Understanding the EHR
Marketplace HIT Toolkit
Health Information
Technology Toolkit
for Critical Access
and Small Hospitals
http://www.stratishealth.org/HIT_Toolkit_hospitals
Presenter
• Margret Amatayakul
RHIA, CHPS, CPHIT, CPEHR, FHIMSS
President, Margret\A Consulting, LLC
Schaumburg, IL
• Independent consultant, who focuses on achieving value from
electronic health records, HIPAA/HITECH, and health information
exchange. Developer of tools in Toolkit
• Adjunct faculty College of St. Scholastica, Duluth, MN, masters
program in health informatics
• Founder and former executive director Computer-based Patient
Record Institute, associate executive director AHIMA, associate
professor University of Illinois
• Active participant in standards development, former HIMSS BOD,
and co-founder of and faculty for Health IT Certification
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Stratis Health
● Stratis Health is a nonprofit organization that leads
collaboration and innovation in health care quality
and safety, and serves as a trusted expert in
facilitating improvement for people and communities
● Stratis Health works toward its mission through
initiatives funded by federal and state government
contracts, and community and foundation grants,
including serving as Minnesota’s Medicare Quality
Improvement Organization (QIO)
● Stratis Health operates the Health Information
Technology Services Center for health care
organizations seeking to use health information
technology in support of their clinical transformation
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Agenda
• What are you buying?
• Vendor state of affairs
• Interoperability
• Requirements analysis
• Going to market with request for proposal
• Key differentiators
• Due diligence
• Contracting
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What are you buying?
EHR Migration Path
Timeline
Current
Goals
Applications:
- Financial/
Administrative
- Operational
- Clinical
Technology
- Database
- Network &
Infrastructure
- Interfaces
Operations
- People
- Policy
- Process
R-ADT/MPI
Patient Accounting
Payroll/T&A
Laboratory IS
Pharmacy IS
Home Health IS
Results Retrieval
D.M. Registry
Frame Relay
IT Director
Phase I
Phase II
Phase N
Support ambulatory
Patient safety
Quality of care
PM System
Radiology IS
EDMS
Order Communication
Provider Portal
E-prescribing
POC Documentation
BC-MAR
PACS
CPOE
Ambulatory EHR
CDR
WLAN
Tablets
T1
Unit Dose Packager
1 FTE Pharmacist
Retail Pharmacy
Readiness
Critical Pathways
Clinical Guidelines
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Reality for Many Small and Rural
Communities
• Buy from incumbent
– What incumbent offers
• Or
– Depend on standalone systems
– Utilize expensive interfaces
– Wait for the vendor to catch up
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Vendor State of Affairs/CCHIT
(Certification Commission for Health Information Technology)
Total Number of Ambulatory EHR Vendors
CCHIT
CCHIT Certified
# EHR
vendors
w/same
name as
previous
year on
annual
EHR
market
survey
250
Estimates
24 Acute
Care
EHR
Vendors
CCHIT
Certified
0
200
150
100
50
LTC
# Vendors*
2005
2008
No CCHIT
Certification
•Source:
Provider
1995
1997
1999
2003 2008A 2008H LTC
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Interoperability vs. Functionality
180 pages of functional requirements
for NH
Interfaced
Integrated
Connected

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Institute of Medicine EHR Core Functionality
• Health Information &
Data
• Results Management
• Order
Entry/Management
• Decision Support
• Electronic communication
& connectivity
• Patient support
• Administrative processes
• Reporting & population
health management
● Describes detailed
www.nap.edu/catalog/10781.html
functionality along ● For:
o Hospitals
a timeline:
o 2004-5
o 2006-7
o 2008-10
o Ambulatory
o Long term care
o Care in the community
(personal health records)
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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HL7 EHR – System Functional Model
(www.hl7.org/ehr)
• Direct Care
– Care management
– Clinical decision support
– Operations management
& communication
• Information
infrastructure
• Supportive
– Clinical support
– Measurement, analysis,
research & reports
– Administrative & financial
Initial focus of CCHIT certification
for ambulatory care (www.cchit.org)
– Security
– Health record information
& management
– Registry & directory
services
– Standard terminologies &
terminology services
– Standards-based
interoperability
– Business rules
management
– Workflow management
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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CCHIT 2007 Hospital Certification
Specialty Clinical Applications
Intensive
Care
Perioperative/
Surgical
Cardiology
Oncology
Emergency
Medicine
Labor &
Delivery
Departmental Clinical Applications
Imaging
Blood
Bank
Inpatient
Pharmacy
Lab
Dietary/
Nutrition
Radiology
Core Clinical Applications
Clinical
Documentation
CPOE
EMAR
Results
Management
Reporting
EHR Foundation
R-ADT, Order Communication
Medicine
Dispensing
Devices
Robotics
Smart
Infusion
Pumps
Monitoring
Equipment
“Smart” Peripherals
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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Do Your Own Functional
Requirements Analysis
• Work flow and process
mapping
• Goal setting
• Scenario development
• Use case analysis
•
•
•
•
•
•
Performance-based RFP
Due diligence
Contract
System build
Testing and Training
Benefits realization
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Triangulate Information from
Product Resources to Narrow Field
•
Trade publication product lists
•
Web searches
•
Professional organization trade shows
•
User groups
•
Recommendation lists
•
Peer experience
•
Recognition or award programs
•
Product certification
– Self-reported, but most complete and permits side-by-side review
– Likely to reveal most aggressive vendors with no side-by-side screening
capability, but often provides demos
– Good way to get educated on the “possible” but may include an eclectic mix of
established vendors and those only exploring the marketplace
– Provides “bird’s eye view” of many users outside the context of a selection
process and may yield great objectivity and potential candidates for due diligence
– Compiled by professional organizations or other groups for specific purposes
– Interesting but criteria may not match yours; positive experience is good to know,
negative experience may be unique and due to poor planning
– Some are more objective than others, but consistency in appearance is helpful
– Certification Commission for Healthcare Information Technology
– Proprietary vendors of product analysis tools are also resources
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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Used with permission of Medical Strategic Planning
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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*Key
Differentiators
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Due Diligence
• Functionality is very important, and vendors under consideration
should provide type of functionality you want. For example, don’t
look at a vendor that only supplies clinical messaging or
document management if you want full EHR functionality
• Other factors are also very important, for example:
– What is the vendor’s reputation for help with implementation and
ongoing support?
• Does the vendor provide local support? Is there an established local
presence of users to provide community support?
– How long has the vendor been in business?
• With a dynamic marketplace, the vendor should have at least survived
their initial few years
• But the trade off in acquiring an EHR from a long-established vendor
may not be the latest technology or most comprehensive clinical
functionality!
• Check these other characteristics through performance-based
demonstrations, site visits, and reference checks; but . . .
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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Contract Negotiation
• Negotiation is an iterative
process of give and take
• Do not plan to work out details
after contract is signed. There is
no leverage after contract signing
• Get it in writing. What you are
told in demos, see on site visits,
or are promised by sales staff
have no contractual impact.
• Maintain validity of business
points
• Keep a list of contract issues and
resolutions
• Read and verify the final contract
version prior to signing
• Manage to the contract
Vendor
Buyer
Down payment
50%
10%
Software install
25%
10%
# days after software install
25%
Schedule
Completion of training
20%
Completion of testing
20%
Go live
20%
90 days after go live
20%
Price is an offer to sell
Cost is what you pay to vendor
Total cost of ownership is all costs
Payment is transfer of funds.
Value is what you get
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Questions to Consider . . .
• What are you planning to acquire next to help you
enhance your clinical information systems?
• Are you planning to go to market?
– If not originally, how might doing so help you?
– If so, how can you avoid “analysis paralysis” in light of so
many vendor offerings?
• If you decide not to go to market, will you do some
due diligence before acquiring the next component
from your incumbent to assure you have the
technology, people, policy, and process in place to
support your new acquisition?
Copyright © 2005-8, Margret\A Consulting, LLC. Used with permission of author.
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For More Support
Contact:
Stratis Health
2901 Metro Dr., Suite 400
Bloomington, MN 55425
952-854-3306
1-877-787-2847 (toll free)
www.stratishealth.org
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