Selection Process for Electronic Health Record Systems

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Selection Process for Electronic Health Record
Systems
VITL Summit Presentation October 19, 2007
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Getting Started

• Identify Goals What are you expecting to
  achieve by installing an EHR System?
• What are your specific needs?
• Develop a project budget
• Develop your list of specific requirements and
  prioritize them.
• Assess your technology readiness (network,
  internet connection, computer literacy)
• Dont underestimate the importance of a Project
  Sponsor!

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So many choicesso little time

• VITL will post list of pre-screened products in
  December
• Links to resources for practitioners evaluating
  EHRs is available at www.vitl.net
• Talk to your Practice Management system vendor.
  Do they have an EHR Solution? What specific EHR
  systems have they interfaced with?

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The Selection Process

• Schedule system demos the more systems you see,
  the more you know what you want.
• Sit down with the team before the demos what do
  you want to see? Develop scenarios that are
  common to your practice. Ask the vendors to
  demonstrate them.
• Rate the demos ease of use, functions and
  features

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Considerations

• Will you want an ASP model?
• Dont underestimate the cost of interfaces if you
  dont opt for an integrated solution
• Ask to see an implementation workplan before you
  decide on a system
• Determine the quality of vendor support by
• Reviewing industry data www.healthcomputing.com
• Talking to as many other users of the system as
  possible - ask them about support and
  implementation - what they would do differently
  if they had to do it over dont learn the hard
  way!

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Narrow your Focus

• Meet with your team discuss the demos. What did
  you like? What didnt you like?
• Choose the top 3-4 systems
• Develop your written RFP (Jim has more) and send
  to those vendors. Your requirements list should
  be part of the RFP
• Decide how you will score your RFP
• Decide on the top two vendors based on your
  criteria
• Negotiate a contract with your top two vendors
  (Jeff has more)
• Agree on vendor of choice and sign contract.
• To ensure your functional requirements are met,
  make the vendors response to your RFP part of the
  contract.
• Then the fun begins

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Request For Proposal

• Vendor primary contact
• Corporate headquarters
• Field support offices
• Programming/technical support
• Acquisitions / mergers
• Financial statements
• How long in business

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Request For Proposal

• Total number of installations
• Client installations in similar practices
• Complete client list of similar practices
• Specific examples of Return on Investment
• Customization options
• Remote/ Internet access
• Handheld/wireless compatibility

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Request For Proposal

• Provide a pricing proposal
• How are products priced (total users, concurrent
  users)
• Provide copy of standard contract
• Future enhancements
• Operating system and related software
• Interface maintenance
• Architectural changes (migration to emerging
  technologies)

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Request For Proposal

• Source Code
• System Support
• Implementation
• Documentation and Training
• Technical Design and Operational Requirements

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Request For Proposal

• PMS Integration
• Other Interfaces
• Report Generation and Tools
• Security
• HIPAA

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Sample RFP

• http//www.ompro.org/downloads/doqit/RFP-EHR-PMS.d
  oc

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Choose a Vendor

• Characteristics of a Quality EMR
• Support and Service.
• Vision.
• Its all about the company!

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The Company You Keep

• Choose your vendor carefully. Trust is paramount
• Make sure your vendor has an implementation plan
• Expect them to help you define your needs and
  workflow analysis

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The Company You Keep

• Expect them to help you customize their software
  to fit your needs
• Expect them to listen to your ideas and
  suggestion for future improvements

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The Company You Keep

• Talk to colleagues with EMR
• Go to conventions/seminars
• Visit websites associated with EMR comparison
• KLAS (www.healthcomputing.com )

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Implementation Team

• The team should include representation from all
  pertinent departments.
• Individual skills may be different but should
  complement each other.
• Teach employees to work as a team.

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The Team

• Building Your Implementation Team
• Champion
• Implementation Specialist
• Key Users

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The Team

• Build Your Implementation Team
• Champion
• Imperative
• MD is best
• Computer savvy
• Cheerleader
• Respected by staff

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The Team

• Build Your Implementation Team
• Champion
• Endorses the project
• Understands the processes
• Ensures necessary funding
• Commits personnel to the project
• Team leader

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The Team

• Build Your Implementation Team
• Implementation Specialist
• Vendor relationship
• Communicative
• Knowledgeable
• Experienced

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The Team

• Build Your Implementation Team
• Key Users
• Computer savvy
• Energetic
• Respected
• Cheerleaders

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CCHIT ProgressToward EHR Adoption
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Brief Update on CCHITs Work
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Mission and Milestones

• Mission accelerate the adoption of robust,
• interoperable health IT
• Reduce the risks of investing in HIT
• Facilitate interoperability of HIT products
• Enhance availability of adoption incentives and
  regulatory relief
• Ensure that the privacy of personal health
  information is protected

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Scope of Work Under HHS Contract

• Phase I (Oct 05 Sep 06)
• Develop, pilot test, and assess certification
  ofEHR products for ambulatory care settings
  maintenance
• Phase II (Oct 06 Sep 07)
• Develop, pilot test, and assess certification
  ofEHR products for inpatient care settings
• Phase III (Oct 07 Sep 08)
• Develop, pilot test, and assess certification of
  infrastructure or network componentsthrough
  which EHRs interoperate
• Scope Expansion (effective Oct 06)
• Address specialized EHR needs
• Concurrent effort (April 06 Sep 08)
• Transition to become an independent,
  self-sustaining organization

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Update Specialized EHR Certification Development

• Concept
• Core Criteria with Additional Criteria serving
  particular specialties, settings, or populations
• All EHRs certify to core criteria vendors choose
  which additional sets to certify against
• Full transparency on CCHIT website
• Status
• Environmental scan done
• Commission published draft roadmap
• Public comment Feb 2007
• Begin development for 2-3 specialties during 2007

Specialty A AdditionalCriteria
Setting M AdditionalCriteria
Population XAdditionalCriteria
Core Criteria
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Understanding the CertificationProgram
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Certification Program

• All requirements published well in advance
• Functionality Criteria
• Interoperability Criteria
• Security Criteria
• Test Scripts
• Interoperability Practice Test Files
• Vendors apply, complete documentation
  requirements, and receive an inspection date
• Multiple fail-safe mechanisms
• Appeals process is available

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Evidence of Certification Impact on HIT Adoption

• Official recognition/deeming of CCHIT by HHS/AHIC
• Stark and Anti-Kickback safe harbors require
  certification of donated EHRs
• Physician community certification endorsed by
  AAFP, AAP, ACP, MGMA, AEP, and Physicians
  Foundations
• Evidence that communications efforts reaching
  physicians in their practices and influencing
  buying decisions
• High interest from specialties in expanding EHR
  certification to their areas

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Accessing the Certification Program
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Which Products are Certified?
Or...
Look for the official certification seal on the
product, documentation, or marketing literature
Find latest list at www.cchit.org website
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How Certification Helps

• An EHR is a major, long-term investment for a
  practice.
• Take advantage of the work CCHIT has done in
  evaluating Ambulatory EHR products then combine
  it with due diligence.
• Look for the seal be sure its CCHIT Certifiedsm

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Download the Guide to Certification from
www.cchit.org
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Frequently asked questions

• For certified products, can practices skip all
  the pre-purchase evaluation steps previously
  performed?
• No, but they can probably spend evaluation time
  more efficiently.
• They can use CCHIT certification to narrow the
  initial field of vendors.
• They can also use CCHIT certification to assure
  basic functionality, letting them focus their
  evaluation more on any special or unusual needs
  of their practice

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Frequently asked questions

• Are the certification criteria universally
  applicable to all practices?
• CCHIT developed criteria that provide a broad
  foundation of required capabilities in typical
  ambulatory care settings.
• However, some specialties may not need all of the
  functionality required by CCHIT, while others may
  need additional specialized capabilities. Take
  this into account when evaluating products and
  their certification status.
• CCHIT has begun to evaluate program expansions to
  specialty practice, special settings and special
  populations.

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Frequently asked questions

• Does CCHIT evaluate the vendors support
  capabilities?
• No, CCHIT tests only the product and does not
  evaluate service aspects of the company.
  Practices should perform this due diligence
  themselves.
• Can CCHIT eliminate concerns about vendor
  financial viability?
• No, CCHIT only evaluates products, not vendor
  financial status. Practices must continue to
  perform this due diligence.

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Frequently asked questions

• Can certification guarantee compatibility with
  other IT systems?
• In health IT, interoperability is at an early
  stage. CCHIT criteria are just beginning to
  establish requirements for interoperability.
  Choosing a certified product does increase the
  likelihood that a system can interoperate with
  others now and in the future, but the problem
  will take years to completely solve.

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Frequently asked questions

• Is CCHIT controlled by a particular set of
  interests?
• CCHITs decisions involve many stakeholders
  physicians, health IT vendors, payers, and
  others. CCHIT strives to find fair and balanced
  solutions that deliver value for all
  stakeholders. CCHIT leadership and volunteers
  must disclose all conflicts of interest, and
  multiple protections are in place to reduce the
  possibility of undue influence by any one group.
• Is CCHIT a government agency?
• No, CCHIT is a private sector organization,
  currently transitioning to nonprofit,
  self-sustaining status. In 2005, CCHIT was
  awarded a 3-year, 7.5M government contract to
  develop certification criteria and an inspection
  process

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Frequently asked questions

• Vendor sometimes claim to be CCHIT-compliant.
  Is this the same as being certified?
• No, look for the CCHIT seal on the product or
  marketing literature. It tells you not only that
  the vendor is certified, but which years
  criteria it was tested against. Criteria are
  updated every year in May.
• To be certain, visit the CCHIT website
  (www.cchit.org) for the list of currently
  certified products.
• Report any deceptive misrepresentations to
  certify_at_cchit.org

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Summing Up
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Summary

• An independent, nonprofit initiative to
  accelerate the adoption of robust, interoperable
  HIT
• Building a reputation for transparency,
  credibility, integrity
• Successful launch of Ambulatory EHR certification
• Officially recognized by HHS certification
  required for EHR donations under Stark/AKA safe
  harbor
• Next challenges
• Deliver on our commitment to launch inpatient EHR
  certification in 2007
• Expand certification to specialties / special
  settings
• Establish relationships with emerging networks,
  learn their challenges, and determine how CCHIT
  can deliver value

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VITL SUMMIT 2007 Breakout Session 2 Vendor
Selection and Contract Negotiation Friday,
October 19, 2007 Burlington, Vermont EHR
CONTRACT ISSUES Jeff McMahan Dinse, Knapp
McAndrew, P.C. Burlington, Vermont www.dinse.com
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• The Contract is Negotiable
• Price and Payment Terms
• Legal Terms

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• License Type and Scope
• Perpetual, Term or Subscription License
• How is software support provided?
• What is the scope of the license?
• Internal purposes
• Broader Enterprise
• RHIO use
• How is the license measured?
• Users, Visits, Organization

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• Implementation Services
• Where will the software be hosted?
• What hardware and network equipment do you need?
• Who will do what?
• How will training be done?
• When will it be completed?

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• Testing Acceptance
• Contract should describe pre- and post-live
  testing processes.
• Testing period should be sufficiently long to
  include month-end or quarter-end processes.
• Contract should provide a remedy for testing
  failures.

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• Warranties
• Functional Warranty
• Ties to documentation and sometimes to RFP
  responses or requirements list
• No viruses or disabling devices
• System response times
• Support response times
• Interoperability with other systems
• Equipment Configuration

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• Intellectual Property Indemnification
• The contract should contain this protection from
  the vendor
• Read the fine print carefully

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• Updates, Enhancements, Regulatory Changes
• These are typically included as part of the
  on-going support services
• Will there be separate or additional charges?
• You may need enhancements to comply with new
  regulatory mandates

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• ASP Arrangements
• Where will the software and data be hosted?
• What are the security and privacy protections?
• How will you connect?
• Special Warranties
• Latency
• Availability

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• ASP Arrangements
• Is there a back-up plan to get access to data
  during a downtime
• What happens to your access in a dispute?
• How will your data be returned to you upon
  termination?
• Who owns the data?

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• Questions?
• VITL Resource Center at www.vitl.net.