Many healthcare organizations are working to implement electronic health records to meet HITECH Act requirements and receive payments through CMS' Medicare and Medicaid Electronic Health Records Meaningful Use Incentive Program. The process of implementing an EHR starts with choosing a specific product, a difficult task given the number of vendors and EHR systems available.
"This is a truly overwhelming process for folks just starting out to know where to begin," says Susan Brown, director of Telligen's Health Information Technology Regional Extension Center. Furthermore, the implications of choosing an inappropriate EHR can be enormous, according to Ms. Brown. "It's worth it to get the right product, because it's a long-term relationship. Once an organization has endured the challenges and costs of an EHR implementation, they don't want to have to go through that again." She provides nine steps that the Telligen HITREC team advises hospitals, medical clinics and other organizations follow when choosing an EHR system. "If you go through the process correctly and have a diligent project manager who does [his or her] homework, you can be successful in filtering through this overwhelming decision," she says.
1. Select a team. The organization should create an EHR selection team that includes at least one physician, a nurse or other support providers and other staff, according to Ms. Brown. "Make sure the users of the system are part of the selection team, and include someone from the billing/practice management side in addition to the clinicians," she says. She suggests assigning one project manager to lead the process and monitor timelines and budgets.
2. Identify goals. Before looking at products, the selection team should identify the goals of their EHR — to receive incentive money, to improve the quality of care, etc. The team should look at the organization's current workflows to determine weaknesses that an EHR could improve. For example, Ms. Brown says one workflow the clinic or hospital can examine is managing lab results. In a paper-based system, staff usually receive calls from patients wanting to know their lab results, then must call the lab and finally call the patient again with the answer. An EHR that could interface with the lab could electronically provide results and in some cases allow patients direct access through a portal, dramatically reducing the number of phone calls required.
Another workflow that an EHR could streamline is patient visits, Ms. Brown says. "Staff no longer have to chase down charts, and have ready access to medication lists, allergies and alerts such as harmful drug-drug or drug-allergy interactions. These aspects of an EHR not only help streamline the access to information but also improve the quality of patient care," Ms. Brown says.
3. Make a list of 10 products. Once team members have identified their goals for the EHR, they should use resources such as regional extension centers, their professional associations and their peers to make a list of about 10 potential EHR products. While the Internet offers a great deal of information on EHR systems, it may be too overwhelming, Ms. Brown says. She suggests talking to colleagues who have chosen EHRs to learn from their experience. However, "Just because other practices down the street use [a certain EHR] doesn't mean it's applicable to [your organization,]" Ms. Brown says.
4. Send requests for information. The EHR selection team needs to develop a request for information to send to the 10 vendors on the list. The cover memo should include information on what makes the practice or hospital unique, its EHR goals and the specific workflow issues the organization wants to resolve, Ms. Brown says. Providing this information upfront will help the vendor explain how its product can meet the particular needs of the organization.
5. Narrow down the list. The selection team needs to narrow down the list of 10 to three or four products based on the RFI responses, Ms. Brown says. Online demonstrations and discussions with the products' users can also help shorten the list. The organization should also ask the vendors about cloud computing versus server-on-site EHRs. Considerations such as broadband access, availability of health IT support in the community and price may factor in the decision to use an Internet-based or client-based model, Ms. Brown says. She suggests the organization then choose only two products that will perform a live demonstration at the hospital or clinic, as good demos can take a half or full day and this is a significant amount of staff time to dedicate to the process. She emphasizes that webinar demonstrations should not replace live demos, as the face-to-face interaction with the vendor staff and the product are critical to decision making.
6. Participate in demonstrations. The EHR selection team should develop an evaluation tool that can compare products based on the vendors' demos. In addition, all staff should attend the demo so the team can get as much feedback as possible. Ms. Brown recommends the hospital or clinic ask the vendor ahead of time to demonstrate specific scenarios that are applicable to the organization. The team should also save some scenarios for the day of the demo to evaluate the product's performance without the vendor possibly tweaking it beforehand, Ms. Brown says.
Besides the ability of the product to manage specific workflows, the organization also needs to assess the EHR's capability to interface with other systems such as labs and pharmacies, according to Ms. Brown. "The user interface has to be a huge consideration, as these can be very costly and are usually not considered part of the initial EHR purchase price," she says. She suggests the organization consider the number of clicks, the number of screens and the "look and feel" of the product. The team should request the vendor send a test version of the product for the staff to evaluate the interface.
7. Check references. After the demos, the EHR selection team should request references for the vendor so members can see the product in use on site at a hospital or clinic. The team may also want to research references the vendor did not mention. "We encourage [clients] to find their own references and visit the product in action to make sure [they] get an unbiased viewpoint," Ms. Brown says. "It is time consuming, but well worth it for the selection committee to visit another clinic using the product under consideration before making a final decision."
8. Choose first choice and backup. The EHR selection team should rank vendors based on their RFI responses, demos and references to determine a first-choice product. The organization should also choose a backup in case negotiations with the first-choice vendor fall through, Ms. Brown says.
9. Negotiate contract. The last step is for the team to ask their first-pick vendor to make a proposal and to negotiate a contract. "The contract language is very important, and an organization should carefully research and understand all aspects of their EHR contract, such as data ownership and price protections. This may require seeking legal advice along the way," Ms. Brown says.
About Iowa’s Health Information Technology Regional Extension Center:
As the federally designated HIT Regional Extension Center for Iowa, Telligen will help at least 1,200 primary care providers and 87 critical access and rural hospitals improve care for their patients through the adoption and meaningful use of EHRs. Telligen’s strategy to successfully implement a self-sustaining Regional Center in Iowa builds on its practical experience, quality improvement expertise and high level technology support. These competencies will help Iowa practices achieve meaningful use of EHRs and engage in health information exchange. For more information, visit www.telligenhitrec.org or call 800-373-2964.
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"This is a truly overwhelming process for folks just starting out to know where to begin," says Susan Brown, director of Telligen's Health Information Technology Regional Extension Center. Furthermore, the implications of choosing an inappropriate EHR can be enormous, according to Ms. Brown. "It's worth it to get the right product, because it's a long-term relationship. Once an organization has endured the challenges and costs of an EHR implementation, they don't want to have to go through that again." She provides nine steps that the Telligen HITREC team advises hospitals, medical clinics and other organizations follow when choosing an EHR system. "If you go through the process correctly and have a diligent project manager who does [his or her] homework, you can be successful in filtering through this overwhelming decision," she says.
1. Select a team. The organization should create an EHR selection team that includes at least one physician, a nurse or other support providers and other staff, according to Ms. Brown. "Make sure the users of the system are part of the selection team, and include someone from the billing/practice management side in addition to the clinicians," she says. She suggests assigning one project manager to lead the process and monitor timelines and budgets.
2. Identify goals. Before looking at products, the selection team should identify the goals of their EHR — to receive incentive money, to improve the quality of care, etc. The team should look at the organization's current workflows to determine weaknesses that an EHR could improve. For example, Ms. Brown says one workflow the clinic or hospital can examine is managing lab results. In a paper-based system, staff usually receive calls from patients wanting to know their lab results, then must call the lab and finally call the patient again with the answer. An EHR that could interface with the lab could electronically provide results and in some cases allow patients direct access through a portal, dramatically reducing the number of phone calls required.
Another workflow that an EHR could streamline is patient visits, Ms. Brown says. "Staff no longer have to chase down charts, and have ready access to medication lists, allergies and alerts such as harmful drug-drug or drug-allergy interactions. These aspects of an EHR not only help streamline the access to information but also improve the quality of patient care," Ms. Brown says.
3. Make a list of 10 products. Once team members have identified their goals for the EHR, they should use resources such as regional extension centers, their professional associations and their peers to make a list of about 10 potential EHR products. While the Internet offers a great deal of information on EHR systems, it may be too overwhelming, Ms. Brown says. She suggests talking to colleagues who have chosen EHRs to learn from their experience. However, "Just because other practices down the street use [a certain EHR] doesn't mean it's applicable to [your organization,]" Ms. Brown says.
4. Send requests for information. The EHR selection team needs to develop a request for information to send to the 10 vendors on the list. The cover memo should include information on what makes the practice or hospital unique, its EHR goals and the specific workflow issues the organization wants to resolve, Ms. Brown says. Providing this information upfront will help the vendor explain how its product can meet the particular needs of the organization.
5. Narrow down the list. The selection team needs to narrow down the list of 10 to three or four products based on the RFI responses, Ms. Brown says. Online demonstrations and discussions with the products' users can also help shorten the list. The organization should also ask the vendors about cloud computing versus server-on-site EHRs. Considerations such as broadband access, availability of health IT support in the community and price may factor in the decision to use an Internet-based or client-based model, Ms. Brown says. She suggests the organization then choose only two products that will perform a live demonstration at the hospital or clinic, as good demos can take a half or full day and this is a significant amount of staff time to dedicate to the process. She emphasizes that webinar demonstrations should not replace live demos, as the face-to-face interaction with the vendor staff and the product are critical to decision making.
6. Participate in demonstrations. The EHR selection team should develop an evaluation tool that can compare products based on the vendors' demos. In addition, all staff should attend the demo so the team can get as much feedback as possible. Ms. Brown recommends the hospital or clinic ask the vendor ahead of time to demonstrate specific scenarios that are applicable to the organization. The team should also save some scenarios for the day of the demo to evaluate the product's performance without the vendor possibly tweaking it beforehand, Ms. Brown says.
Besides the ability of the product to manage specific workflows, the organization also needs to assess the EHR's capability to interface with other systems such as labs and pharmacies, according to Ms. Brown. "The user interface has to be a huge consideration, as these can be very costly and are usually not considered part of the initial EHR purchase price," she says. She suggests the organization consider the number of clicks, the number of screens and the "look and feel" of the product. The team should request the vendor send a test version of the product for the staff to evaluate the interface.
7. Check references. After the demos, the EHR selection team should request references for the vendor so members can see the product in use on site at a hospital or clinic. The team may also want to research references the vendor did not mention. "We encourage [clients] to find their own references and visit the product in action to make sure [they] get an unbiased viewpoint," Ms. Brown says. "It is time consuming, but well worth it for the selection committee to visit another clinic using the product under consideration before making a final decision."
8. Choose first choice and backup. The EHR selection team should rank vendors based on their RFI responses, demos and references to determine a first-choice product. The organization should also choose a backup in case negotiations with the first-choice vendor fall through, Ms. Brown says.
9. Negotiate contract. The last step is for the team to ask their first-pick vendor to make a proposal and to negotiate a contract. "The contract language is very important, and an organization should carefully research and understand all aspects of their EHR contract, such as data ownership and price protections. This may require seeking legal advice along the way," Ms. Brown says.
About Iowa’s Health Information Technology Regional Extension Center:
As the federally designated HIT Regional Extension Center for Iowa, Telligen will help at least 1,200 primary care providers and 87 critical access and rural hospitals improve care for their patients through the adoption and meaningful use of EHRs. Telligen’s strategy to successfully implement a self-sustaining Regional Center in Iowa builds on its practical experience, quality improvement expertise and high level technology support. These competencies will help Iowa practices achieve meaningful use of EHRs and engage in health information exchange. For more information, visit www.telligenhitrec.org or call 800-373-2964.
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