1. Vendor Selection and Understanding the EHR Marketplace Health Information Technology Toolkit for Chiropractic Offices

2. 2 Presenter Margret Amatayakul RHIA, CHPS, CPHIT, CPEHR, FHIMSS President, Margret\A Consulting, LLC Schaumburg, 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 2

3. 3 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

4. 4 What are you buying? Vendor state of affairs Interoperability Requirements analysis Going to market with request for proposal Key differentiators Due diligence Contracting Agenda

5. 5 What are you buying? 5 Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author. Results Retrieval EHR Migration Path TimelineCurrentPhase IPhase IIPhase N GoalsSupport ambulatoryPatient safetyQuality 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 RelayT1 Unit Dose Packager CDR WLAN Tablets Operations -People -Policy -Process IT Director1 FTE Pharmacist Retail Pharmacy Readiness Critical PathwaysClinical Guidelines

6. 6 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

7. 7 Vendor State of Affairs/CCHIT (Certification Commission for Health Information Technology) # EHR vendors w/same name as previous year on annual EHR market survey Total Number of Ambulatory EHR Vendors CCHIT Estimates 24 Acute Care EHR Vendors CCHIT Certified CCHIT Certified LTC # Vendors* 2005 2008 No CCHIT Certification Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author. Source: Provider

8. 8 Interoperability vs. Functionality Interfaced Integrated Connected  180 pages of functional requirements

9. 9 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: o2004-5 o2006-7 o2008-10 ●For: oHospitals oAmbulatory oLong term care oCare in the community (personal health records)

10. 10 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

11. 11 Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author. CCHIT 2007 Hospital Certification Radiology Lab Inpatient Pharmacy CPOE Clinical Documentation EMAR Results Management Reporting Imaging Blood Bank Dietary/ Nutrition Medicine Dispensing Devices Robotics Smart Infusion Pumps Monitoring Equipment “Smart” Peripherals Departmental Clinical Applications Core Clinical Applications Intensive Care Perioperative/ Surgical CardiologyOncology Emergency Medicine Labor & Delivery Specialty Clinical Applications EHR Foundation R-ADT, Order Communication

12. 12 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

13. 13 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

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

15. 15 *Key Differentiators Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

16. 16 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

17. 17 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 sell Cost is what you pay to vendor Total cost of ownership is all costs Payment is transfer of funds. Value is what you get Schedule VendorBuyer Down payment50%10% Software install25%10% # days after software install25% Completion of training20% Completion of testing20% Go live20% 90 days after go live20%

18. 18 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...

19. 19 Contact: Stratis Health 2901 Metro Dr., Suite 400 Bloomington, MN 55425 952-854-3306 1-877-787-2847 (toll free) www.stratishealth.org Copyright © 2011 Stratis Health. Funded by Chiropractic Care of Minnesota, Inc. (ChiroCare), www.chirocare.comwww.chirocare.com __________________________________________________________________________________________ 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. For support using the toolkit­­ Stratis Health  Health Information Technology Services 952-854-3306  info@stratishealth.org www.stratishealth.org For More Support