Vendor Selection Criteria

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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]

Planning and Implementation Approach

Vendor Selection Criteria: Planning and Implementation Approach

Physician Participation plays a major role in EHR implementation.

  1. The article "Successful Introduction of an Electronic Health Record" by Propp shows how the Physician leadership, training and tactics used helped in successful implementation process.

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 [7]

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. [8]

According to Phillips, et al (2015 ) Strategic Suggestions for PHR are to fully integrate EHR and PHR and "improve patient and population health". [9]

  • 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) [9]

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. [10]

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.[11] In addition, meaningful use should be assessed.[12]

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.[13] 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 [14]

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. http://www.mmafoundation.org/portals/mmaf/HIT_Toolkit/Printpages/select3.pdf
  8. http://www.healthit.gov/providers-professionals/patient-participation
  9. 9.0 9.1 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).
  10. 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
  11. EHR/HIE: Interoperability http://interopwg.org/certification.html/
  12. Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives
  13. Types of vendors http://www.greenwayhealth.com/wp-content/uploads/2013/03/Replacing_an_EHR-Coker_Greenway_white_paper.pdf
  14. SMART http://www.healthit.gov/providers-professionals/faqs/what-types-goals-should-i-set-during-readiness-assessment-process