Selecting a Clinical IT Vendor
Introduction
Clinical information technologies offer health care organizations the benefits of improved care quality and outcomes, financial performance, and greater physician and patient satisfaction. Realizing these benefits depends on many factors, but selecting the right vendor for your organization's needs is clearly one of the most important ones. The question is: How does one go about doing it?
In this paper, we set out key guidelines for the selection process; criteria for selecting a vendor; the basic steps in the selection process; and guidance on thinking beyond "go live." Vendors will profit from our advice on how to sharpen their proposing techniques. At the end, we provide an actual and accelerated timeline for selecting a vendor.
Accelerating the Selection Process
Knowing where you are going, getting buy-in from key staff and executives, and careful planning form the foundation of an efficient and successful vendor selection process. Following these guidelines can accelerate the process.
Where Are You Going Strategically?
Do you want the system to drive increased market reach across the region? Increase patient, physician, or employee satisfaction? Get access to data now spread across multiple service areas with "siloed" systems? What business problems are you trying to solve? It is important that your system support goals further your organization's strategic goals. Since clinical IT vendors specialize and don't do all things equally well, your strategic goals should play a large role in the selection process.
Get all Key Players Involved
The success of clinical IT systems depends on the committed and knowledgeable participation of representative key players within your organization. Major departments excluded from the selection process may result in missed business requirements as you conduct the system evaluation. Early participation may also reduce resistance toward using the system once it is up and running. Physicians, nurses, and other key clinicians, in particular, must be heavily represented on the selection team.
Plan in Advance to Ensure Involvement
Establish all key dates, such as vendor discussions, system demonstrations, and site visits, ahead of time so that everyone can reserve the dates on their calendars. Getting busy nurses and physicians away for half-day sessions requires a lot of advanced notice. You must also be clear about what the selection process will be, how the final decision will be made, and what you expect team members to do. Careful planning and clear communication are key to getting and keeping everyone involved.
Conduct Physician Sessions Around Times
Working around physicians' busy work schedules is the best way to get them to participate. Early mornings and evenings are often the best times. Serving food can be a good lure.
Dedicate the Right Resources to Drive the Process
You need to dedicate the right and sufficient resources for the job. Resources might include consultants to provide an objective perspective on the vendor market, approaches to selecting a vendor, and project management.
Narrow the Field of Bidders
You can narrow the field of potential vendors from three or more to as few as one. Many organizations feel that they need to evaluate several vendors to ensure they have conducted enough due diligence in the marketplace. They fear (with some reason) that they will lose leverage with only one bidder in the running. However, if there is a strong business justification to go with one particular vendor, there is no reason not to.
Following these guidelines can accelerate the selection process from the normal three to six months to as little as 10 weeks (see Figure 1). Accelerating the process can alleviate time pressures on the selection team and speed your transition to a clinical transformation environment.
Criteria for Selecting a Vendor
Each organization will develop vendor selection criteria based on its unique circumstances. Here are five general criteria you can use to organize your thinking about judging the suitability of vendors: vision, cost, functionality, technology, and risk. How much weight you give these criteria will depend on your organization's goals and the factors driving your transition effort.
Vision: Do They Fit Your Vision?
Will the vendor be a good business partner? Are they developing products in areas important to your organization's future? If you plan to expand heavily in ambulatory care services, the vendor should have strong ambulatory care systems, or be developing that strength. Clinical transformation means changing work processes as well as automating them. You may have already transformed your work processes, or may be planning to do it later as the new technology is installed. Either way, make sure your vendor is ready to work with you during a period of change.
Cost: What Will the Total Cost of Ownership Be?
Make sure vendors account for all costs, such as implementation and maintenance, and don't overlook hidden costs for items such as training and infrastructure costs (wireless, etc.). Here is a list of common expenses:
- Hardware
- Software
- Interfaces
- Conversions
- Ongoing maintenance
- Human resources
- Networking
- Peripherals (printers, PCs, bar-code readers, handheld devices)
- Training
- Facility renovation to accommodate hardware and training
Functionality: Do Their Strengths Match Your Needs?
Which of your work processes need to be enabled by technology? What are the critical business functions that must be supported? Make sure you give prominence to these requirements in your request for information (RFI) and request for proposal (RFP). Using the 80/20 rule, focus on the key drivers of functionality and don't let your requirements become littered with details. Ask your prospective vendors to justify functionality in terms of ROI or other benefit measures. Some vendors will contract to deliver a specified ROI based on an initial ROI study.
Technology: Which Capabilities Are Important to You?
Is the vendor committed to the same hardware or operating system you are? Some organizations insist on the same technology for their clinical systems that they use elsewhere. They don't want to have to retool their IS department just to support their clinical systems. Other organizations place functionality first: They want the best technology for the job and are willing to retool to get optimum performance. Other technology options and choices might be important to your organization. If so, they should all be specified in your RFI and RFP (see sidebar). They include:
- Hardware/software platforms (open and standard or proprietary)
- Accessibility (handheld devices and native Web technologies)
- Ability to interface with legacy systems
- An intuitive user interface
- Customizable screens and reports
- Image, text, and voice recognition capabilities
Risk: What Risks Does a Vendor Pose?
When you select a vendor, you are committing to a long-term partnership with the company. It is important to determine the risks associated with this partnership. For example: How stable is the vendor financially? How new is their technology? Would you be one of the first users? What is the vendor's history and product development track record? Are their customers satisfied with their products and service? Overall, are you willing to "hitch" your organization's future to this vendor?
Thinking Beyond "Go Live"
"Go live" is the moment when your hard work starts to pay off and your organization begins to benefit from clinical transformation. Unless you plan for this moment, however, these benefits might not materialize in the way you expect. Here are some things to plan for before going live:
- What internal resources will you need? Inventory the people, skillsets,
and processes your IS department and end users will need after you go
live. Make sure you have these capabilities in place beforehand. Plan
for any training necessary to support new roles after you go live.
- Are you ready to handle system enhancements? Once your system is operational,
your users will begin to request changes and enhancements. Don't let the
process become chaotic. Establish a management process for requesting,
accepting, evaluating, and implementing requests for enhancements.
- Who will manage your system's "expert rules?" Clinical transformation
systems provide expert rules and reminders that drive clinical decisions
and outcomes. Rules governing the administration of medications are a
good example. Your clinicians, not the IS department, must develop and
manage these rules according to a process established by them.
- Are your policies and procedures updated? Old procedures and policies
must be updated to meet the requirements of your new system and new work
processes.
- Do you have ongoing training for new personnel? New people will have
to be constantly trained on the system well after the initial "go live."
The smooth and efficient functioning of your system will demand that new
hires, students, interns, and residents be efficiently brought up to speed.
- How will you phase in the new system? Most clinical transformation systems are implemented in phases. Many different factors — business and technological — can drive the content, order, and timing of these phases. It is important to understand, and communicate to end users how, why, and when the various parts of the system will be implemented. You need to manage end-user expectations as well as the system.
Maintaining Your New System
Once your new system is operational, ongoing maintenance will be key to realizing benefits over the long term. Here again, maintenance plans must be established before the system goes live.
- Know your vendor's release schedule. Every vendor has a process
and schedule for releasing enhancements. It is important to understand
how a vendor's release process works, how you can request enhancements,
and how you can plug into the release process to grow your system.
- Create an environment to test enhancements. You will need to
establish a separate environment for testing enhancements (and training
users on them) before taking them live. You must plan to communicate to
end users the schedule for the periodic downtimes when new releases will
be implemented.
- Stay current with new releases. This is critical. In some cases,
you can't implement a release unless you have the previous one. Moreover,
new releases frequently incorporate the most recent code to maintain compliance
with recent laws and regulations.
- Participate in the relevant users' groups. User groups offer valuable networking opportunities with other users of the technology (who are often founts of information) and are the mechanism by which enhancements are initiated and announced by vendors.
Advice for Vendors
Though we have written this article primarily for health care organizations seeking vendors, vendors themselves can do much to make the selection process efficient and improve their chances of winning contracts. For example:
- Know and stick to the client's schedule. The health care organization
has gone to great lengths to create a selection timetable that accommodates
the busy schedules of its clinicians. They have made a commitment to meeting
this timetable; you need to make the same commitment. If you have problems
with the schedule, let them known up front, not days or weeks later. Your
commitment to meeting the hospital's timetable reflects your credibility
and desire to work with them. Demonstrate that you will be easy to work
with as a partner.
- Play by the rules. The health care organization will assign a
contact person for all vendors during the selection process. This is part
of their attempt to create a level playing field. Always communicate with
the hospital through the contact person. Don't try to get a leg up on
the competition by going around the contact person to influence other
members of the organization.
- Know the client's business. Show how your system can help the
health care organization solve their business problems, now and in the
future. Connect the dots for them; don't expect them to "get it." Your
primary focus should include the present, as well as how you can help
the client grow into a much better future state.
- Don't sell vaporware. Clearly distinguish future releases from
what you can deliver now. Nothing will ruin a potential relationship faster
than getting a health care organization excited about functionality that
you can't deliver. It is fine, even advantageous, to promote future releases
as long as you tell hospitals when they will be available.
- Stick to the hospital's scripts. If the hospital asks you to
demonstrate how your system would register a woman pregnant with twins,
admit the patient to an OB unit, and have the physician order medications,
follow the script to the best of your ability. If you think the system
should have additional functionality, explain your reasoning up front
and demonstrate this functionality after you have shown the health care
organization what they have asked for. The hospital is looking to you
to demonstrate how your system supports the processes and functionality
outlined in the scripts.
- Facilitate client site visits. Your prospective client will want
to consult with customers who have already installed your system. Match
your prospective client with a site similar to theirs. Give your prospect
time alone with your customer so that they can have an honest and unfettered
conversation about how your technology works.
- Be clear about staffing requirements for implementation. Vendors
frequently underestimate the staff needed for implementation and maintenance.
This can lead to extended, over-budget implementations and burned-out
staff - not the start of a beautiful friendship. Make sure you budget
sufficient staff for the implementation and maintenance in accord with
the hospital's timeframe and performance criteria.
- Explore different support models. You may offer different support options for your technology: full onsite installations, offsite processing, and rental (the ASP model). Talk through these options and the pros and cons of each in the context of your prospect's situation.
Summary
Selecting a vendor is a long-term commitment and a critical one. No other single decision will have as great an impact on the success of your clinical transformation initiative as choosing the right vendor. With the right vendor, your organization is far better positioned to reap the maximum benefits. Careful planning and asking the right questions beforehand are the keys to getting it right.
