1. Making the Most of the Vendor Selection Process in Healthcare
October 6, 2015

2. Discussion Topics Introduction European EHR Drivers and Barriers
Common Pitfalls and Lessons Learned
Vendor Evaluation Approach
Suggested Questions for Vendor Presentations
Questions and Answers

3. Introduction Bart Briers Managing Director
11 years of experience in IT Service & Solutions Management (CTG)
+2 years Managing Director etrinity, a CTG Health Solutions company health,
+8 years Director Belgium-Luxembourg for Software Testing
Extensive experience with financial/clinical systems, planning, selections, contract negotiations, assessment and implementation

4. >600 Healthcare Clients Over 25 Years
Experience Matters!
>600 Healthcare Clients Over 25 Years
>200 Implementation and Optimization Clients
>80 CTG Provider Clients (2012)
>150 Selections, Strategic Plans, and Assessments in the Last Four Years
>160 Technology and Integration Services Clients
>200 Healthcare Vendors Supported

5. Healthcare Service Portfolio
Strategy
Clinical Systems
Implementation
Interface Development
IT Support
Audit
Support
Health Applications Support
Advisory
IT Solutions for
Healthcare
Integration
Medical Device Integration
Lean in
healthcare
Implementation
Infrastructure
(Mobile) Apps
Health Technology
Selection
Health Data Exchange
Information Security
Data Migration
Training

6. European EHR Drivers and barriers

7. European EHR Drivers and barriers
Reduce Medical errors
Meet legal requirements
Increase organizational performance

8. Drivers for IT Deployment
Reduce medical errors
Improve quality of care
From “automated islands” to one continent
Sharing patient information
Facilitate access to test results
Meet legal requirements
Improve security and privacy provisions
Automate of statutory registrations
Comply with accreditation requirements
Comply with government-funded policies (Lux. and European) related to medical error reduction or organizational performance

9. Drivers for IT Deployment cont.
Enhance overall organizational performance
Increase clinical capacity and productivity
Improve control of costs/increase revenues and reduce costs
Support reorganization and change
Create more effective supply chain links
Improve registration and billing

10. Barriers to EHR Adoption

11. Barriers to EHR Adoption
High total costs and no guarantees on ROI
Time issues
User habits
Preference of paper-based processes
Low technology acceptance rate
“No urgent need”
Management: “organization is too small”
End-users: “not important”
“Medical records are only important for one single, specialized medical area”

12. Common Pitfalls And Lessons learned
Speaker: TBD - Transition to ?

13. European EHR Adoption ModelSM
“Paperless” patient record environment for highest quality of care, data continuity, and full HIE
Full electronic clinical decision support and highest medication safety
Completely electronic diagnostic image management
Electronic order entry with decision support and result reporting
Clinical ordering and documentation— especially nursing care
Patient-centered electronic data repository
Electronic diagnostic and pharmacy department information
© Copyright by HIMSS Analytics Europe

14. Common Vendor Misconceptions
Vendor Myths
You can implement on your own
Vendor provides experienced, FT resources to help
Once you are trained, you know the system
“Out of the box” is robust, and works for most
All costs are known up front
Most large implementations use consulting services
Many vendor firms lack depth in:
Project mgmt.
Process improvement/ re-engineering
General healthcare and clinical knowledge
Scope always larger than first expected: more resources, time, and money
Resources are not consistently onsite
Project resources often support multiple clients at the same time
Resources may be recent college graduates with limited healthcare experience
It may be the first implementation for your assigned project team
Vendor training provides only a baseline knowledge of application functionality/build
Vendor training is done “functionally,” not in a workflow- driven manner
Vendor training is often by application and does not show the integrated workflow
Vendor training does not profile the experience an implementation provides
Model/gold standard has very little “specialty-based” content
Model content requires review and editing; may contain errors (not plug-and- play)
Implementation resources and costs are often underestimated
Comprehensive project planning and monitoring is required to manage costs and timeframes

15. Lessons Learned / Critical Success Factors
Recommendation and Considerations
A defined governance model and issue escalation process not in place/ not functioning
Fragmentation of leadership between the hospital, medical staff, and other clinicians
Avoid “analysis paralysis” to make timely decisions
Use change management process as needed
Expectations management
A new system does not solve systemic organizational problems -> introduce Process Optimization (LEAN)
Insufficient project controls
Establish solid governance model, PMO, project control, and management processes early
Change management, project communication plan, training programs
Inexperienced team
Must include clinicians/operation staff on the team
Must have ≥ 40% project experienced personnel
Must have > 40% clinical operational staff on the team
Organizations have not anticipated “the unexpected”
Project leadership must be five steps ahead, anticipating any turbulence and developing alternative routes
Control your destiny
Expert implementation planning and experience yields achievable plans and realistic budgets

16. Lessons Learned / Critical Success Factors cont.
Lessons Learned/CSFs
Recommendations and Considerations
Realistic expectations of base/model system
Great educational introduction to vendor capabilities
Align vendor implementation approach with your specific requirements
Identify and define strategic drivers early, and design to the model
Workflows perform fairly well in most clinical settings
Maximize workflows to prevent “paving the cow paths”
Be prepared for the esoteric
Be sure to include all parties in the review
Clinical content may not meet advanced expectations. What to do?
Set a deadline to review, revise, and finalize
Develop/commit to optimization strategy early
Realistic expectations of vendor staff
Good motives
Technical experts of vendor capabilities often lack operational or clinical expertise
Focused on application and technical workflows with little focus on enterprise effort
Implications of third-party applications are not understood
Implement quickly ● Optimize post-live

17. Lessons Learned / Critical Success Factors cont.
Lessons Learned/CSFs
Recommendations and Considerations
Realistic expectations of clinical/operation staff assigned to the project
Bring current state and concerns knowledge
Do not let them replicate existing system in future system
Recognize and address lack of project experience
Time is your main challenge
Most difficult problem is to recover from slipped mid-project deadlines
Don’t underestimate impact of education and research
Understanding true impact on remaining systems and workflows
Ensure inclusion of multi-disciplinary team members for cross-application functions
EHR impacts all areas when it goes live
Understanding motivations of stake holders
Everyone wants to protect their territory
Comfort level with the old system may be stronger than desire to embrace the new system
Fear of the unknown
Implement—then optimize!
Hard to understand future until you’ve been there
Most customizations are never used
Anticipate/expect the need to meet legal/regulatory requirements
A tough road in the best of times
Have fun!
Celebrate!
Build momentum by delivering on promises

18. Lessons Learned and Common Pitfalls During System Selection
Must not be viewed/approached as an IT project; process knowledge is crucial
Clients tend to over-commit their personnel; use of knowledgeable consultants helps keep your vendors honest
Objective, consistent approach and methodology are key (provide legal and board assurance)
Clearly define strategic, stakeholder, process, and legal requirements
Identify a consistent group of stakeholders who will see all demonstrations
Standardize offers, proposals, and indirect costs
Understand all costs upfront—vendor-specific costs are only part of the total
Example: 5-year total cost of ownership (TCO) model
Vendor licenses: 10–15%
Vendor maintenance: 15–20%
Labor (vendor, training, internal consultants): 50–60%
Workstations: 20–30%
Servers: 5–10%
Third-party software/hardware/installation: 5–15%

19. Lessons Learned and Common Pitfalls During System Selection cont.
Define change management considerations
If it’s not currently written down in a paper environment, it will NOT automatically become a part of the EHR
Define
What successful end-user buy-in means
Process optimization requirements and timelines
Implementation team requirements
End-user support requirements (can they be supported with existing staff or is external consulting support necessary?)
Vendors
Should be able to provide a reference site for EVERY piece of their solution
Have a tendency of failing to follow through on their deliverables and promised features
Might have difficulty adopting to changing/new markets (localization)

20. Vendor evaluation approach
Speaker: TBD - Transition to ?

21. Why Invest in a Vendor Selection Process?
Baseline: a complete Request For Proposal (RFP) process for a full complement of applications wrapped up as an EMR or EHR solution
Why invest in this process?
To create a level playing field for all vendors
All are treated equally and offered the same opportunities to respond to the RFP
Recommend a “pre-fit” assessment limiting the number of vendors receiving the RFP to no more than five (5) when possible
To build consensus internally and ensure process is viewed as fair
To create and maintain a consistent process for a defendable legal decision
To assure the board that participants were treated consistently
A well-defined process and approach is necessary because the same group of individuals in an organization rarely participates in more than one major selection in a career—experience and independence helps!

22. Typical EMR/EHR Selection Approach and Timeline
Major Selection Phases
Engagement initiation and planning: 1–2 weeks
RFP development: 6–8 weeks
Send RFP to vendor set and allow time for vendor response—typically 30 working days/4 weeks
RFP response evaluation and invitation to demonstrate: 2–3 weeks
Demonstrations: 2–8 weeks (dependent upon organization’s personnel availability and vendor availability)
Final vendor scoring against organization major selection criteria: 2–3 weeks
Contract negotiations: 4–XX weeks

23. Typical Evaluation Criteria Scoring Recap Tool Example
Criteria Categories
Vendor 1
Vendor 2
Vendor 3
Vendor 4
Strategic IT architecture guidelines  77 68
104 72
Alignment to organizations vision
202
149
241
169
Workflow improvements potential1 88 54 96 75
Strategic technology 34 33 42
Additional business impacts items 25 24 39
Totals
426
328
534
382
Financial—Cost of Ownership (7 yrs)2
€34M
€9M
€26M
€45M3
Monthly Premium vs. Low Cost Provider*
€302K €0
€211K
€439K
1 Specific tools and services provided by each vendor are included in notes in the Vendor Candidate Scorecard
2 5,5M€ in planning costs have been included in the XX financial estimates to cover the missing General Financials and ERP workflow bids that client will require in the final solution
3 XX has suggested an 11th-hour price reduction with a total lower cost of approximately % (€XX software license cost)

24. Suggested Questions for Vendor Presentations
Speaker: TBD - Transition to ?

25. Questions to Keep in Mind During International Vendor Presentations
What are their plans and commitments for the local market?
What’s your healthcare expertise?
Work with local partners who know the Lux. Market?
Past track record & current commitments on timelines/budgets?
How can they support the continuum of care?
What’s the system roadmap and how much do they invest in R&D?

26. Questions and answers
Speaker: TBD - Transition to ?

27. Thank you! Bart Briers Managing Director
etrinity, a CTG health solutions company