Shopping for an EHR Contract

October 4, 2005

Alea jacta est, The die is cast. The time has come. You have decided to join the 21st century with an electronic health record, or EHR. But what comes next?

Alea jacta est, The die is cast.

The time has come. You have decided to join the 21st century with an electronic health record, or EHR. But what comes next?

The answer, according to EHR consultant Michael Uretz, executive director of The EHR Group in Issaquah, WA, is a whole series of questions.

How do I choose the best vendor?

How do I know I got the best price?

How do I get the right contract?

How do I get tech support?

What happens if the vendor goes bust?

Important questions all, Mr. Uretz told the American Academy of Family Physicians Scientific Assembly. All are part of a more basic question, How do I shop for an EHR contract?

No contract is perfect, he cautioned. Experienced buyers follow a eight step plan that gets them an appropriate vendor at the right price with a fair contract and reliable support.

Step one is a formal needs assessment, figuring out just what is that you want that EHR to accomplish.

"If you don't know what you want from an EHR, you probably aren't going to get it," Mr. Uretz warned. "You have to know what you must have, what you'd like to have, and what might be nice to have. Put it in writing so you can ask every vendor for the same set of features."

Step number two is a Request for Proposal (RFP), sometimes called a Request for Quote (RFQ). First-timers think an RFP is about getting the best price on specific features, Mr. Uretz said.

"An RFP is really about the vendor, the staff size, their R&D program, how many people work in support compared to sales, how often they schedule releases, how flexible they seem to be, how interested they are in you as a potential customer, the benefits you get from their product versus any comparable EHR."

Step number three is getting quotes. Talk to vendors, give them your feature list. Tell them the kind of support you want, how you want to handle installation and training, and all the other details - then listen to the responses.

"Wouldn't it be nice if people listen to what you want instead of telling you what they think you need?" Mr. Uretz asked. "If the sales rep talks instead of listening, seems impatient, is slow to respond, gives you a cookie cutter approach, these are all red flags."

Step number four is a demo of the systems that seem to meet your needs. Mr. Uretz suggested creating a form to rank the different feature each system offers for easy comparison later. Give each feature a score from one to five for usability and another score for design. Most important of all, he said, insist that the demo follow your practice pattern and workflow, not fictitious cases created to make each system look perfect.

Step number five is choosing a vendor.

"You have to do due diligence on your vendors," Mr. Uretz said. "There are a lot of details and they are all important." Important factors include the vendor's reputation, financial health, customer list, references, your own gut feeling about whether the vendor is trustworthy.

Step number six is negotiating the price. Not the best price, Mr. Uretz emphasized, a fair price that leaves both parties happy. Everything is negotiable, he emphasized, from the number and type of licenses to the implementation plan, training, support, financial terms, and more.

Step number seven is negotiating contract terms. Most practices spend their time and effort negotiating the price, Mr. Uretz said. They should be putting more effort in structuring the contract itself, not the dollars. Price is important, he explained, but payment structure is even more important.

Does the vendor want 100% in advance or are there milestone payments that protect the buyer? How are future costs for license renewal, tech support, customization, and continuing training to be handled? What are the response times required for technical support? Is the source code in escrow so you can keep working even if the vendor goes under? The final step is develop an implementation plan and start working.

"EHRs are a new field, which means contracts and terms are constantly changing," Mr. Uretz said. "It is up to you to be an informed consumer, to know what you need and want, and make sure you get it. Remember, you don't have to accept the first deal that is offered."