Services of Iowa’s Regional Extension CenterExtension Center THE TRUSTED HEALTH IT ADVISOR
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 IFMC HITREC Ground Rules
Steps to Reviewing EHR’s • Develop an EHR Selection Team • Identify workflow issues, goals and timeline • Create a short list of EHR vendors to review • Ask for On-Site Demonstration • Participate in EHR demonstration • Ask for references and possible site visit • Make an informed decision
Step 1: • Develop an EHR Selection Team (no matter how small you are) • Representatives should include: • Providers • Clinical Staff • Office Staff
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
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
Step 4: • Participate in EHR demonstration • View vendor’s sales demo • Ask to see the workflows you identified • Have them elaborate on features and functions that are important to you • Ask for references • Consider onsites
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
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 maywant to negotiate
Reviewing Contracts Now the real work begins…..
EHR Toolkit EHR Toolkit
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
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
Contracting Guidelines Divide into several categories • General • Software • Support • Interfaces • Training • Implementation
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
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?
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?
MU Clause • Since MU is so important, ensure there is clause relating to MU certification • Is there an extra charge for this update?
Support clauses • What are support hours? • Response time? Problem escalation? • Costs for additional support? • The contract should clearly outline the terms of support agreement
Interfaces • For each interface, contract should include cost and detail • Should include interface specs • What happens when errors occur
Training • How many training hours are included? • Onsite vs. internet? Can you choose? • Who is paying travel costs? • Cost of additional hours?
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
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
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”
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?
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
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.
Contact Information: CatheyHalsten 515-440-8284 email@example.com www.IowaHITREC.org 1-800-373-2964 IowaHITREC@ifmc.org 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