Vendor Selection Criteria: Research

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Research Functionality

  • 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. [1]
  • Does the EMR have informed consent alerts and documentation systems for clinical research?
  • If the proposed installation site is a research hospital, what are the research capabilities of the EMR?
  • How is research achieved?
  • How are reports produced?
  • How is data exported from the production system?
  • Which database is used for reporting? For research? Vendor or other?
  • Does the vendor provide natural language processing for entry data or document?
  • 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? [2]
  • 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?
  • Does the EMR system provide functionality to identify clinical related concepts?
  • Does the EMR provide the flexibility to normalize the clinical concepts found in the document?
  • Does the EMR provide the assistance to automatically generate the de-identified document for research purpose?
  • Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? [3]
  • Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? [3]
  • Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? [3]
  • Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. [4] To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:
  1. After a rigorous investigation of vendor statements and industry statements, a standardized questionnaire was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged.
  2. Literature search:
    • PubMed was used to search MEDLINE covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.
    • Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.

Patient Quality Improvement

  • 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.
  • Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?
  • Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?
  • Are vendor-provided and supported order sets available?
  • Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?
  • Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?
  • Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?
  • How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?
  • Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.
  • Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?

Public Health Research

  • 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?
  • Does the vendor have the ability to report to the State, CDC Registry and external sources

Hospital Inpatient Quality Reporting Program (IQR)

The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.

In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the Hospital Compare Website. [5] It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.

Physician Quality Reporting System (PQRS)

PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer).

Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] [6] EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.

The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found here. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:

  • Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.
  • Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.
  • Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures [7].

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    1. Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24
    2. 3.0 3.1 3.2 Integrating Electronic Health Records and Clinical Trials .
    3. 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.
    4. Hospital Inpatient Quality Reporting Program.
    5. Physician Quality Reporting System
    6. Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04