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Experience Matters

Making the Most of the Vendor Selection Process in Healthcare

October 6, 2015

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Discussion Topics

Introduction

European EHR Drivers and Barriers

Common Pitfalls and Lessons Learned

Vendor Evaluation Approach

Suggested Questions for Vendor Presentations

Questions and Answers

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Introduction

11 years of experience in IT Service & Solutions

Management (CTG)

+2 years Managing Director etrinity, a CTG Health

Solutions company health,

+8 years Director Belgium-Luxembourg for Software

Testing

Extensive experience with financial/clinical systems,

planning, selections, contract negotiations, assessment

and implementation

Bart BriersManaging Director

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Experience Matters!

>80 CTG Provider Clients (2012)

>200 Implementation and Optimization Clients

>600 Healthcare Clients Over 25 Years

>160 Technologyand Integration Services Clients

>200 Healthcare Vendors Supported

>150 Selections, Strategic Plans, and Assessments in

the Last Four Years

5© 2015 CTG, Inc.

Ad

vis

ory Strategy

Audit

Lean inhealthcare

HealthTechnologySelection

Imp

lem

en

tati

on

Clinical SystemsImplementationIT Solutions forHealthcare• Infrastruct

ure• (Mobile)

Apps• Information

Security

• TrainingIn

teg

rati

on

Interface DevelopmentMedical Device Integration

Health Data Exchange

Data Migration

Su

pp

ort IT Support

Health Applications Support

Healthcare Service Portfolio

6© 2015 CTG, Inc.

EUROPEAN EHR DRIVERS AND BARRIERS

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European EHR Drivers and barriers

Reduce Medical errors

Meet legal requirements

Increase organizational performance

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Drivers for IT Deployment

• Reduce medical errors

• Improve quality of care

• From “automated islands” to one continent

• Sharing patient information

• Facilitate access to test results

• Meet legal requirements

• Improve security and privacy provisions

• Automate of statutory registrations

• Comply with accreditation requirements

• Comply with government-funded policies (Lux.

and European) related to medical error

reduction or organizational performance

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Drivers for IT Deployment cont.

• Enhance overall organizational performance

• Increase clinical capacity and productivity

• Improve control of costs/increase revenues

and reduce costs

• Support reorganization and change

• Create more effective supply chain links

• Improve registration and billing

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Barriers to EHR Adoption

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Barriers to EHR Adoption

• High total costs and no guarantees on ROI

• Time issues

• User habits

• Preference of paper-based processes

• Low technology acceptance rate

• “No urgent need”

• Management: “organization is too small”

• End-users: “not important”

• “Medical records are only important

for one single, specialized medical area”

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COMMON PITFALLS AND LESSONS LEARNED

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European EHR Adoption ModelSM

© Copyright by HIMSS Analytics Europe

Electronic diagnostic and pharmacy department information

Patient-centered electronic data repository

Clinical ordering and documentation— especially nursing care

Electronic order entry with decision support and result reporting

Completely electronic diagnostic image management

Full electronic clinical decision support and highest medication safety

“Paperless” patient record environment for highest quality of care, data continuity, and full HIE

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Vendor Myths

Common Vendor Misconceptions

• Most large implementations use consulting services

• Many vendor firms lack depth in: • Project mgmt.• Process

improvement/re-engineering

• General healthcare and clinical knowledge

• Scope always larger than first expected: more resources, time, and money

You can implement on

your own

Vendor provides experienced, FT resources to help

Once you are trained, you know

the system

“Out of the box” is robust, and works for most

All costs are known up front

• Resources are not consistently onsite

• Project resources often support multiple clients at the same time

• Resources may be recent college graduates with limited healthcare experience

• It may be the first implementation for your assigned project team

• Vendor training provides only a baseline knowledge of application functionality/build

• Vendor training is done “functionally,” not in a workflow-driven manner

• Vendor training is often by application and does not show the integrated workflow

• Vendor training does not profile the experience an implementation provides

• Model/gold standard has very little “specialty-based” content

• Model content requires review and editing; may contain errors (not plug-and-play)

• Implementation resources and costs are often underestimated

• Comprehensive project planning and monitoring is required to manage costs and timeframes

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Lessons Learned / Critical Success Factors

Expert implementation planning and experience yields achievable plans and realistic budgets

Lessons Learned Recommendation and Considerations

1. A defined governance model and issue escalation process not in place/not functioning

• Fragmentation of leadership between the hospital, medical staff, and other clinicians

• Avoid “analysis paralysis” to make timely decisions

• Use change management process as needed

2. Expectations management • A new system does not solve systemic organizational problems -> introduce Process Optimization (LEAN)

3. Insufficient project controls • Establish solid governance model, PMO, project control, and management processes early

• Change management, project communication plan, training programs

4. Inexperienced team • Must include clinicians/operation staff on the team

• Must have ≥ 40% project experienced personnel

• Must have > 40% clinical operational staff on the team

5. Organizations have not anticipated “the unexpected”

• Project leadership must be five steps ahead, anticipating any turbulence and developing alternative routes

• Control your destiny

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Lessons Learned / Critical Success Factors cont.

Lessons Learned/CSFs Recommendations and Considerations6. Realistic expectations of

base/model system • Great educational introduction to vendor capabilities• Align vendor implementation approach with your specific

requirements• Identify and define strategic drivers early, and design to the model• Workflows perform fairly well in most clinical settings

• Maximize workflows to prevent “paving the cow paths”• Be prepared for the esoteric• Be sure to include all parties in the review

• Clinical content may not meet advanced expectations. What to do?• Set a deadline to review, revise, and finalize• Develop/commit to optimization strategy early

7. Realistic expectations of vendor staff

• Good motives• Technical experts of vendor capabilities often lack operational or

clinical expertise• Focused on application and technical workflows with little focus on

enterprise effort• Implications of third-party applications are not understood

Implement quickly ● Optimize post-live

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Lessons Learned/CSFs Recommendations and Considerations

8. Realistic expectations of clinical/operation staff assigned to the project

• Bring current state and concerns knowledge• Do not let them replicate existing system in future system• Recognize and address lack of project experience

9. Time is your main challenge • Most difficult problem is to recover from slipped mid-project deadlines

• Don’t underestimate impact of education and research

10. Understanding true impact on remaining systems and workflows

• Ensure inclusion of multi-disciplinary team members for cross-application functions

• EHR impacts all areas when it goes live

11. Understanding motivations of stake holders

• Everyone wants to protect their territory• Comfort level with the old system may be stronger than desire to

embrace the new system• Fear of the unknown

12. Implement—then optimize! • Hard to understand future until you’ve been there• Most customizations are never used• Anticipate/expect the need to meet legal/regulatory requirements

13. A tough road in the best of times

• Have fun!• Celebrate!

Lessons Learned / Critical Success Factors cont.

Build momentum by delivering on promises

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Lessons Learned and Common Pitfalls During System Selection• Must not be viewed/approached as an IT project; process knowledge is crucial

• Clients tend to over-commit their personnel; use of knowledgeable consultants

helps keep your vendors honest

• Objective, consistent approach and methodology are key (provide legal and

board assurance)

• Clearly define strategic, stakeholder, process, and legal requirements

• Identify a consistent group of stakeholders who will see all demonstrations

• Standardize offers, proposals, and indirect costs

• Understand all costs upfront—vendor-specific costs are only part of the total• Example: 5-year total cost of ownership (TCO) model

– Vendor licenses: 10–15%– Vendor maintenance: 15–20%– Labor (vendor, training, internal consultants): 50–60%– Workstations: 20–30%– Servers: 5–10%– Third-party software/hardware/installation: 5–15%

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Lessons Learned and Common Pitfalls During System Selection cont.

• Define change management considerations

• If it’s not currently written down in a paper environment, it will NOT

automatically become a part of the EHR

• Define • What successful end-user buy-in means

• Process optimization requirements and timelines

• Implementation team requirements

• End-user support requirements (can they be supported with existing staff or is

external consulting support necessary?)

• Vendors

• Should be able to provide a reference site for EVERY piece of their solution

• Have a tendency of failing to follow through on their deliverables and

promised features

• Might have difficulty adopting to changing/new markets (localization)

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VENDOR EVALUATION APPROACH

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Why Invest in a Vendor Selection Process?

Baseline: a complete Request For Proposal (RFP) process for a full

complement of applications wrapped up as an EMR or EHR solution

• Why invest in this process?

• To create a level playing field for all vendors

• All are treated equally and offered the same opportunities to respond to the RFP

• Recommend a “pre-fit” assessment limiting the number of vendors receiving the RFP

to no more than five (5) when possible

• To build consensus internally and ensure process is viewed as fair

• To create and maintain a consistent process for a defendable legal decision

• To assure the board that participants were treated consistently

A well-defined process and approach is necessary because the same group of individuals in an organization rarely participates in more than one major selection in a

career—experience and independence helps!

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Typical EMR/EHR Selection Approach and Timeline

Major Selection Phases

1. Engagement initiation and planning: 1–2 weeks

2. RFP development: 6–8 weeks

3. Send RFP to vendor set and allow time for vendor response—typically

30 working days/4 weeks

4. RFP response evaluation and invitation to demonstrate: 2–3 weeks

5. Demonstrations: 2–8 weeks (dependent upon organization’s personnel

availability and vendor availability)

6. Final vendor scoring against organization major selection criteria: 2–3

weeks

7. Contract negotiations: 4–XX weeks

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Typical Evaluation CriteriaScoring Recap Tool Example

Criteria Categories Vendor 1 Vendor 2 Vendor 3 Vendor 4

Strategic IT architecture guidelines 77 68 104 72

Alignment to organizations vision 202 149 241 169

Workflow improvements potential1 88 54 96 75

Strategic technology 34 33 54 42

Additional business impacts items 25 24 39 24

Totals 426 328 534 382

Financial—Cost of Ownership (7 yrs)2 €34M €9M €26M €45M3

Monthly Premium vs. Low Cost Provider* €302K €0 €211K €439K

Fair

Poor

Best

Better

Good

1 Specific tools and services provided by each vendor are included in notes in the Vendor Candidate Scorecard

2 5,5M€ in planning costs have been included in the XX financial estimates to cover the missing General Financials and ERP workflow bids that client will require in the final solution

3 XX has suggested an 11th-hour price reduction with a total lower cost of approximately % (€XX software license cost)

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SUGGESTED QUESTIONS FOR VENDOR PRESENTATIONS

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Questions to Keep in Mind During International Vendor Presentations

• What are their plans and commitments for the local market?

• What’s your healthcare expertise?

• Work with local partners who know the Lux. Market?

• Past track record & current commitments on timelines/budgets?

• How can they support the continuum of care?

• What’s the system roadmap

and how much do they invest in R&D?

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QUESTIONS AND ANSWERS

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Bart BriersManaging Directoretrinity, a CTG health solutions company bart.briers@etrinity.eu+32 477 77 90 02

THANK YOU!