Vendor Selection Criteria
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.
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. 
- 1 EHR Vendor Selection
- 1.1 Preliminary selection criteria for EHR vendors
- 1.2 Assess EHR Requirements
- 1.3 Decide what paths and vendors you need to obtain your EHR
- 1.4 Check out possible vendors through current users
- 1.5 Interview certified EHR vendors
- 1.6 Arrange for vendor demonstrations
- 1.7 Common Vendor Selection Mistakes
- 1.8 EMR Selection Tips From A CCRC
- 2 Planning and Implementation Approach
- 3 Planning and Implementation Approach
- 4 Core clinical features
- 5 Personal Health Records
- 6 IT and technical requirements
- 7 Usability
- 8 Interoperability
- 9 Future relationship with vendor
- 10 Certification and meaningful use
- 11 Why need vendor certification
- 12 Vendor assessment
- 13 Go live support
- 14 Evaluation post implementation
- 15 References
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. 
- 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:
- 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 should be performed systematically in order to meet the goals of the given institution: 
- 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 
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. 
- 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. 
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.  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
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.
Planning and Implementation Approach
Planning and Implementation Approach
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 
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. 
According to Phillips, et al (2015 ) Strategic Suggestions for PHR are to fully integrate EHR and PHR and "improve patient and population health". 
- 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) 
IT and technical requirements
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. 
Future relationship with vendor
Purchasing an EMR is a long-term decision with many hidden costs to consider.
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. In addition, meaningful use should be assessed.
Why need vendor certification
- certification assures certain level of quality of EHR.
- provides sustainability and support by vendor.
- CCHIT -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
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. 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.
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 
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.
Go live support
Evaluation post implementation
- Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf
- What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor
- 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.
- How to Select a Certified EHR. http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html
- 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/.
- 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.
- Miller,D. Best Practices in Software Vendor Selection http://www.slideshare.net/advantiv/cfakepathbest-practices-in-vendor-selection-advantiv
- 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¶mdict=en-US
- 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).
- 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
- EHR/HIE: Interoperability http://interopwg.org/certification.html/
- Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
- CCHIT website.http://www.cchit.org
- Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf
- SMART http://www.healthit.gov/providers-professionals/faqs/what-types-goals-should-i-set-during-readiness-assessment-process
- Herding Cats: The Challenges of EMR Vendor Selection http://www.providersedge.com/ehdocs/ehr_articles/Herding_Cats -Challenges_of_EMR_Vendor_Selection.pdf