Vendor Selection and Understanding the EHR Marketplace

Health Information Technology Toolkit for Chiropractic Offices

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Presenter• Margret Amatayakul

RHIA, CHPS, CPHIT, CPEHR, FHIMSS

President, Margret\A Consulting, LLCSchaumburg, IL

• Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit

• Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics

• Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor University of Illinois

• Active participant in standards development, former HIMSS BOD, and co-founder of and faculty for Health IT Certification

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Stratis Health● Stratis Health is a nonprofit organization that leads

collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities

● Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO)

● Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation

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• What are you buying?

• Vendor state of affairs

• Interoperability

• Requirements analysis

• Going to market with request for proposal

• Key differentiators

• Due diligence

• Contracting

Agenda

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What are you buying?

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Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Results Retrieval

EHR Migration Path

Timeline Current Phase I Phase II Phase N

Goals Support ambulatory Patient safety Quality of care

Applications:- Financial/

Administrative- Operational

- Clinical

R-ADT/MPI

Patient Accounting

Payroll/T&A

Laboratory IS

Pharmacy IS

Home Health IS

PM System

Radiology IS

Provider Portal

E-prescribing

EDMS

Order Communication

POC Documentation

BC-MAR

PACS

CPOE

Ambulatory EHR

Technology- Database- Network &

Infrastructure- Interfaces

D.M. Registry

Frame Relay T1

Unit Dose Packager

CDR

WLAN

Tablets

Operations- People- Policy- Process

IT Director 1 FTE Pharmacist

Retail Pharmacy Readiness

Critical Pathways Clinical Guidelines

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Reality for Many Small and Rural Communities• Buy from incumbent

– What incumbent offers• Or

– Depend on standalone systems– Utilize expensive interfaces– Wait for the vendor to catch up

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Vendor State of Affairs/CCHIT(Certification Commission for Health Information Technology)

0

50

100

150

200

250

1995 1997 1999 2003 2008A 2008H LTC

# EHRvendorsw/same name as previous year on annual EHR market survey

Total Number of Ambulatory EHR Vendors

CCHITEstimates 24 AcuteCare EHRVendors

CCHITCertified

CCHIT Certified

LTC # Vendors*20052008No CCHITCertification

Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

•Source: Provider

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Interoperability vs. Functionality

Interfaced

Integrated

Connected

180 pages of functional requirements

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• Health Information & Data

• Results Management• Order

Entry/Management• Decision Support

• Electronic communication & connectivity

• Patient support• Administrative processes• Reporting & population

health management

www.nap.edu/catalog/10781.html

Institute of Medicine EHR Core Functionality

● Describes detailed functionality along a timeline:o 2004-5o 2006-7o 2008-10

● For:o Hospitalso Ambulatoryo Long term careo Care in the community

(personal health records)

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HL7 EHR – System Functional Model(www.hl7.org/ehr)

• Direct Care– Care management– Clinical decision support– Operations management

& communication

• Supportive– Clinical support– Measurement, analysis,

research & reports– Administrative & financial

Initial focus of CCHIT certification for ambulatory care (www.cchit.org)

• Information infrastructure– Security– Health record information &

management– Registry & directory

services– Standard terminologies &

terminology services– Standards-based

interoperability– Business rules

management– Workflow management

11Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.

CCHIT 2007 Hospital Certification

RadiologyLab InpatientPharmacy

CPOEClinicalDocumentation EMAR Results

ManagementReporting

Imaging

BloodBank

Dietary/Nutrition

MedicineDispensing

DevicesRobotics

Smart Infusion Pumps

MonitoringEquipment

“Smart” Peripherals

Departmental Clinical Applications

Core Clinical Applications

IntensiveCare

Perioperative/Surgical

Cardiology OncologyEmergencyMedicine

Labor &Delivery

Specialty Clinical Applications

EHR FoundationR-ADT, Order Communication

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Do Your Own Functional Requirements Analysis

• Work flow and process mapping

• Goal setting• Scenario development• Use case analysis

• Performance-based RFP• Due diligence• Contract• System build• Testing and Training• Benefits realization

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• Trade publication product lists– Self-reported, but most complete and permits side-by-side review

• Web searches– Likely to reveal most aggressive vendors with no side-by-side screening

capability, but often provides demos• Professional organization trade shows

– Good way to get educated on the “possible” but may include an eclectic mix of established vendors and those only exploring the marketplace

• User groups– Provides “bird’s eye view” of many users outside the context of a selection

process and may yield great objectivity and potential candidates for due diligence• Recommendation lists

– Compiled by professional organizations or other groups for specific purposes• Peer experience

– Interesting but criteria may not match yours; positive experience is good to know, negative experience may be unique and due to poor planning

• Recognition or award programs– Some are more objective than others, but consistency in appearance is helpful

• Product certification– Certification Commission for Healthcare Information Technology – Proprietary vendors of product analysis tools are also resources

Triangulate Information from Product Resources to Narrow Field

14Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.

Used with permission of Medical Strategic Planning

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*Key Differentiators

Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

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• Functionality is very important, and vendors under consideration should provide type of functionality you want. For example, don’t look at a vendor that only supplies clinical messaging or document management if you want full EHR functionality

• Other factors are also very important, for example:– What is the vendor’s reputation for help with implementation and

ongoing support?• Does the vendor provide local support? Is there an established local presence

of users to provide community support?

– How long has the vendor been in business? • With a dynamic marketplace, the vendor should have at least survived their

initial few years• But the trade off in acquiring an EHR from a long-established vendor may not

be the latest technology or most comprehensive clinical functionality!

• Check these other characteristics through performance-based demonstrations, site visits, and reference checks; but . . .

Due Diligence

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Contract Negotiation• Negotiation is an iterative process

of give and take• Do not plan to work out details

after contract is signed. There is no leverage after contract signing

• Get it in writing. What you are told in demos, see on site visits, or are promised by sales staff have no contractual impact.

• Maintain validity of business points• Keep a list of contract issues and

resolutions• Read and verify the final contract

version prior to signing• Manage to the contract

Price is an offer to sellCost is what you pay to vendorTotal cost of ownership is all costsPayment is transfer of funds.Value is what you get

Schedule Vendor Buyer

Down payment 50% 10%

Software install 25% 10%

# days after software install 25%

Completion of training 20%

Completion of testing 20%

Go live 20%

90 days after go live 20%

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• What are you planning to acquire next to help you enhance your clinical information systems?

• Are you planning to go to market?– If not originally, how might doing so help you?– If so, how can you avoid analysis paralysis in light of so

many vendor offerings?

• If you decide not to go to market, will you do some due diligence before acquiring the next component from your incumbent to assure you have the technology, people, policy, and process in place to support your new acquisition?

Questions to Consider . . .

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Contact:

Stratis Health

2901 Metro Dr., Suite 400

Bloomington, MN 55425

952-854-3306

1-877-787-2847 (toll free)

www.stratishealth.orgCopyright © 2011 Stratis Health. Funded by Chiropractic Care of Minnesota, Inc. (ChiroCare), www.chirocare.com

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Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting, LLC, and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

 

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