Imagine you've spent months, maybe years, investigating electronic medical record (EMR) systems. Your team has chosen a vendor which offers an exceptional package, and the project is in your budget. Everything is in place. Yet when you get to the final presentation before the board, there's a stalemate.
Since the first modern behavioral health information technologies were created more than two decades ago, boards have been denying EMR purchases that they initially authorized. In the 1990s, many software offerings were insufficient to fully computerize patient records. Some systems lacked adequate integration, and others were offered by vendors with limited expertise working with human service agencies. In a few cases, truly premature software offerings (so-called “vaporware”) caused havoc. So back then, maybe some of these board denials were a blessing.
Organizations that remain paper based today, however, are scrambling to catch up-and trying to do so in an economy in which every penny counts and every purchase must demonstrate return on investment (ROI). Thankfully, comprehensive EMR solutions now are available from highly capable vendors, and many providers are significantly cutting costs and improving treatment and management practices by implementing EMR systems. Specialized offerings exist for different market segments, and deployments generally are well managed. Yet it's widely recognized that the majority of providers don't have complete electronic record-keeping systems in place. So with all these advances, why are so many boards still holding off?
Cost is a major factor. For most behavioral healthcare providers, an enterprise EMR system is a substantial purchase. It's not enough to demonstrate long-term ROI, particularly if a board is weighing purchasing an EMR against hiring clinicians, opening a group home, or building a gymnasium.
Technophobia is part of the problem. Many board members are from industries that make little or no use of IT. A board member may be an alumnus of the organization and received life-changing help without any technology. Many are human service professionals who focus on treatment, not software, to solve problems.
Timing also has an impact. It is not uncommon for budgets and fiscal years to elapse during rigorous EMR evaluations. During these long time frames, many factors change. Funding, regulatory, and accreditation requirements evolve. Treatment and business models are modified. New programs and populations emerge. Recently, the economy tanked. With slumping reimbursements and shaky staff morale, boards are mission focused. So in these uncertain times, an EMR selection committee must meet the board's new (and undoubtedly tighter) vision.
It has been my experience that the following guidelines can dramatically increase the likelihood of board approval following the often arduous process of vendor selection.
Involve the CEO and keep the board informed
Major stakeholders must arm the CEO with what he/she needs to make the case to the board. Because bottom-up initiatives and EMR purchases driven by individual department heads often fail, the CEO must not only support the EMR selection, but also get to know the vendor and be intimately engaged in the selection process. All too commonly a CEO says to the selection committee, “Just pick the system you want, and I will take it to the board.” This approach rarely succeeds, so get the CEO onboard from day one.
The CEO must be convinced of the EMR system's value. He/she probably does not have time to review a request for information or request for proposal (RFP) in detail, and the CEO certainly cannot participate in dozens of software demonstrations and internal requirement-gathering sessions. Thus, the CEO should receive regular oral and written progress reports about the evaluation process, expected benefits, challenges, and key milestones. The CEO can digest this information and update the board. The EMR selection committee should invite the CEO to the finalist vendors' presentations, and the selected vendor should provide the CEO with support and even presentation materials to make the case to the board.
If appropriate, it's best to have the vendor present directly to the board. Vendors should not be shy about presenting to the board-and a CEO should not hold back from requiring this commitment.
Define and refine your project plan
A multiyear EMR selection process is not uncommon. Sadly, many of these initiatives never culminate in vendor selection, wasting resources and senior staff's time. Developing a specific project plan, including RFPs and on-site demonstrations, is a necessity. And organizations must act deliberately. They must set a budget, define a timeline, and select the best vendor. Selection processes that take longer than six to nine months often are costly and reflect a lack of leadership commitment.
Few people want to take responsibility for choosing a software system that is a large chunk of the operating budget. Most senior staff are fully aware that an EMR represents a radical change for their organization, raising issues previously shrouded by paper. Staff performance, quality improvement, documentation compliance, and individual programs' fiscal performance suddenly will be more easily analyzed. Taken in combination, these factors even may make the CEO, let alone the department heads typically charged with championing an EMR, reluctant about the purchase.
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