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GUIDE HIGHLIGHTSCompile your EHR requiremetsand research suitable vendorsConstruct your RFP using ourcustomizable template80-step checklist for a wellplanned selecrion projectCMCONVERTED MEDIA

INDEX3Gather your EHR requirements6Prioritize your EHR requirements8Create your vendor shortlist10Send out RFPs to shortlisted vendors12Evaluate responses to your EHR RFP14Invite top vendors to demo their EHR16Make your final decision18EHR selection checklistEHR selection survival guidePage 2CMCONVERTED MEDIA

GATHER YOUR EHR REQUIREMENTSThe process of selecting an EHR system is daunting.Technology businesses are well aware of the required transition for most health practices to movefrom paper to electronic health record keeping. Because of this vendor awareness, the EHR marketis ever-expanding, making the job of selecting the right EHR system even more challenging.If users are unhappy with an EHR system, they will often point their fingers at the selection team.To save yourself this unnecessary headache, it is essential to establish a clear plan for the EHRselection process. That plan should always begin with a requirements gathering phase.MAP OUT YOUR EHR PROJECT STAKEHOLDERSYour key stakeholders for EHR requirements gathering include: Clinical staff members, for Physiotherapists Support staff, for example:Reception staffBilling teamOperations team Insurance and accounting Board members and senior managersAll of your key stakeholder and user groups should be represented on your EHR selection team.EHR selection survival guidePage 3CMCONVERTED MEDIA

You should also include: A project manager (if you’re reading this, that’s likely to be you) A C-level sponsor, who will act as the voice of senior management throughout the project An IT representative: essential to ensure no-one overlooks your practice’s technicalrequirements and limitations whilst being wowed by up-to-the-minute new featuresOnce you have built an EHR selection team representative of your practice makeup, you candirect your search in a focused manner. You should now begin to develop a prioritized list of EHRrequirements which will allow you to eliminate systems that are less than qualified for your practice.The process of building a well-balanced EHR selection team involves a lot of work, but if youdon’t take a considered approach, you may miss out on the key needs of your clinicians. A poorrequirements gathering phase leads to money wasted on inadequate systems and the risk of losingexcellent clinicians because of poor operations. In the end, patient care could suffer.ESTABLISH YOUR ‘WHAT’, ‘WHY’ AND ‘HOW’ EHR REQUIREMENTSNow that you’ve consulted with your key stakeholders and have their concerns are represented onyour team, you’re in a position to think strategically about what you - and your practice as a whole hopes to achieve by selecting a new EHRBefore looking at any system in detail, it is essential that you delineate your EHR requirements.Before you undergo detailed requirements analysis for your practice, you should ask these keyquestions: Why are we using electronic health records? Who will be using the new system? Who will require access to this system? How will EHR serve our medical billing operations? What patient population are we documenting? (i.e.: pediatrics, geriatrics, outpatient vs.inpatient, hospital systems, specialty niche etc.) What hardware do I have in place? Will this hardware be able to support a modern EHR system, or will we have to replace certainhardware components?EHR selection survival guidePage 4CMCONVERTED MEDIA

What compliance and insurance documentation requirements do we have? Do I need an EHR that also works as a management/productivity/reporting system?In order to answer these questions, and to better understand what your practice needs, you mustspeak directly with the physicians who will be using the EHR system.Do not rely on conferring with the heads of each department. Those in management maynot have daily access to record keeping and patient care so it’s essential that you discuss anddeliberate with the direct users. One strategy for getting valuable input would be to create a briefbut thorough survey to be completed by your practice staff.EHR selection survival guidePage 5CMCONVERTED MEDIA

PRIORITIZE YOUR EHR REQUIREMENTSHaving formed your EHR selection team and mapped out your basic requirements, you must beginto perform a detailed requirements analysis.Unfortunately, unless you develop your own EHR system, it is unlikely there will be a single systemthat is perfectly suited and designed for your practice needs. You will need a well documented andthoughtfully prioritized set of requirements in order to identify the closest match possible.YOUR NUMBER ONE PRIORITY: REGULATIONWhether your requirements analysis begun with billing management or mobile access, yournumber one priority must be meeting all regulatory (meaningful-use or compliance-based) andinsurance guidelines within the EHR system.You want to capture functional codes, exception codes and all other insurance codes withinthe encounter note so you are not left fixing problems after claims have been processed. Yourclaims must be submitted accurately to avoid audits and denials. You must also have a securesystem that is HIPAA compliant and provides discharged patients with online access to their healthinformation within 36 hours. If these basic needs are not met, then your practice cannotoperate.It is tempting to make your bottom line the number one priority. Too often large practices andinstitutions make decisions based on what is the least expensive. Try to avoid this temptation.Finances should, of course, be an important factor when prioritizing EHR software requirements,but don’t use them as a driving force in selection decisions at the expense of your practice needs.Unfortunately, this will likely rule out some of the cheaper EHR options on the market. But, you getwhat you pay for, so invest in a quality system and you will see a return through high user adoptionand process improvements.YOUR NUMBER TWO PRIORITY: MEETING THE NEEDS OF CLINICAL STAFFYour clinical staff will be using the system during every patient encounter. If the clinical staffmembers are frustrated with the system, it will show in their job performance and patient care willsuffer.EHR selection survival guidePage 6CMCONVERTED MEDIA

For example, your nurses may have requested a system that provides a simple workflow fortaking blood pressure, gathering basic history, producing the patient report, and carrying out amedication review. Even if you provided three out of the four workflow process, your nurses willfeel their contribution to the requirements gathering process has been ignored.When your clinical staff feel their needs are being met, they will be more willing to buy into the newEHR system. As a bonus, you will have happier clinicians who will be more likely to give excellentpatient care.After prioritizing legal guidelines, clinician needs, and cost, you can then rank everything elsethat is important for your practice. You can determine if your practice needs a second language,marketing portals and other ‘nice to haves’, denoting their importance in a prioritized list.EHR selection survival guidePage 7CMCONVERTED MEDIA

CREATE YOUR VENDOR SHORTLISTOnce you have your practice requirements delineated and prioritized, you must begin to researchand shortlist available vendors.One of the best ways to gather vendor options is by turning to your fellow professionals. Yourprofessional network offers a wealth of experience and knowledge regarding systems they haveworked with in the past. As a professional courtesy, they should happily share their experienceswith you. Professional networking sites like LinkedIn, offer an easy way to connect with fellowhealthcare professionals.It is also important to look to your professional association for insight. As an example, members ofthe American Physical Therapy Association can connect with other physical therapists in varioussettings and with various experience levels. Reach out for advice and insight. Ask specific questionsrelated to your prioritized list of EHR requirements. Speak with past employers and formercolleagues that have moved on to other practices. Ask what they are using and determine theirlevel of satisfaction. Do not automatically discount an EHR vendor from one bad review, but knowthat personal experience is usually very valuable.OBJECTIVE SEARCH STRATEGIESRecommendations from colleagues are a great start, but it is necessary to include more objectivesearch strategies. Try reaching out to insurance companies you work with regularly. Insurancerepresentatives can provide insight as to which vendor they have had the most success with andwill know what documentation system best meets the needs of their claims. You will also wantto shortlist systems that works seamlessly with your payment source so you are not delayingreimbursement.You may also consider using an EHR consultant to assist in the development of your shortlist.There are companies that work exclusively to improve the efficiency and profitability of medicalpractices. These consultants are knowledgeable about many EHR systems, and may be able toadvise on the system best suited to your practice.However, know that many of these companies charge a very steep rate to execute the difficult taskof choosing an appropriate EHR vendor. In addition, they may require an ongoing royalty paymentfor future revenue. Be sure to define these financial obligations up front before committing.valuable data that can measure the efficacy of population-based health measures.EHR selection survival guidePage 8CMCONVERTED MEDIA

You will likely perform an online search for EHR. Be cautious here. Just because a vendor hasinvested heavily in marketing to ensure search prominence, does not make it the best system.Consider researching top EHR vendor survey results instead. Medscape, Black Book MarketResearch, and Medical Economics all publish independent survey results, ranking EHR vendors on arange of criteria. Most of this information is accessible online at no cost.The above methods should provide you with enough information to able to finalize your EHRvendor shortlist. You can then move onto some direct research on the vendor’s site before makingdirect contact and sending out RFPs.EHR selection survival guidePage 9CMCONVERTED MEDIA

SEND OUT RFPS TO SHORTLISTED VENDORSOnce you know what you require from your EHR system, you need to identify the vendor that canmeet these needs. In addition, you need to be sure your vendor can give you what you want withina reasonable budget. A useful weapon in your EHR selection arsenal is an RFP (Request for Proposal) document.PROVIDING CONTEXT FOR YOUR EHR PROPOSALSAn RFP is simply a document asking vendors to provide information you will need to make adecision when choosing an EHR system. You will outline your needs and vendors will provide youwith information on their services as well as the cost of these services.Your RFP must clearly outline the goals, specialties, and clinical specifications of your practice. Youshould also identify the top priorities for your new EHR system. Be sure to include a basic timelineyou need for submitting the proposal, in addition to the timeline you will need services initiated inyour practice. If the vendors have basic, clear information about your needs, then they will be ableto better describe their features in the context of your practice.HOW TO STRUCTURE YOUR RFPIn your RFP, request proposals are structured in a certain way, to allow you to easily compare. Youneed to be able to attain specific information (timeframe, cost, implementation, training etc) clearly.You do not want to be searching a document for this information.Obviously, what goes in your RFP will depend on the requirements you mapped out before creatingyour RFP. However, the template below provides a good basic structure which you can customizeto your needs:Pitfalls in this typically stem from poor communication of what your practice needs. If you are notclear on your EHR requirements, a vendor will not be able to decipher your practice needs.In addition, it is essential to provide realistic timeframes, as companies cannot put together aquality, custom proposal in only one day.EHR selection survival guidePage 10CMCONVERTED MEDIA

RFP sectionWhat to includeIn a nutshell: why you want a new EHR. Tie this to the fundamental needsProject purposeof your practice, referencing your practice’s background and specialty,your current EHR system and why you want to replace itBaseline projectlimitationsEstablish absolute timing and budgetary constraints. These limitations willhelp vendors get a sense of the scale of your project and whether theywould be a good fit for youLay out a timeframe for each of your selection and implementation stepsup to system go live (When will you be scheduling demos? When are youTimelinelooking to make a final selection decision? When do you aim to have yournew system up and running?)Essentially the specific products and services the vendor should deliver.Give each requirement a separate section in your RFP and detail itspriority. You can also specify whether you need this out of the box, orthrough customization/integration.Don’t forget: these aren’t just your feature requirements. Also includeRequirements Legal compliance features, including HIPAA and required functionalcoding abilities Technical requirements, such as deployment method, integrationrequirements, mobile requirements Support requirements -what sort of support package do you want? Is24/7 phone support with a dedicated account manager essential, orwould email support suffice?VendorAsk the vendor to provide information on the implementation packageimplementationthey offer and projected costs. Ask for details of their implementationservicesteam, and their skills and experience.Other vendorqualificationsLook outside the EHR and ask about what you want in a partner. Thiscan include the uptime of their cloud services, or company culturerequirementsProvide a deadline for responses and guidelines for RFP responses. AProposal evaluationgood way of ensuring that responses are uniform (and easy to evaluate)criteriais by including a template for responses. Detail how you’ll be evaluatingresponses and when you expect to reply to successful proposalsAsk for at least two references from practices similar to yours who haveReferencesimplemented the vendor’s EHR system, including contact details so youcan check up on themA template structure for your EHR RFPEHR selection survival guidePage 11CMCONVERTED MEDIA

EVALUATE RESPONSES TO YOUR EHR RFPWhen you receive vendor responses to your EHR RFP, you will have the challenging but ultimatelyrewarding task of evaluating your EHR vendor shortlist.Whilst you go through your RFP responses, keep this one thing in mind: your EHR vendor willbecome a partner to your practice.It is easy to think of a vendor as an adversary or nuisance because of the high cost of theirproducts. You will need to change your mindset and think of them as a partner. With the right EHR,you can deliver a higher standard of patient care, smooth out your billing workflows, and streamlinepractice operations. To realize these benefits, you need to ensure not only that your vendor canmeet your requirements, but that you can establish a solid, mutually respectful working relationshipwith them.ASSESS POTENTIAL VENDORS’ COMPANY CULTUREIt is therefore very important to evaluate the company’s operations and professionalism as well asthe EHR system’s technicalities.When you receive the proposals, make a note of the timeliness and completeness of each. It maysound simple, but each EHR vendor proposal provides the first idea of how the software will fit withthe context of your business. Each proposal should be well organized and submitted within yourrequested timeframe.In addition, the proposals should address each of your EHR requirements. These components areexcellent indicators of the company’s professionalism and attention to detail. You want to hire avendor that is timely and respects your needs.ASSESS VENDORS’ RESPONSE TO YOUR REQUIREMENTSThe next step in evaluating your EHR vendor shortlist is to cross-reference each proposal with thelist of prioritized requirements you developed for your EHR system.EHR selection survival guidePage 12CMCONVERTED MEDIA

Focusing on your top three priorities, analyze how closely each proposal meets your needs.Evaluating a system by grading the extent to which each requirement is satisfied. Keep it simple,and don’t leave room for over-analysis. A grading system involving something as simple as a 3- or5-point scale works well. Assign low scores to proposal sections that do not satisfy your needs andhigh scores to those that address your requirements accurately and extensively. This may soundlike an oversimplification, but if you have accurately prioritized requirements during the previoussteps, your evaluation process should be simple.Of course, cost will be of great importance, so if you find a proposal that is completely out of yourbudget, you can easily remove it from your list. However, remember there is typically some roomfor negotiation when it comes to costs. You should also consider the fact that a quality EHR systemis highly valuable to your practice, so expect to pay for this quality.EHR selection survival guidePage 13CMCONVERTED MEDIA

INVITE TOP VENDORS TO DEMO THEIR EHRAfter you have identified the vendors that best match your needs, it is time to see the EHRsystems in action. To do this, you will need to conduct software demonstrations with the vendorrepresentatives. You will want to limit your software demonstrations to three to five vendors toavoid confusion and simplify your process.Contact each vendor from the shortlist and set up a time for demonstration a week or two aheadof time so you can be organized and include your key stakeholders and selection committee inthe process. Inform your vendor contact you are interested in seeing a software demonstration atyour practice location. Give him or her a list of points you would like covered in your meeting so thesales representative can prepare accordingly.THE IMPORTANCE OF CONTROLTo ensure demonstrations are beneficial and informative, it is important to stay in control of theprocess. Typically, the vendor representative will be a salesperson who will show you all the bestfeatures of their system. However, you need to find out how the system will work in your practice,not in the ideal world of a hypothetical practice. Since you already asked for specific topics to becovered when you set up the meeting, you should have a head start here.During your product demonstration, be sure to have your key stakeholders present, includingclinicians, operations management, and administration team members. Allow your clinicians to askquestions regarding the input/workflow/billing of a specific patient situation.Create a “real-life” problem, and ask the representative to show you how it would be documentedin the system. This will allow you to better analyze ease of use and functionality within the contextof your clinic. Don’t just ask, “How would I input a patient history?” Instead, ask the representative,“How would I input a past medical history, patient complaint, pain rating scale, vitals, and planof care?” You will get a much more detailed indication of the completeness and efficiency of thesystem.EHR selection survival guidePage 14CMCONVERTED MEDIA

EVALUATING YOUR EHR VENDOR DEMOSThe process here is similar to the one you used to evaluate RFPs. Create a scorecard based onyour clinic’s top priorities. Rate each component for each vendor and include a section on yourscorecard for miscellaneous notes. Pay attention to ease of use. If it seems like the representativeis clicking his or her mouse far too often, the system may be cumbersome to use.Avoid making the mistake of missing out on important feedback. You need input from your clinicalstaff because they will be using the system each day. Make sure you encourage them to ask realclinical questions and explore how clinical scenarios will be documented in the system.Avoid letting the sales representative focus on all the wonderful assets of the system with aninspirational sales pitch. Be sure to take control of the meeting with respectful and direct questions.Keep your scorecards handy, and write down comments as you progress through the meeting.Don’t wait until later to analyze the demonstration and system.EHR selection survival guidePage 15CMCONVERTED MEDIA

MAKE YOUR FINAL DECISIONBased on software demonstrations, proposals and many hours of analysis you should now be ableto make a final decision on your perfect EHR system. It is never that simple though.Know that no EHR system will give you everything you desire. When you find a great system thatmeets the needs of your practice, you will likely have an issue with the cost being higher than youhoped. Remember, you are looking for a system with a high value to your clinic. If your clinic canafford to pay for the system (even though it is not your cheapest option) and you feel it will addvalue to your practice, then it is likely the right choice, even if the finance department disagrees.FINAL DECISION FACTORSOne of the factors that will affect your final purchase decision will be how well the clinical,operations, and administrative team members responded to the proposals and demonstrations.Foremost, you want your clinical staff members to feel they have their needs met. Give theiropinions high merit, as the clinicians will be using the system day in and day out.If you choose an EHR system based on user needs, you will have greater user buy in. Simple as that.Your clinical staff members will be pleased you met their needs and this sense of acknowledgementwill spread throughout the practice.Determine timelines for staff training. You will need a vendor that can provide ongoing staff trainingfor regular intervals for several months. The vendor should also have readily available customerservice support via phone or internet conferencing. Analyze what technical equipment you haveand what equipment you may need to purchase to institute the new system. Hopefully you chosea system with your hardware landscape in mind, but if not, ensure you identify where your currentsystems fall short.THE EHR CONTRACTWhen you have identified your preferred vendor and determined they can meet your clinicalsystem and training needs, you will need to create a software contract.EHR selection survival guidePage 16CMCONVERTED MEDIA

Many vendors have their own software contracts pre-produced for adding new clients. If not, youmay choose to create your own software contract with the help from your practice legal team.Your contract document must include information regarding pricing and payment plans. You willlikely pay an implementation cost upfront and then pay for continued use for each user on SaaSbasis unless you have opted for a perpetual license. Review the document and be sure to includespecifics about your practice, including number of users, locations, and billing specifications. Haveyour lawyers review the document for completeness and to ensure all specifications are met.Once the software contract is complete and finalized, you can look forward to the next phase ofyour EHR journey; the looming specter of implementation.EHR selection survival guidePage 17CMCONVERTED MEDIA

EHR SELECTION CHECKLISTCREATE YOUR EHR SELECTION TEAMIdentify key stakeholder groupsRecruit representatives from each stakeholder rapistsAdmin teamOperations teamBilling teamAccountantsInsuranceSenior managementIT departmentFind a C-level sponsor for your EHR selection projectAppoint a project manager(Optional): hire and onboard an EHR selection consultantCONDUCT AN EHR REQUIREMENTS GATHERING EXERCISEIdentify weaknesses of current system and how a new EHR would change thingsIdentify key user groupsIdentify patient populations you need to document (e.g. pediatrics, geriatrics, outpatientinpatient, hospital systems, specialty niche)Survey current hardware and decide whether you need to replace itEHR selection survival guidePage 18CMCONVERTED MEDIA

Identify key requirements across all areas:compliance and insurance documentation requirements (e.g. HIPAA, Meaningful Use)feature requirements (e.g. lab integration, e-prescribing, patient portal)whether you need any non-clinical features (e.g practice management, billing, reporting)technical requirements (e.g. deployment method, mobile access, integration)support requirements (e.g. phone support, email support, dedicated account manager)Prioritize your requirements into ‘essential’, ‘like-to-have’ and ‘bonus’ categoriesCREATE A VENDOR SHORTLISTConduct online researchComparison tools and review sitesVendor websitesOnline networks (LinkedIn, Quora, user forums)EHR software surveys (Medscape, Black Book Market Research, Medical Economics)Mobilize your professional networkReach out to former colleagues for recommendationsReach out to members of your professional organization for recommendationsAsk current colleagues for recommendations from previous jobsSEND OUT AN RFP TO SHORTLISTED VENDORS AND EVALUATE RESPONSESCreate your RFP document, including:Project purpose (why you want a new EHR)Baseline project limitations (cost limitations, timescale limitations)A timeline for your selection project, from the RFP stage to system go-liveSections for your key requirements:Feature requirementsTechnical requirementsSupport requirementsCompliance requirementsEHR selection survival guidePage 19CMCONVERTED MEDIA

Request for implementation services informationA deadline for responsesAsk current colleagues for recommendations from previous jobsProposal evaluation criteriaRequest for referencesEvaluate your RFP responses:Disregard late or incomplete proposalsAgree on a scale for evaluating responsesAgree on a deadline for each selection team member to read and evaluate responsesAverage out scores for each proposalInvite to three to five best-performing vendors to software demoCONDUCT AND EVALUATE EHR VENDOR DEMONSTRATIONSEstablish how many people will be attending demosBook suitably sized meeting roomBook suitable amount of inter-demo refreshmentsEnsure attendees block time out of their regular work day - particularly important forclinical staff who might otherwise expected to be on callAsk vendors what hardware they need to conduct their demo (e.g computer, projector, tablet)and ensure it is availableSend demo script to vendors to ensure all your key requirements are coveredCreate example scenarios to run through during presentationAgree on a scale and method for evaluating vendor demos, and the criteria used to make afinal selection decisionCreate scorecards for each demo and ensure all attendees complete during each demoAttend and score each vendor demoAverage out scores to identify top-performing systemsEHR selection survival guidePage 20CMCONVERTED MEDIA

MAKE YOUR FINAL SELECTION DECISIONGather your selection team to discuss pros and cons of each systemMake your decisionIdentify a ‘second choice’ in case contract negotiations fall throughReach out to preferred vendor regarding contract negotiationsConsult your practice’s legal team for help drawing up contractDraw up and negotiate your contract, including clear details onPricing and payment plansImplementation feesNumber of usersLocationsBilling specificationsProof-read final draft of contract and sign off with practice’s legal team before proceedingfurtherSign contractBegin preparations for EHR implementationEHR selection survival guidePage 21CMCONVERTED MEDIA

This guide was written by Jeff Green & Amy Vant, EHR in Practice columnists, withcontributions from Kathryn Beeson, EHR in Practice EditorFor more exclusive EHR advice and resources follow EHR in Practice on social mediaThis guide was brought to you by www.ehrinpractice.comIcons made by Freepik, www.flaticon.com licensed by CC BY 3.0EHR selection survival guidePage 22CMCONVERTED MEDIA

The process of selecting an EHR system is daunting. Technology businesses are well aware of the required transition for most health practices to move from paper to electronic health record keeping. Because of this vendor awareness, the EHR market is ever-expanding, making the job of selecting the