Every line of work, every executive position, has its most difficult and impressive feats. Among CIOs, perhaps none is more daunting than the EMR implementation do-over. But that’s just want Chad Brisendine and St. Luke’s will be attempting when they give their ambulatory EMR rollout for employed docs another go. The first time around, those docs were less than enamored with the functionality and, after some study, the organization deemed it couldn’t suffer the attendant loss of productivity (as in cash flow). But the next time around, lessons learned will make the outcome quite different, he says. To learn more about St Luke’s new ambulatory EMR strategy — and to discuss the CHIME Member to Member survey that will help Brisendine inform his Meaningful Use-related vendor contracting — healthsystemCIO.com editor Anthony Guerra recently chatted with the Bethlehem, Pa.-based CIO. (Scroll down for the survey data)
- About St. Luke’s
- McKesson for clinicals; GE for imaging and billing
- The employed and non-employed (Stark) ambulatory EHR strategy
- Best of breed versus integration
- CIO/physician relations
CHIME Survey Data
Do you have any representations and warranties regarding: certification process, meeting MU criteria for Stage 1, Stage 2 or Stage 3?
14 – No
13 – Yes
If yes, what kind?
Warranty they will get certification at the various levels.
Not in contract, but a public commitment that “no one will miss out on meaningful use because of us”.
We don’t but attempted to do so. This was such a moving target at the time, it was.
difficult for a vendor to commit. Plus, a lot of MU depends on the hospital or practice processes, regardless of the certification of the product.
Our current vendors are representing themselves that they are going to meet the criteria.
Money back guarantee if vendor fails to achieve MU certification.
Contractual obligations to meet criteria or forfeit fees.
No maintenance costs until certification achieved.
Contract states they will meet requirements.
Allscripts indicates certification with next release.
2. Are you withholding payment Ability based on schedule/performance?
21 – No
6 – Yes
If so, how much are you holding on schedule / performance?
It depends, we usually have milestone payment terms for new installs and leave at least 20% of overall to be paid after go live.
What kind of payment terms do you have?
No payment terms associated wiht MU
We have not tied payment terms to meeting Stages of MU. What is the organization is at fault and did not get organization compliance to meet MU?
License is paid in 4 equal payments less $1,000,000 holdback. 20 equal payments for implementation (14 month project). Hardware net 30 of delivery.
License fees due upon signing, installation and implementation fees due upon go live.
We pay based on implementation of the various modules we are implementing. We pay the final 20% once we are live with an individual module.
Was able to negotiate 36 month payment plan @ 0% interest
25% upon signing, 25% upon installation, 25% upon go live, 25% upon final acceptance
20% Up front for install, pay as you go fur services/travel, 30% at live, 50% at aceptance
Depends on contract, services as we use them and software based on milestone or spread across a period of time that exceeds the implementation.
I generally try for 20% at signing, 20% when 20% first productive use and 40% upon certification which is generally 60 days post go live.
Software purchase over 7 years installation over 30 months. Hardware on delivery
Do you have any penalties if you vendor isn’t able to make Stage 1, Stage 2 or Stage 3?
Not at this time. Good thought. I am working on that contract now.
We are working on the contract
$100,000 if we don’t make stage 1 – which implies they will be certified. Nothing for stages 2 & 3.
Money back guarentee if vendor fails to achieve MU certification.
Typcailly 30-50% of contract for new contracts. Stuck with old ones.
No maintenance costs, product is free of charge until certified
No – we just have to upgrade. Very litte capital investment required for MU Stage 1. Not sure about 2 and 3.
Yes. We reduce licensing fees if MU incentives are not realized due to vendor missteps.