • Warranties and disclaimers
    • Limits on liability
    • Dispute resolution
    • Termination and wind down
    • Intellectual property disputes
  • IT support agreement
  • Training Contract
  • Applied area contract
  • User and vender liability
  • Disputation judgment
  • Attorney of vender and clients


According to Carolyn Hartley, President and CEO of Physicians EHR, Inc., “[C]ontracts are as much a business tool as they are a purchasing agreement.” She suggests the following contracts and related information to assist in contract negotiation for lowering costs when purchasing an EHR. For further tips and suggestions, visit the website, http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx

  • User License - The person who has access to data using a user ID and password. Pricing structures vary according to the definition of user.
  • Interface - The EHR vendor's contract includes the cost of interfaces. These include interfaces such as those with your scanner or fax machine; and more complex interfaces such
  • Hardware Contract - Review the EHR vendor's hardware quote, but research may lower costs. Check the vendor's website for hardware specifications the vendor supports. Hardware includes servers, high-speed scanners, computers, handhelds, computer on wheels (COW), wall mounts, etc. Hardware installation to a wholesaler means assembling the server and software to make it work at their location prior to delivering it to you. It usually does NOT mean the installation at your location, a difference that will create a significant budget surprise. Clarify the term "installation" with any hardware wholesaler before making the purchase.
  • Third Party Software Contracts – Software includes encryption, speech-recognition, password management, Microsoft™ suite, anti-virus, golden image, bar-coding or webcams.
  • Internet Connectivity and Redundancy Contract - There are three main types of connections for clinical data connections: business class digital subscriber line (DSL), business class cable, and T1 connection. Redundant back up systems and procedures to ensure your data will be backed up in multiple locations and securely stored off-site.
  • Implementation Project Manager – A project manager is necessary to bring vendor experience and guidance to the implementation process and should hand off the implementation to your internal team within 12 to 15 months.
  • Training Contract - Training should be included in the licensing and service agreement, but some vendors provide separate online and onsite training contracts.
  • Service Agreement - A service agreement identifies what the EMR vendor will do to maintain the software, including software maintenance, technical support, and upgrades.
  • IT Support Agreement - Hardware installations are your responsibility, not the EHR vendor. However, if you do not have onsite IT support, request an estimate for the following:
    • Installation charges for electrical requirements, cable and phone connections for the system
    • Networking design and administration charges related to the set-up and service of client's network
    • Hardware onsite installation and maintenance
    • Third-party software maintenance for products not provided by the vendor
    • Correcting errors that result from changes you or a third-party made to the software. This applies primarily to client-server agreements
    • Backup capabilities. This applies primarily to client-server agreements.
  • Terms and Conditions - Irrespective of the contract length, ask about penalties for withdrawing your data. Any vendor interested in preserving its reputation will provide you with data in a common format able to be transitioned to another system, but there is a withdrawal fee. [13]

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 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?
  • Will the vendor be readily available to conduct training for all shift and service line?
  • How much extra financial cost will it be to train outpatient clinics that are a subset of the system?
  • Does the vender return loss money if their system can not complete established goal in scheduled time?
  • Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?

Research Functionality

  • If the proposed installation site is a research hospital, what are the research capabilities of the EMR?
  • How is research achieved?
  • Does the EMR have informed consent alerts and documentation systems for clinical research?
  • How are reports produced?
  • How is data exported from the production system?
  • Which database is used for reporting? For research? Vendor or other?
  • Resources required
  • Support for research billing including research orders (6)
  • Does the EHR system provide data mining capabilities to support clinical research?
    • Are there limits on the fields that researchers can use?
    • How difficult is it to interface with the database?
    • Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.
    • Does the vendor assist in research endeavors, or is it left up to the institution?
  • Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? [9]
  • 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?

Population Health Functionality

  • Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?
  • Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?
  • Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?

Other Criteria

  • 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.

EHR Evaluation Resources

The ONC’s Regional Extension Centers (RECs), located in every region of the country, serve as a support and resource center to assist providers in EHR implementation and HealthIT needs. As trusted advisors, RECs “bridge the technology gap” by helping providers navigate the EHR adoption process from vendor selection and workflow analysis to implementation and meaningful use. (http://www.healthit.gov/providers-professionals/regional-extension-centers-recs)

  • Office of the National Coordinator for Health Information Technology’s vendor evaluation matrix tool: Matrix Tool
  • California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [8]

References

  1. RI Regional Extension Center. 2011. Vendor members and applicants. Retrieved from http://www.docehrtalk.org/selecting-ehr/for-vendors
  2. The Certification Commission for Healthcare Information Technology (CCHIT). CCHIT Certified 2011 Ambulatory EHR Certification Criteria. May 17, 2011. Available at: https://www.cchit.org/documents/18/158304/CCHIT+Certified+2011+Ambulatory+EHR+Criteria.pdf.
  3. http://mhcc.dhmh.maryland.gov/hit/ehr/Documents/sp.mhcc.maryland.gov/ehr/cmsdemo/februarycmsehrdemonstrationarticle.pdf
  4. McDowell SW, Wahl R, Michelson J. Herding Cats: The Challenges of EMR Vendor Selection. Journal of Healthcare Information Management. 2003; 17(3):17.
  5. http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor
  6. Kannry J, Mukani S, Meyers K. 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. 2006; 20(20) 84-99. http://www.ncbi.nlm.nih.gov/pubmed/16669592
  7. Weber, M. (January 2008). "Selecting an EHR, Now What????" wwww.healthconsultingstrategies.com
  8. Eastaugh, S. R. (2013). Electronic Health Records Lifecycle Cost. J Health Care Finance, 39(4), 36-43.
  9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/
  10. Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23(42), 1-4.
  11. Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24
  12. http//:www.healthit.gov: National Learning Consortium. Advancing America’s Healthcare
  13. Hartley, C. (2010). Signing an EHR Contract? 25 Tips to Control Costs. Retrieved from http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx