Preparation for Vendor Selection

Personal Goals List

1 of 7

1 of 7

This tool is meant to help clinics outline the goals that will guide them in selecting an EHR vendor. Goals can be general, and if you do name specific features, make sure the goal for that feature is also stated.

Step 1: Write down goals that relate to different EMR areas. Use the list of sample goals (page 3) to guide you.

Functionality and Usability: Include rationale for features at left and additional goals and features. For usability, include goals about: tasks often done that must be done fast, peculiarities of the practice such as computer literacy, and desired input method that impact usability.

My goals that relate to functionality/usability:

Company and Service: This list should include, but is not limited to goals about: how established the vendor needs to be (level of risk adversity), what sort of relationship you would like to have with the company (you’re not just buying software, you’re forming a relationship with a company whose software will change over time), internal resources needed to customize and maintain the database, overall support needs, etc.

My goals that relate to company/service:

Price and pricing flexibility: This list should include pricing needs, and whether an ASP (application service provider) option is desired.

My goals that relate to price:

1 of 7

1 of 7

Step 2: Now that you have thought about your EMR goals, check off needed/desired functions from this short list. For a longer list, see pages 4–7. Write additional needed or desired features in the blank boxes.

Desired Functions

Charting/Documentation
(Health Data) / Structured Templates
Voice Recognition
Digital Dictation
Importing of scanned or electronic documents
Patient Summary
Automated Referrals
E&M Coding recommend
e-Prescribing / Digital send of Rx
Electronic fax send of Rx
Drug-Drug Interaction Checking
Drug-Allergy Interaction Checking
Drug-Diagnosis Checking
Lab and Results Management / Interface with laboratory (LabCorp)
Interface with laboratory (Sonora Quest)
Other laboratory interface
Decision Support / Linked to external evidence source
Prompts for visits/health maintenance events
Evidence support for Rx writing
Evidence support for lab ordering
Evidence based order sets
Patient Support / Patient education materials
Patient portal for self-scheduling
Personal Health Record
Care Management / Generate Patient Lists
Produce Care Reminders
Basic reporting available
Possible to do complex queries by multiple criteria
Other / Internal Messaging
Electronic Tasking
Wireless option
Remote connectivity
Practice management / PMS included and integrated with EMR
Ability to interface existing PMS with EMR

Example Goals for Vendor Selection

1 of 7

FUNCTIONALITY/USABILITY

1 of 7

Visit

  • Simplify communication by obtaining functionality that shows the provider and staff where patient is in the visit process
  • Standardize MAs tasks by using templates for common presenting problems
  • Allow maximum ability to customize templates for efficiency and quality improvement at the practice level
  • Minimize implementation and maintenance costs by allowing, but not requiring, minimal customization of templates by each provider
  • Simplify providing patient education by enabling printout of patient education materials on the spot
  • Enhance chronic care by setting up goals for patients and allowing printout of the goals/ compliance
  • Improve formulary compliance and reduce rework by making patient formulary information available to the physician while prescribing
  • Improve patient safety with alerts for potentially hazardous drug-to-drug, allergy, and diagnosis combinations
  • Improve care by making decision support on best practices based on entered symptoms/diagnoses available to the provider
  • Improve care by making medical knowledge sources such as PIER accessible
  • Improve care by using various forms of fully customizable decision support
  • Reduce data entry by interfacing with medical device X
  • Reduce pharmacy calls/call-backs through full e-prescribing with pharmacies
  • Improve the accuracy of coding through system-generated recommendations
  • Enable the provider to complete the note with minimal typing
  • Enable providers to enter data voice or point and click, depending on their style
  • Enable entry of a note quicker than is now possible with paper
  • Allow some providers to continue transcription

Other

  • Formalize communication and task management throughout the office and make everybody accountable
  • Improve communication with other offices through ability to automate and customize referral letters
  • Eliminate paper completely by scanning and capturing old records efficiently
  • Enable capture of charges from PDA for efficiency and minimization of lost charges
  • Be able to access application remotely with no major performance degradation
  • Setup a patient portal for self-scheduling and access to test results
  • Save lab communication costs by enabling mostly automated communication of lab results to patients by mail
  • Interface electronically with pharmacies, minimizing call backs

COMPANY/SERVICE

  • Reduce risk by contracting with an established vendor
  • Contract with a vendor that has the right long-term vision, not necessarily one that has all the features we want right now
  • Minimize office setup and customization required for implementation
  • Get hardware and software technical support from the same source

PRICE

  • Keep within 15 k per provider.
  • Keep cost of system as low as possible
  • Contract with a vendor where we can minimize software costs and help improve the product, e.g. be a beta site

1 of 7

Possible EHR Features*

1 of 7

FUNCTIONAL

1. General Features

  1. For multiple office locations
  2. For multiple users simultaneously
  3. Multiple encounter records on the same patient to be open simultaneously (e.g., phone call plus office visit)
  4. Multiple patient records to be open simultaneously
  1. Workflow Management Tools
  2. Provider schedules
  3. Prioritized task lists by user
  4. On-screen flags to indicate patient visit status
  5. Customized work flows by provider/clinician
  1. Documentation Methods
  2. Note templates
  3. Templates customizable by practice
  4. Templates customizable by provider
  5. Ability to insert free text within templates
  6. Pick lists customizable by practice
  7. Pick lists customizable by provider
  8. Smart lists (e.g. learn / add items as you type)
  9. Free text
  10. Speech recognition for dictation
  11. Dictation / transcription
  12. Anatomical drawings
  13. SOAP charting
  14. Addendum to closed record
  15. Free-hand drawings
  16. Scanned images
  17. Annotations to images
  18. Integrated video imaging
  19. Track episodes of care such as pregnancy
  20. Recall patient’s last menstrual period (LMP) and statuses such as post-hysterectomy, post-menopausal or pregnancy all without user re-entry
  21. Support repeat vital signs readings on the same visit (e.g., repeat pulse, blood pressure)
  22. Support error checking for vital sign data entry
  1. Documentation/results reporting types
  2. Chart notes for visits
  3. Chart notes for phone calls
  4. Emergency room reports
  5. Lab results
  6. Radiology reports
  7. Consultation reports
  8. Discharge summaries
  9. Medication lists
  10. Allergy lists
  11. Problem lists
  12. Growth charts
  13. Patient telephone messaging
  14. Blood pressure lying, sitting, standing
  15. Pulse: oral, radial, pedal, femoral
  16. Temperature: Fahrenheit, Celsius
  17. Height: feet / inches, centimeters
  1. Generating forms
  2. Referral letters
  3. Letter summaries for referring physicians
  4. Summaries for patients
  5. Test report letters to patients
  6. Prescriptions
  7. Forms and letters modifiable by practice
  8. Forms modifiable by location and site
  9. Ability to create custom forms for any purpose
  1. Prompts, Alerts & Reminders
  2. Unfinished patient chart documentation
  3. Spellchecking
  4. Provider alerts for missing charting elements
  5. Electronic team messaging
  1. Medical History
  2. d capture of history & physical exam data
  3. Risk factor tracking
  4. Import of history
  5. Hospital data
  6. Allergy types
  7. Immunizations
  8. Genogram capture
  9. Family history
  1. Charting
  2. Problem-oriented format
  3. Multiple measures of functional status
  4. Health surveys
  5. Current health status
  6. Problem lists
  7. Progress notes
  1. Medication/ Prescription Writing
  2. Drug database
  3. Maintains multiple formularies
  4. Formulary linked to patient benefits
  5. Cost information
  6. Dosage algorithms
  7. Allergen type
  8. Drug–allergy checking
  9. Drug-drug interaction checking
  10. Drug-food checking
  11. Drug administration info
  12. Weight-based dosing
  13. Prescription renewal
  14. Access to online Rx reference tools
  15. BSA (body surface area) calculation
  16. BMR (basal metabolic rate) calculation
  17. Co-signature required based on security
  18. Identifies current, expired, historical medications
  19. Notes “Dispensed as Written”
  20. Fax and remote printing of prescriptions
  1. Order Management
  2. On-line ordering
  3. Order cancellation
  4. “Most common list” of orders
  5. “Most common list” varied by provider/clinician
  6. Automatic suggestion of orders required to satisfy protocols
  7. Future orders
  8. Notification to provider for tests not completed within specified time frame
  9. Trending & graphing of discrete results data
  10. Graphing of results to medications and other clinical data
  1. Printing & Transmission Of Full Patient Record
  2. Print full patient record
  3. Transmit patient record electronically
  4. Transmit with encryption
  5. Print user selected patient record items
  1. Coding
  2. Current diagnosis and procedure codes built-in
  3. Coding updates
  4. E&M coding advice to providers based on documentation
  5. Automated translation of the following codes to data:

i)ICD9-CM

ii)CPT (4 and 5)

iii)ICD-10

iv)SNOMED (11 and 111)

v)APG

vi)NDC

  1. Data validation of :

i)Procedure to diagnosis

ii)Procedure & diagnosis to patient age and gender

  1. Dictation
  2. Support voice recognition software
  3. Support integration of transcription
  4. Create placeholder tag in medical record for dictation text to be inserted later
  5. Notify provider when dictation available in medical record for review and signature
  6. Audit report for dictation not yet inserted in medical record
  7. Signing/ Authentication
  8. Electronic signatures
  9. Allow signing of individual sections
  10. Separate signatures for each provider/clinician
  11. Records locked after signature
  12. Co-signature of records
  13. Authentication required when medication ordered
  14. Authentication required when orders transmitted
  15. Authentication required when electronically signing chart
  1. Clinical Reporting
  2. Query function and customizable report writer
  3. Mail merge
  4. Exporting of data for further analysis
  5. Patient population profiles
  6. Productivity by provider, site, practice
  7. Utilization tracking
  8. Protocol adherence reports
  9. Comparative reports
  10. Ability to schedule reports for regular production
  11. Ability to save and rerun reports
  12. Supports use of third party query / reporting tools (e.g. Crystal reports)
  1. Clinical Decision Support
  2. Point of care decision support tools
  3. Patient registry and outreach reports
  4. Practice analysis tools & reports
  5. Plotter support capability
  1. Reminders
  2. Reminders based on health plan
  3. Reminders based on protocols
  4. Reminders based on preventative health indicators
  5. Reminders by phone
  1. Patient Access To Information
  2. Practice-controlled patient access to actual medical records

i)Access at practice location

ii)Access via Internet

  1. Provides printed summary for patient after visit
  1. Practice Management (PM)
  2. Integrated with PM system
  3. Demographics uni-directional interface (PM to EMR)
  4. Demographics bi-directional interface
  5. Billing / coding interface (EMR to PM)
  6. Access to PM financial / insurance information
  7. Access to PM appointments and scheduling
  1. Other Interfaces & EDI
  2. Lab orders (EMR to Lab)
  3. Lab results (Lab to EMR)
  4. Radiology orders (EMR to X-ray)
  5. Radiology reports (X-ray to EMR)
  6. Diagnostic images (X-ray to EMR)
  7. Other diagnostic tests
  8. Hospital records system
  9. Transcription system
  10. Encrypted email
  11. Direct internet access
  12. Referral authorization requests & approvals/denials
  13. Electronic payer connectivity
  14. Support HIPAA standards for electronic transactions
  15. Support HL7 interface standards
  16. Medical terminology system
  1. Display Options (In addition to text)
  2. Tables / flowsheets
  3. Graphics
  4. Free-hand drawing
  5. Stored images
  6. Annotations to images
  1. Custom Views
  2. Views customizable by user
  1. Patient Identifiers (for accurate searching)
  2. Patient identification number
  3. Health plan member ID number
  4. Patient name
  5. Patient AKA
  6. Social Security number (patient’s)
  7. Social Security number (responsible parties)
  8. Account number
  9. Patient name by Soundex
  10. Medical record number
  11. Family identification number (separate from responsible party)
  12. Wildcard search on patient name
  13. Merge charts if patient has more than one record
  1. Data Searching
  2. By date
  3. By problem
  4. By text search
  5. By encounter type
  1. Confidentiality
  2. Word protection
  3. Required password changes
  4. Access limited by user function
  5. Access limited by patient record type
  6. Access limited by encounter type
  7. Screen time-outs
  8. HIPAA compliant access audit trail

TECHNICAL

  1. Security
  2. Support inquiry, update and delete capabilities for all information entered based on user security level
  3. Provide multiple levels of security with definable levels of privilege (e.g., application, function, job function, functional group, screen, user)
  4. Support a security reporting function including, but not limited to:
  5. User audit trail
  6. All users who have used a given function
  7. All users who have updated a given record
  8. Provide security to control remote access (e.g., dial back, VPN)
  9. Support the creation and use of “profile templates” and provide a method for defining access privileges for groups of users
  1. Report Writer
  2. Provide one integrated report writer with access to all fields within all modules
  3. Provide a report writer that is menu driven
  4. Provide a report writer for use by end users
  5. Have a report writer that allows users to use programming level commands, if desired
  6. Have help text available within the report writer
  7. Provide the capability for the user to select whether the report will run immediately or in batch
  8. Allow report to be scheduled to run at a specific date/time
  9. Allow report writer to be defined by the user to the data element level of detail (field level security)
  10. Allow the user to prepare reports using any combination of data elements whether those elements are standard or user-defined
  11. Allow elements to be defined as a variable parameter that prompts the user for values at report execution time
  12. Allow downloading/ exporting of current and historical data in standard PC formats for use by standard PC packages
  13. Provide generation of output files that can be saved for further report production with the ability to increment monthly totals

m. Provide templates (e.g., “Query for Example”) for customization and the creation of new reports

  1. Boolean logic included as a report writer capability including:
  2. “if / then / else”
  3. “equal to”
  4. “greater / less than”
  5. “and / or”
  6. “not”
  7. Allow selection criteria that include macros to automatically indicate current month, last month, etc., so that requests do not need modification before execution each month.
  8. Allow the use of formatting functions
  9. Provide sorting by any data element within the report
  10. Allow reports to be placed on a menu for repeated use
  11. Allow arithmetic functions to be performed within the report writer
  12. Include a date routine which performs calculations against dates
  13. Permit the generation and print of subtotals for sort breaks as well as page breaks
  14. Allow the user, when executing a report, to direct the output to any given device
  1. Allow reprinting of all reports on demand
  2. Allow the user to search and report contents on the screen
  3. Support a web based report distribution mechanism
  4. Allow reports to be viewed on-line
  1. Hardware

Support the use of portable devices (e.g., pen tablets, PDAs) for the collection of data for subsequent upload to the appropriate module

  1. Application And Imaging
  2. Support digital imaging
  3. Support video imaging
  4. System fully integrates and supports web based technology. Please explain functionality provided.
  5. Allow reports to be viewed on-line?
  1. Network Access
  2. Application can be executed in a thin client environment such as Citrix. Please describe.
  3. System allows for full automated backups
  4. System allows for incremental automated backups
  5. System able to send messages to users through the corporate mail server
  6. Firewall between Internet and corporate network
  7. User authentication is supported for data access
  1. Documentation And Tutorials
  2. Provide summarized user guides:
  3. For each screen/series of screens
  4. For specific functions (e.g., documenting with a template)
  5. Provide a dictionary/ glossary for each field discussed in the above user guide
  6. Provide a hard copy tutorial/study for use during training and subsequent reference by the end user
  7. Provide on-line tutorial for self-paced, self-directed training by end user (i.e., Computer Based Training (CBT))
  8. Provide the capability for the end user (non-programmer) to customize the tutorial
  9. Control access to customization of tutorial by security
  1. On-Line Help
  2. Provide on-line prompting for menu-screen selections
  3. Provide “pull-down” menus for screen prompting
  4. Provide on-line help at the screen level (e.g., when the user selects “help” from within a screen, the help text is specific for that screen and related topics)
  5. Provide prompting for field level entry
  6. Provide on-line help at the field level (e.g., when the user selects “help” with the cursor on a particular field, the help text is specific for that field and related topics)
  7. Offer on-line user & technical support

HealthInsight prepared this material under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (DHHS). The contents presented do not necessarily reflect CMS policy. PUB# 8SOW-OM-TN-07

1 of 7