BOSTON Choosing an electronic health record for your practice involves a comprehensive readiness and needs assessment, according to participants in a congress sponsored by the American Medical Informatics Association.
A group of about 100 physicians, nurse "informaticians," clinical informaticians, pharmacists, consultants, and others met during AMIA's spring congress to brainstorm ideas about how best to select an EHR.
Participants in the work group, who had a range of experience with electronic health records, contributed their advice, which was then condensed into a short presentation given at the close of the AMIA meeting.
The work group made recommendations in several areas.
Readiness Assessment
Develop an information strategy. The first step is to figure out the organization's information strategy by determining goals, the information needed to achieve those goals, and how the information needs to be accessed.
"If you don't have an information strategy, first and foremost, you're really not ready," said Eric Rose, M.D., a physician consultant for IDX Systems in Seattle, who presented the recommendations from the AMIA workshop on selecting an EHR.
Develop an education strategy. Once an information strategy is in place, the practice needs an education strategy for getting everyone up to speed on the EHR product selection process.
Let everyone in the organization know this is a business transformation process, not an IT project.
Don't try to nail down costs too precisely. While it's important to have a budget, practices also need to recognize that some of the costs will be unpredictable, the group advised.
Determine the capabilities, willingness, and expectations of everyone in the practice.
Needs Assessment
Next, practices should assess their needs in terms of features and functions, the work group concluded.
Focus on "pain points" to uncover functional requirements. "Don't ask people what you want the EHR to do for you, ask people where does it hurt," Dr. Rose suggested.
Figure out the organization-wide goals and objectives to determine its EHR needs.
Assess your in-house IT expertise to determine desirable features. If the practice employs a skilled database analyst, it may not need an EHR with built-in reporting functionality, Dr. Rose said.
Use available resources on successful needs assessment processes. For example, the Healthcare Information and Management Systems Society has an online selector for electronic health records at
How to Write an RFP
Once the practice has taken stock of its needs, they can begin to write a request for proposals (RFP).
Keep it simple. "The more complex your RFP is, the more complex the responses will be," Dr. Rose said.
Address all aspects of the practice's relationship with the vendor in the RFP. An RFP should ask: What training options are available? How much will training cost? How do software upgrades work? How will the vendor work with third-party vendors?
Ask vendors to differentiate themselves from the competition. The RFP is one way to get vendors to tell you what they can offer that is different or better than other companies.
Involve all clinical disciplines in RFP development.
Establish a straightforward, replicable assessment process before sending out the RFP. Practices should be able to redo the RFP in case the procurement process is derailed or one of the key staff members leaves the practice.
Site Visits and Demos
When a practice has narrowed down its choice of vendors, the physicians and administrators may want to begin demonstrations and site visits to test the products.
Consider site visit locations other than those suggested by the vendor. The AMIA group recommended that physicians do their own research to find out who is using a vendor's software. Don't just call the references on a vendor's list, seek out independent sources, the work group reported.
Call ahead when conducting site visits. Practices should try to make the most of the visit by calling ahead and making sure they are visiting a similar organization. The site visit team should collect contact information to bring back for those staff members who couldn't attend the site visit but may want to ask follow-up questions over the phone.
In scripted demonstrations, hold back some portion to be revealed at the time of the demo. The AMIA group suggested that practice representatives ask a few unplanned questions to get around some the lack of transparency in the scripted process.
Make scoring simple and explicit.