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Six Questions Every Hospital Should Ask an EHR Vendor
By Theresa Meadows, RN, MS, FHIMSS

In today’s increasingly complex world of medicine, perhaps one of the largest undertakings for healthcare organizations is converting paper records to a streamlined EMR system. Whether you’re part of a major multifacility system in a metropolitan area or a small independent hospital, the process of converting to an EHR system is a huge process—one that involves a great deal of resources both financially and organizationally.

Yet with the governmental pressure on hospitals that fail to make the switch and the need to become compliant with initiatives such as meaningful use, HIPAA 5010, and ANSI 5010, many healthcare executives and physicians alike may feel pressured to adopt the first EHR system they come across—a decision that could prove disastrous.

While there is no guaranteed way to navigate a vendor vetting process, establishing the specific functions and features that are important to your organization will help the search committee make an informed decision. With this in mind, here are six questions every organization should ask each EHR vendor they vet:

1. What is the vendor’s track record for providing IT services to hospitals? As if interviewing a job candidate, this is where you essentially ask the vendor to “tell us a little about yourself.” This should always be the first question in the vetting process because it sets the stage for not just the entire first meeting but can give insights into the type of working relationship you may have with the vendor. Each vendor is trying to court you, so they’re trying to put their best foot forward; thus it’s your job to cut through the marketing speak and look beyond the software itself.

Some of the factors to examine include the following:

• How long has the vendor been in business? How many employees work for it? What portion of the employee base is devoted to support? Are any of the support staff local?
• How long has the vendor’s EHR suite been on the market?
• How many live sites does the vendor have? Here it’s perfectly acceptable to inquire about references and case studies to confirm the vendor’s experience.
• Does the vendor monitor customer satisfaction? If so, what is the satisfaction rating? What is the customer retention rate?
• How solvent is the vendor’s company? (This information can be tough to procure if the vendor isn’t publicly traded.) Request a copy of the vendor’s annual financial reports.
• Request references to ascertain feedback from current customers.

2. How will the vendor’s software interface with other important systems regularly used within the organization? Making the switch from paper to electronic records is all well and good, but the vendor’s software also must seamlessly integrate with other important systems used by physicians on a regular basis, namely for lab work and medical devices. Quite often, these issues arise only after the implementation, so it’s important to address this head on and make sure you’re clear as to what the vendor’s EHR system can and can’t interface with and what the associated costs will be for these interfaces. Are there costs to develop, implement, and maintain interfaces? Also inquire as to whether the vendor supports industry standard protocols.

3. What precautions are being taken to prevent data breaches, and where do the data reside? Security is one of the biggest areas to explore when vetting a vendor, particularly if you are a large institution servicing thousands of patients daily. Not only is it important to safeguard the data, but you also must be comfortable as to where the data reside. Is this something the hospital will host on site or will the vendor store it? Or do you both “share custody”? Is the EHR system server or cloud based? What type of certifications does the vendor have regarding data security? How does the vendor test or monitor vulnerabilities?

4. How will the system be implemented, and how will training be carried out? Implementations vary greatly from vendor to vendor. It’s important to clarify whether the vendor will personally set up the system and how much time it will take for physicians and staff to train on the new system and associated protocols. Does the vendor offer online learning tools to accommodate varying staff schedules? It’s also important to ask if parallel systems can be run to ensure a smooth transition.

5. What is the time frame associated with updating the system to handle new regulatory and compliance mandates such as stage 2 meaningful use and ICD-10? Once the system is up and running, the organization must ensure that any updates require minimum downtime. It’s important to clarify whether there are additional costs associated with each update, how long they will take, whether any new training will be required, and whether the organization will be responsible for any part of the updates from a technical standpoint. You also should consider the frequency of the vendor updates, the types of resources required to install the updates, and how many releases the vendor will support. The timing of the release update process is critical to understanding a vendor’s commitment to meeting the changing regulatory and compliance mandates.

6. What happens if the system crashes, and what is the ratio of system fails? Any system failure can be catastrophic, so you’ll want to ensure that questions associated with a system blackout are addressed, planned for, and well documented within the contract. As unpleasant as it is to discuss, every conceivable scenario must be considered to ensure that should something happen, the chaos is contained—as is all the data. How confident is the vendor in its system reliability and stability? Ask the vendor about up-time guarantees or how it supports a redundant infrastructure.

Obviously, depending on your organization’s needs, there will be many more questions to pose. However, the list above should help put everyone involved in the vetting process on the same page and make sure that whichever system is chosen, it’s the right one for the organization.

— Theresa Meadows, RN, MS, FHIMSS, is senior vice president and chief information officer for Cook Children’s Health Care System in Fort Worth, Texas.