© 2015 ctg, inc. experience matters making the most of the vendor selection process in healthcare...
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© 2015 CTG, Inc.
Experience Matters
Making the Most of the Vendor Selection Process in Healthcare
October 6, 2015
2© 2015 CTG, Inc.
Discussion Topics
Introduction
European EHR Drivers and Barriers
Common Pitfalls and Lessons Learned
Vendor Evaluation Approach
Suggested Questions for Vendor Presentations
Questions and Answers
3© 2015 CTG, Inc.
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
4© 2015 CTG, Inc.
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
14© 2015 CTG, Inc.
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
15© 2015 CTG, Inc.
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
17© 2015 CTG, Inc.
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
18© 2015 CTG, Inc.
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
23© 2015 CTG, Inc.
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)
24© 2015 CTG, Inc.
SUGGESTED QUESTIONS FOR VENDOR PRESENTATIONS
25© 2015 CTG, Inc.
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?
26© 2015 CTG, Inc.
QUESTIONS AND ANSWERS
27© 2015 CTG, Inc.
Bart BriersManaging Directoretrinity, a CTG health solutions company [email protected]+32 477 77 90 02
THANK YOU!