With the seismic changes taking place in the health IT landscape these days, it becomes more important than ever for health IT leaders to be able to gauge whether their most critical business partners are going to be able to be there for them – three, five, or even ten years down the road. At the most basic level, will your critical business partner/vendor still be in business? Will they have merged with another organization that may have other strategic priorities? Will they be able to effectively support the new imperatives for Meaningful Use, not only from a programming perspective, but from an operational perspective?
It has always been wise practice for CIOs and other health IT leaders to engage their Finance Departments in ensuring that the vendors seeking the provider’s business are in a financially-sound position, have good long-term growth plans, and don’t have any pending litigation or other environmental clouds hanging over them that could pose a risk to their viability. In the HITECH/ARRA era, this becomes extra critical as the consequences of a key vendor’s failure now go beyond just the monumental expense of EMR systems, but also include the potential loss of millions upon millions of dollars of incremental incentive revenue for years to come.
For public companies, many important documents can be gleaned from commercial websites such as Hoovers.com or Edgar (among many other reliable sources). Commercial financial news outlets can also provide a wealth of information (even Yahoo Finance is a great tool). Better to know up front that the vendor may be hemorrhaging money or may be undergoing major leadership changes that could be evidence of volatility or a lack of strategic direction. For privately-held companies, insist on receiving detailed financial statements as part of the RFP process and have your Finance leadership review these in detail. Do Google searches; also engage your professional network for anecdotes about the vendor. First-hand experiences are an exceedingly important part of the “due diligence” process. The CHIME communications vehicles (listservs and other communication vehicles) are excellent resources for this type of research, as are members of other professional organizations such as local Chapters of HIMSS. You will want to be aware of any mergers and acquisitions that your vendor may have recently experienced or may be in the process of experiencing, as these type of activities often augur changes in direction relating to product support and maintenance and may signal a change in how your vendor partners with you for the long-haul.
While this has always been important – and certainly now more important than ever – the HITECH/ARRA era ushers in a whole new realm of due-diligence activities that providers bypass at their own peril. With the advent of “meaningful use” as a barometer of a provider organization’s eligibility to receive Medicare or Medicaid incentive funds, providers need to have a confidence level that their business partner has the wherewithal on a number of different fronts to allow successful achievement and documentation of health IT “meaningful use”. You need to have detailed discussions with your vendor partners and have them provide you with detailed roadmaps outlining exactly how their systems are going to comply with “meaningful use” requirements, what system structure changes will happen, any incremental cost that may be incurred, and a realistic timetable for those changes. You also have to budget for aligning resources on the provider side to install, test, and deploy these changes.
Remember, much of the “meaningful use” standard, as currently written, necessitates that detailed percentages of compliance need to be documented? Ask how the vendor plans on documenting those percentages? How would it factor in events occurring outside the EMR; for example, physician orders written on paper? How would the system track something particularly complex like “medication reconciliation”? These are the types of questions you would want to ask and you really would want to get a very good sense of a vendor’s predilection for effective “business intelligence/quality improvement” reporting, in general, from the system, as requirements may change and there is clearly an evolving focus in “meaningful use” on using the wealth of information in EMRs to drive improved outcomes.
Since the sharing of health information is such an important component of “meaningful use”, you also want to learn about a vendor’s track record in interacting with other EMR systems (ambulatory or post-acute, for example) and health information exchanges (HIEs). While pretty much all vendors say they can do this; in practice, it is not always so straightforward. Exactly who have they interfaced with and what were the challenges they faced in establishing those interfaces? Is the vendor capable of generating “CCD” records (the evolving standard) on demand and to what depth can these systems support flexibility in creating CCDs (different amounts of history to be shared, etc.)?
Most importantly, perhaps, it is imperative to understand what operational systems a vendor has in place to assist providers with the process changes that are going to inevitably going to happen when “meaningful use” officially kicks in. It may be all well and good to have the capability native to a system to support “meaningful use” mandates, but if there is no plan to engage clinicians and work through the inevitable change management and workflow processes, the likelihood of adverse consequences grows dramatically. If you are not comfortable with a provider’s ability to navigate your organization at a “human level” through these changes, you should seek out third-parties who can help you with this. This last piece is exceedingly critical as there will need to be whole new structures set up to capture these new key indicators and aggregate them and share them with the appropriate regulatory agencies. No small task, and as we all know, technology implemented without a proper infrastructure for effectively utilize it will fail.
More to come on this – it is evolving by the minute – but I think we all need to be seriously thinking about this aspect of things as we go through our key decision-making processes.