Notes

Outline

Creating An RFP Sarah Corley, M.D., FACP ACP-ASIM Annual Session 2001

Why an RFP? Narrows down candidates Allows EMRs to be evaluated in a systematic fashion Allows for side by side comparison of features

Desired Goals of Your EMR Paperless? More legible? Rx writing only? Notes only? ASP

Features to Consider Scheduling Billing Patient Education Decision Support Drug Interactions

Desired Features Meet with all staff and determine what features are important These should be separated in those that are required and those that are desired

Gathering Data List existing hardware and software that is to be used Consider level of staff training needed Consider who will use the system and how

Background Data What is your budget? Consider both acquisition costs and maintenance costs? What is your practice growth anticipated to be?

Slide 8

Vendor Experience How long have they been in business? In what capacity? # of Programmers, support staff, trainers R&D budget Financial references

Services Included Software Hardware Training Updates Support

Hardware Cost of hardware to run software Minimal and optimal requirements Purchased separately? Maintenance costs/support contracts

Platforms, Data Bases Type of platforms supported NT, Windows, Unix, Novell Are there data base requirements Sequel, Oracle...

Training Cost of training Included in software price? Amount of time for price Scheduling requirements for trainer

Bottom Line COMPLETE cost of software All packages desired Correct number of users All interfaces

Slide 15

Conducting a Vendor Analysis Sarah Corley, M.D., FACP

Vendor Information Http://www.computingforclinicians.com Http://www.cpri.org http://www.yahoo.com/Business_and_Economy/Companies/Health/Software/Health_Care_Management/Practice_Information_Management/Medical_Record_Systems/

Narrowing the Focus Trade shows and meetings ACP_ASIM Annual Session Publications Medical Software Reviews Health Care Informatics

Submit an RFP Narrow request to 2-4 vendors Give reasonable deadline for response Review proposals for completeness as they arrive

Rejection Criteria Record does not have basic functions you require Package is too expensive No sites with similar practices are happy with the software

Evaluate Further If all basic required functions are available If similar practice sites are satisfied If it fits your budget

Slide 22

Vendor Demo Have all available users present Do not allow distractions Allow adequate time for complete demo and questions Make sure all features are shown Try it out yourself

Beware“Vaporware” Features which are too good to be true often are Features that cannot be demonstrated are not yet features! Be sure to create new notes and data during the demo

Selecting Sites to Visit A  practice similar to yours At least 2 years of experience with the system Closest ones that meet above criteria

Site Visit Include a representative from all areas of users. Make sure that members are familiar with computers Gather questions from others who will not be traveling to the site

Site Visit- the M.D. Component Reviewing the chart Writing or dictating a note Writing prescriptions Ordering tests and reviewing results Patient phone calls to the physician

Site Visit- Front Office Staff Internal messages between staff Outside requests for charts Internal requests for charts Insurance requests for information Review of transcription Making appointments

Site Visit- Quality Coordinator Audit reports Missing progress notes Unsigned notes Non-reviewed results Health maintenance compliance Documenting no-shows

Site Visit- Nursing Phone messages Prescription refills Entering vital signs, medications, and chief complaint Recording procedures

Site Visit- Lab Interfaces with equipment in office Interfaces with outside labs Test ordering Results Reporting Specimen tracking Quality/ Accuracy monitoring

Questions To Ask How dependable is the system? Any hidden costs? How often are upgrades done? Is vendor responsive to suggestions for upgrades?

Slide 33

Negotiating a Contract Sarah Corley, M.D., FACP

Consider Your Strengths for Possible Discounts Discounts are often given for larger installs Discounts may be given if you can have a several physicians or groups in your area who all purchase a system at the same time

Consider Vendor Factors for Possible Discounts Small number of installs New product New to geographic location

Hardware Manufacturer Cost Service Installation

Network Cable vs. wireless Network software Network cards Network maintenance

Pre-Implementation Assistance to be provided Time frame of assistance Costs if any

Software Modules included cost for adding them later Maximum users cost for additional users Upgrades frequency and costs

Training Number to be trained Hours to be provided Costs of additional training On site vs. distant

Customization Set up forms/demographics/codes try to negotiate a flat rate Set up lab interfaces try to negotiate a flat rate Templates costs for upgrades and customized creation

Technical Support Who provides this local or central Hours of operation costs for extended hours Hours of support provided flat rate vs. hourly charges for additional support

Slide 44

Slide 45

Implementation Issues Sarah T. Corley, MD, FACP

Planning the Implementation Involve everyone whom the EMR will impact Coordinate your “People Strategy” and “Technical Strategy” Use project management software Consider using a consultant

Involve all users in planning Develop user groups Physician user group Nursing user group Office user group Lab user group Meet regularly Make assignments & require input Make it fun

Project Management Software Gantt Chart with time lines Defines tasks, responsibilities, & resources Keeps goals realistic Helps ensure commitment of team members

Timing of Activation The Glacier Approach Function by function, practitioner by practitioner Less pain for a longer period of time Greater opportunity for bad habits & work-arounds

Timing of Activation The “big bang” approach All functions, al users, all at once More pain for less time Better chance of full implementation

Timing of Activation Department by Department Perhaps the best approach for large multi specialty practices Start with most motivated group Play up success Track efficiencies and improved productivity

When you go paperless Plan for the change in practice work flow No filing or hunting for paper charts but scanning and loading of outside results must be done Exam rooms may need to change

Slide 54

Slide 55

Outside Providers Talk to referring/referral sources Explain cost savings of sending reports/referrals electronically Develop HIPAA compliance plan

Slide 57