1. EMR Assessment & Selection Presentation
April 30, 2016

2. Agenda EMR System Selection Process: Identifying EMR Requirements:
Concepts for System Selection Process
Governance
Committee Roles
Sample Timeline
RFP and Requirements
Evaluation Criteria
Use-Cases
Demonstration Schedule
Demonstration Evaluations
Cost Considerations
Identifying EMR Requirements:
CNYCC/DSRIP Requirements
EMR Solution Pathway: Identifying Your EMR Needs

3. Right-Sizing Your Selection Strategy
Selecting an EMR is one of the most significant financial and operational decisions an organization will make
The selection process should include input from multiple roles including input from clinical, operational, and IT staff
The process described in this presentation is comprehensive and is designed to be highly participative and has multiple steps
Steps can be adjusted to meet the selection needs of the organization
Some organizations may have a short list of candidate vendors and be able to omit some steps
Leadership should make a determination for which steps are important to ensure the process identifies a solution that best meets the needs of the organization

4. EMR Selection Process Key Considerations
Multidisciplinary Process – actively engage clinical and operational staff in the process; use for evaluation and feedback during demonstrations
Identify Clinical and Operational Champions – serve as leaders and change agents for the effort
Identify Executive Steering Committee – committee to oversee effort and make final recommendation
Identify System Selection Committee – should be multidisciplinary including representatives for multiple roles within the organization (e.g. nurse, provider, registration staff, lab, billing, etc.)
Focus Groups – use to address specific needs for identified roles or workflows
Plan for Backfill – committee members may spend considerable time on the project; plan for backfill to accommodate their participation during meetings or work sessions
Evaluation – take full advantages of opportunities to evaluate candidate systems (e.g. web demonstrations, on-site demonstrations, hands-on sessions, site visits, reference calls, etc.)

5. Sample System Selection Governance
Define Requirements
Detailed System Assessment
Guide the Selection Process
Establish Selection Criteria
Recommend a Preferred Vendor
Oversight
Set Strategic Objectives
Evaluate Financial Impact
Executive Steering Committee
System Selection Committee
Core Clinical Team
Key Ancillary Team
Revenue Cycle/ Finance Team
Ambulatory Team
Technology Review Team
Executive
Champion(s)
Multi-Disciplinary
Medical Staff
Clinicians
Leadership
Physician Focus Groups

6. Committee Roles Team Responsibilities Executive Steering Committee
Establish vision, direction, rationale, goals
Assist with communication throughout the organization
Provide budgetary oversight
Monitor progress and participation
Review and approval of recommendations
System
Selection Committee
Recruit and assign leaders and members of project teams
Supervise and coordinate progress of assessment teams
Establish selection criteria
Establish formal communication strategies
Serve as liaison with participating vendors
Provide status reports to the Executive Steering Committee
Recommend preferred vendor to Executive Committee
Ambulatory/Inpatient/Ancillary Systems Team(s)
Help guide the detailed assessment process
Develop detailed scenarios for vendor demonstrations
Ensure participation and feedback from sub-groups involved
Report progress and findings to selection committee
Technology Review Team
Same as above
Physician Focus Groups
Core Clinical Team
Nursing
Pharmacy
Physicians

7. Sample Timeline Month 1 Month 2 Month 3 Month 4 Month 5 Month 6
Define Strategy
Distribute RFP
Evaluate RFP Responses
Create Demonstration Scenarios
Conduct Demos & Workshops
Conduct Reference Calls
Conduct Site Visits
Determine Project Scope and Phasing
Conduct Application and Technical Review
Develop Total Cost of Ownership Model
Vendor of Choice
Evaluate Findings

8. Sample RFP Table of Contents
Introduction.………………………………………………………………………………… 3
Scope of Proposal.………………………………………………………………………… 3
Current Volumes and Metrics.………………………………………………………..3
Instructions for Responding…………………………………………………………...4
Selection Process and Timetable……………………………………………..4
Proposal Submission………………………………………………………………..5
Proposal Conditions…………………………………………………………………6
Communication/Questions & Answers…………………………………….6
Submission Deadlines………………………………………………………………7
Proposal Duration…………………………………………………………………….7
Confidentiality………………………………………………………………………….7
Notifications…………………………………………………………………………….7
Evaluation Criteria……………………………………………………………………7
Webinars………………………………………………………………………………….8
On-Site Demonstrations…………………………………………………………..9
Sample

9. Sample RFP Table of Contents (Continued)
SECTION 2 VENDOR RESPONSE
Requirements……………………………………………………………………………….9
General Requirements and Vision..………………………………………..9
Functional Requirements……………………………………………………..10
Operational Requirements……………………………………………………10
Technical Requirements.………………….…………………………………..10
Source of Applications...………………………………………………………………10
Project Costs...…………………………………………………………….……………….11
Project Staffing..………………………………………….……………………………….12
Company Information..………………………….…………………………………….12
Authorized Signature…..…………..………………………………………………….12
Sample

10. Sample RFP Requirements Review Categories
Technical Requirements:
1.    Database & Table Maintenance
2.    Technical Security & Data Display
3.    Mobility/Mobile Computing (kiosk, wall, keypad, tablet, smartphone)
4.    System Monitoring and Maintenance
5.    Storage
6.    Hardware/Desktop/Architecture
Functional Requirements: 1. Analytics / Reporting / Tracking Needs 2. Providers Requirements 3. Regulatory / Other Assessment Needs 4. Health Reform Requirements 5. HIM / Document Management Needs 6. Integration/HIE Needs 7. Medication Needs 8. Customer Relationship Management 9. Operations Management 10. Billing 11. Referrals/Authorizations 12. Consents/Acknowledgements and Notices 13. Client Tracking 14. Patient Engagement 15. Care Management/Coordination
Operational Requirements:
1.    Training and Documentation 2.    Implementation and Conversion
3.    System Performance and Support
4.    System Data and Security
5.    System Change and Configuration
Project Costs:
System Hardware Purchase Cost
System Software Costs
Application Software Costs
Interfaces and Conversions
Implementation and Training Costs
Summary of Costs

11. Sample Evaluation Criteria
Solicit Vendors Who:
Offer an integrated acute care and ambulatory platform (according to your organization’s specific needs)
Have the desired suite of highly functional core clinical and practice management functionality
Inpatient and ambulatory EMR
Specialty clinical systems
Ancillary department systems
Ambulatory practice management
Inpatient patient management and patient accounting
Have demonstrated success in health systems with a similar makeup
Teaching, community, and critical access settings
Distributed ambulatory settings
Highly specialized tertiary and quaternary care
Blend of employed physician practices and affiliated community physicians
Have a track record of successful implementations and satisfied customers
Base Decision On:
Demonstrated ability to meet physician and clinician needs
Demonstrated continuity of the patient record across functions, departments, and care settings
System usability and flexibility
Positive references and site visits / Success in similar organizations
Required investment
Logical implementation, training, and conversion plans
Technical foundation
Support and upgrade processes
History and future focus

12. Identify Key Decision Criteria
[Vendor A]
[Vendor B] 1
Demonstrated ability to meet physician and clinician needs (application functionality) 2
Demonstrated continuity of the patient record (integrated EMR) across functions, departments, and care settings 3
Required Investment (Total Cost of Ownership) 4
System usability and flexibility 5
Positive references and site visits / Success in similar organizations 6
Technical foundation 7
Logical implementation, training, and conversion plans 8
Support and upgrade processes 9
History and future focus (track record of success).
Sample
*Tip: Keep to a manageable list of criteria

13. Use-Cases
Use-cases also known as scripts or scenarios are to be used by the vendor during the demonstration sessions.
The purpose of the use-cases:
Provides structure for vendors to follow
Include current pain points and cumbersome workflows
Vendor should show basic functionality in demonstration while addressing the specifics of the use-case
Help identify significant value features and possible gaps
Use-cases will be used for all demonstrations except for the Interactive Workshops
Advisory and Selection Committees will be engaged in the scenario development process.
The number of use-cases can vary by demonstration topic.
Quantitative demonstration evaluation tools are developed directly from the use-cases for each demonstration session.

14. Use-Case Example (Continued)
Sample
Sample
Vendors should follow the appropriate script to ensure solutions will meet organizational requirements and to ensure comparability among vendors
Evaluators should use evaluation forms that match scripts to ensure candidate solutions are consistently evaluated during demonstration sessions

15. Sample Demonstration Sample Schedule
Vendor 1
Vendor 2
Day 1
Day 2
Time
8:00
9:00
10:00
11:00
12:00
1:00
2:00
3:00
4:00
5:00
Integrated Demonstration
(1.5 hrs, 8 – 9:30)
Data Analytics/BI
(1 hr, 8 - 9)
Revenue Cycle & Occupational Health
Services Billing
(4 hours, 8 to 12)
Clinical Staff
(1.5 hrs, 9:15 – 10:45)
Data Analytics/BI
(1 hr, 9:45 – 10:45)
Integrated Demonstration
(1.5 hrs. 11 – 12:30)
Clinical Staff
(1.5 hrs, :30)
Revenue Cycle
& Occupational Health
Services Billing Overview
(1.5 hrs, 1 – 2:30)
Interactive
Workshops
(2.75 hrs, 1 – 3:45)
Revenue Cycle & Occupational Health
Services Billing
(4 hours, 1 to 5)
Revenue Cycle
& Occupational Health
Services Billing Overview
(1.5 hrs, 4 – 5:30)
Interactive
Workshops
(2.75 hrs, 2:45 – 5:30)
*Sessions are running parallel

16. Demonstration Evaluations
Example: Clinical Demonstration Evaluation
Typical 5 point evaluation (Likert) scale:
Exceptional
Exceeds Expectations
Meets Expectations
Needs Improvement
Does not meet Expectations
N/A
Every survey will ask:
For the submitter’s role (ex: nurse, provider, IT , etc.)
“Is the proposed solution an improvement over what I’m using today?”
*Provide an opportunity to submit feedback comments
Concluding survey:
At the end of the entire series of demonstrations, a concluding survey will ask anyone who attended sessions to force rank-order the three candidate vendors

17. Demonstration Evaluations (Continued)
All committee members present will receive evaluation forms prior to the demonstrations to record their responses and take notes.
An online survey tool can also be used such as SurveyMonkey. The links to each evaluation forms should be out at the beginning of each.

18. Cost Considerations
Identifying cost includes all aspects of the implementation, not just core vendor costs.
Vendor software and hardware, including licenses, implementation, and support.
Third party software and hardware, like voice recognition, document scanning, clinical content, e-prescribing, drug database, CPT code licenses.
Complete staffing costs, including current staff, incremental staff and consulting resources, and costs for keeping current systems operating during the change.
New system will require x to x new full-time IS staff members
Project team, SME and super-user, and end-user training costs.
Backfill costs for SME involvement in the project and user training.
Archiving of existing data and conversion into the new system.
Electronic interfaces to systems not being replaced.
Additional investments, such as monitor upgrades, mobile devices, patient kiosks, team space and furniture, travel costs.
Offset for decommissioning of current systems.

19. Additional Services

20. CNYCC EMR Requirements

21. CNYCC EMR Requirements
Ability to exchange information with HeC and partner organizations in approved format:
Web services utilized by the IHE (SOAP 1.2)
SAML, required by SHIN-NY
C-CDA document constructs
Direct messaging (SMTP and/or XDR)
x.509 certificate security (encryption and digital signatures)
Meaningful Use Certified (if provider(s) qualifies or plans on participating in MU program).
Reporting and analytic capabilities including patient registries, alerting, decision support, etc.
Support for workflow automation, care planning, and preventive care capabilities
Patient outreach capabilities (patient portals/secure messaging)
Ability to support Patient Centered Medical Home (if provider(s) are participating in the PCMH program).
Implementation schedule aligns with CNYCC milestones (implementation complete by DY 3  2017).

22. EMR Assessment & Selection
Questions?