Vendor assessment

Vendor selection can be daunting. Consider the following factors when evaluating specific HIT vendors and their products. For vendor-assessment checklists and worksheets, go to our tools section.

The basics:

• Be sure to use the tips learned during your self-assessment. Apply those details to your assessment of vendors' products and services.
• Consider cost, technical requirements, service and updates, technical support and education services.
• Work with each part of your practice to compile key questions that apply to their work.
• Make sure to have representatives from your staff help in the decision process.
• Use CCHIT and other certification organizations (i.e., ask if this vendor is CCHIT certified).
• Talk to other doctors and use your community. Ask for referrals, testimonials and recommendations from your vendor, and follow up on these.
• Prepare for HIT vendor demonstrations with detailed questions and requirements.
• Take advantage of trials and test-run offers. You need to know whether the technology is a good fit with your practice.

Initial financing:

• Decide how you will finance your EHR implementation, and whether your vendor fits your budget. Will you purchase your software or lease it? Leasing requires a monthly fee; purchasing may be extremely expensive.
• Will you use an application service provider (ASP), which provides all technology support services? An ASP backs up and upgrades systems off-site at a secure data facility and runs your EMR via web-based operations. Remember: ASPs give reduced prices for hardware and manage all technological maintenance themselves. Client-server models, however, mean that you have purchased the software and hardware, are responsible for all backups and data storage, may have to hire outside technological help and pay for continued servicing of your technology. Even with the client-server model, you may have to pay fees for licensing — fees for each PC using the software (See the "server details" section at the bottom of this page for more information).
• Have you considered receiving a donation from an area hospital? Recent relaxation of anti-kickback and Stark regulations means that hospitals can donate HIT (e.g., EMRs/EHRs and eRx systems) to physician practices without sanctions or losing non-profit tax exemption. Typically your practice will still have to pay for a portion of the service, but this could solve interoperability and cost issues at once, if your area care providers are willing to donate to you.

Set-up costs and your set-up needs: Determine whether you need these services and products, and weigh your options for financing.

• Vendor fees, including support services, training, and implementation.
• Add-ons such as customized templates or upgrades.
• Interfacing systems for interoperability between your EMR and the other systems it needs to “talk to," such as your PMS, lab, diagnostic centers, and area hospitals.
• New PCs for exam rooms, work stations and offices.
• Hardware for networking PCs throughout your practices.
• New printers stationed close to exam rooms.
• Scanners for the conversion of paper charts to EHRs.
• Staff training, loss of productivity during adjustment and potential overtime.

Ongoing needs:  What will you need after the HIT is in place? What will be required in terms of post-implementation care? Consider:

• Leasing prices from the software vendor. Some software vendors require licensing payments per PC.
• Maintenance fees such as upgrades, additional customizing.
• Continuing technological support for hardware and software.
• High-speed internet connections.
• Security, firewall and virus protections.
• Back-up procedures and additional storage for back-ups.
• Continued training for new staff or providers.

Functionality and usability:  Spend as much time as possible with vendors’ products. The feel of HIT software may eliminate it from consideration, or it may win your favor. Consider:

• How well does a system transition between activities? Can you move easily between one function and another, between documentation and prescribing, for example?
• Is your basic clinical documentation comfortable? Can you dictate or type, depending on your preference? Can you cut and paste? Are elements of the record pre-populated (allergies, date and time, previous visit, recent labs, etc.)?
• Are the built-in visit templates appropriate for you? Are the templated elements preferable — are the data fields those you use?
• Can you generate relevant reports if you need and want to? Will the system allow you to isolate all the patients taking a particular medication, for example, or all the patients not seen in the last year?
• Is messaging between staff members and providers simple and convenient?

Be sure to use the list of your practice’s work processes and needs (developed in your self-assessment) to evaluate the elements of particular vendors.
 
Server details: Confused about which server model is right for you?  Here are some considerations.

You may be best served by an ASP if you are:

• A practice with limited financial capital for start-up costs, but can afford a monthly lease agreement.
• A practice with no one in your office to handle technology problems.
• A practice that is unwilling or unprepared to do the self-education required to maintain a network.

Pros of using ASPs include:

• Lower initial/implementation costs.
• Ongoing upgrades, servicing and regular maintenance are included in your monthly lease agreement. 
• Recovery of lost data and backups of data are the responsibility of the ASP.
• You have the potential to “test drive” the ASP since you will not be buying the hardware or software you’re using, but you will pay a regular fee for its use.

Keep in mind that you will engage contractually with an ASP, and that you will have little ability to tailor the system to your needs after the contract is in place.

It may make sense to invest in a server and manage your HIT in-house if you are:

• A practice with an existing technology support staff.
• A practice with a technology expert in-house.
• A practice with significant financial resources for start-up costs and that is ready to invest in hardware.
• A practice that is willing to staff a technology professional.

Pros of using a client-server model include:

• Having network bandwidth to yourself (ie., you won’t have to share network resources with the other clients of your ASP.).
• More independence regarding integration with your PMS or existing software (i.e, you can integrate these things yourself.).
• More control over maintenance and upgrade schedules.
• Being able to easily (if you have the financial resources) change the parameters of your server — adding more space or more PCs to your practice.

Keep in mind that if you choose the client-server model, the vendor and its tech support will handle questions related to the software; you will handle the questions related to the server or the hardware. You will have much larger set-up costs but may see the benefit of smaller ongoing costs than the ASP-served practice.

Whichever set-up you choose, be prepared to ask many questions of your vendor or ASP. Ask what will be required to maintain your system six months, a year, three years, five years down the line. Ask what will happen in case of system failure and how your changing needs will be addressed or accommodated.