1. 1 EHR Contract Negotiation Cathey Halsten, EHR Advisor July 13, 2011

2. Services of Iowa’s Regional Extension Center Extension Center 2 THE TRUSTED HEALTH IT ADVISOR

3. 3 IFMC HITREC Ground Rules We advocate for the provider We are vendor-neutral (unbiased) We do not purchase or install EHRs Tools to help during selection process Advocate for the practice

4. Steps to Reviewing EHR’s 1.Develop an EHR Selection Team 2.Identify workflow issues, goals and timeline 3.Create a short list of EHR vendors to review 4.Ask for On-Site Demonstration 5.Participate in EHR demonstration 6.Ask for references and possible site visit 7.Make an informed decision 4

5. Step 1: Develop an EHR Selection Team (no matter how small you are) Representatives should include: –Providers –Clinical Staff –Office Staff 5

6. Step 2: Create a short list of EHR vendors –IFMC short list - a great place to start –Research EHR functionality as it pertains to your workflow issues –Talk to peers using EHR’s 6

7. Step 3: Prepare for EHR demonstrations –Remote and/or on-site demos? –Ensure the selection team participates –Prepare a few workflows –Set aside uninterrupted time for demos –Use evaluation tool 7

8. Step 4: Participate in EHR demonstration 1.View vendor’s sales demo 2.Ask to see the workflows you identified 3.Have them elaborate on features and functions that are important to you 4.Ask for references 5.Consider onsites 8

9. Step 5: Reference checks and On-site visits –Prepare a list of questions –Visit clinics and talk to users –Remember vendors will always provide their best references 9

10. Step 6: Make an informed decision –Rank the vendors based on the evaluation tool and references –Select two finalists –Ask them for a contract to review –Keep track of any issues you may want to negotiate 10

11. Reviewing Contracts Now the real work begins….. 11

12. EHR Toolkit 12 EHR Toolkit

13. Negotiation Tools Provided

14. When you receive the contract…. Ask for electronic format You can add line numbers to capture concerns or clarification Spreadsheet format works well Submit written list of issues and target date for response 14

15. Do you seek legal advice? Contract will be written from the perspective of vendor Do not be afraid to seek legal advice if you are not comfortable Many companies are not flexible about language changes 15

16. Contracting Guidelines Divide into several categories 1.General 2.Software 3.Support 4.Interfaces 5.Training 6.Implementation 16

17. General Contracting Guidelines Should include termination clauses Should stipulate that it may not be transferred without written approval Should have a definition section Should spell out what happens in the event of default Time should be included 17

18. Software Specific Guidelines Who owns the data? Should include language regarding vendor turning over source code, etc should they go out of business Does the cost include upgrades? Third party costs? Does vendor ensure confidentiality and HIPAA? 18

19. More guidelines to consider Is vendor going to comply with interoperability standards? Is there a progressive payment schedule? Are training costs included? Do you have to pay for all training up front? Conditions for breach of contract? 19

20. MU Clause Since MU is so important, ensure there is clause relating to MU certification Is there an extra charge for this update? 20

21. Support clauses What are support hours? Response time? Problem escalation? Costs for additional support? The contract should clearly outline the terms of support agreement 21

22. Interfaces For each interface, contract should include cost and detail Should include interface specs What happens when errors occur 22

23. Training How many training hours are included? Onsite vs. internet? Can you choose? Who is paying travel costs? Cost of additional hours? 23

24. Implementation What is it and what is included? How is this different from training? Is there project management included? Establish per diem rate for implementation 24

25. Tips for Negotiation Remember, everything is negotiable You are in charge of the negotiation Try to find a win/win Ask for a final due diligence product demonstration 25

26. More tips… Prepare for the vendor to be surprised by your negotiation skills Do not fall for vendor tactics, i.e. “no one else has objected to these terms” 26

27. More tips… Terms of the agreement can have financial implications far beyond the price –Payment terms –Maintenance/support fees –Price protection –What if the vendor leaves the business? 27

28. And more… Beware of evergreen clauses (automatic renewals) Down payment and installation or pay in full up front? Hold some percentage of payment until after go- live 28

29. Just a note: EHR’s are very busy right now, and they don’t necessarily have to negotiate. In fact, installation with many EHR’s are months out. 29

30. Contact Information: Cathey Halsten 515-440-8284 chalsten@ifmc.org www.IowaHITREC.org 1-800-373-2964 IowaHITREC@ifmc.org 30 In Partnership with: The Office of the National Coordinator for Health Information Technology (ONC) U.S. Department of Health and Human Services grant 90RC0004/01. IA-HITREC-07/11-275