Just as organizations must take a strategic approach to selecting the right vendor and implementing the right EHR system, vendors too must be strategic in wooing and winning the right customers. “It’s a marriage for us, too, and we’re evaluating you every bit as much as you’re evaluating us,” says Cory Valentine, a vice president at Sigmund Software (Brewster, NY).
Because a successful long-term working relationship depends on a successful system implementation, EHR vendors generally have their own list of “must haves” in a would-be partner. Valentine says that organizations who have “the most successful implementations” share these characteristics:
1) Top-down commitment. “When we present to an organization, we’re looking to see, ‘what kind of initiative is this?’ and ‘has management bought in?’” He says that although strong staff interest and support for EHR adoption are wonderful to have, and may be enough to get an EHR project off the ground, they are not enough to get the job done. “It is essential to know whether leadership – c-level, directors, executives – have bought into what a system can do. If they haven’t bought in, then the project can spiral after the first problem occurs. From then on, the project becomes a rescue.”
2) Careful pre-evaluation. “Prior to speaking with a vendor or even looking at a system, you’ve got to know your processes, starting with department heads, for every level of care. What are the workflows, what are their regulatory requirements, where is automation already involved, where is there redundancy or overlap? If you do this, you will know exactly what your needs are before you engage the vendor,” Valentine says.
This preparation and knowledge gives you a lot of leverage, he adds. “When you’ve narrowed the field and it’s time to meet with a vendor, enable the vendor to make a ‘high-level’ presentation of the system. But then, put the onus on the vendor—not just to show you what the system will do, but how it works with your tasks, your workflows, and your client-specific forms. Run through workflows from every level of care, especially those that are idiosyncratic, the ones that cause problems.” Valentine notes that when customers bring tough challenges, they give knowledgeable vendors a chance to shine.
3) Ability to see the full scope. “EHRs are big systems. They introduce sweeping changes that touch every part of the organization. Ten years ago, when you were looking at a product, you were looking at a billing product or a clinical product. At that time, what we know as EHRs today came in much smaller pieces – you couldn’t get it all in one application. Implementation was different, too. It would be a series of initiatives to improve charting, or compliance, or A/R, or cashflow.
“Today, most vendors offer most everything. So now, if you’re evaluating a product, you’re looking at everything—billing, call center, admissions, clinical, outcomes, everything. You’ve got to A) look carefully at the needs of the business and B) get knowledgeable people from every function involved,” Valentine suggests. Because so many functions are involved, this group can become quite large. Nevertheless, “if you do that, nine times out of 10 you’re going to know what you need and you’re going to be in position to evaluate the products properly.”
Getting enough knowledgeable people involved is an organization’s best defense against “scope creep,” the awful realization of an unforeseen need or problem that can pinch budgets, introduce delays, or give project opponents reason to speak out. “You don’t want unexpected things coming up in the middle of the project,” he warns.
4) Expect some acceptance issues. "No matter how successful the implementation is, it’s inevitable that you’re going to have some sort of reaction, some sort of issue with getting the acceptance of some people or some groups with the system,” he says. “You’ve got to prepare for this, maybe even survey the staff: 'How ready and willing are you to do this project? Will you engage with this and embrace it?' Even in the early stages, during pre-evaluation and selection, it’s good to ask for feedback.”
As the implementation process begins, Valentine looks for project partners who keep their eyes and ears open, looking and listening for clues: “Who or what needs additional attention? Who needs additional training before we put this enterprise system in front of them? What other things should we put into place to make sure that people are able to make the change?”
“The sales process for an EHR can take many months,” says Valentine. “Look for a consultative sales approach. Commit from the top, prepare yourself, then bring any vendor the toughest challenge you can. Work the system over and make sure that you can take that product where you need to go. Then go.”