Electronic Health Records

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Electronic Health Records: Vendor Selection Process and Next Steps 2010 SCPHCA ANNUAL CONFERENCE Saturday October 16, 2010 9:00 am to 10:15 am Michael Randall, HSSC

Abstract Recent ARRA (American Recovery and Reinvestment Act) legislation set the stage for the establishment of 60 Regional Extension Centers throughout the US. Health Sciences South Carolina and its partners collaborated to establish CITIA-SC, the Center for Information Technology Implementation Assistance for South Carolina. As outlined in the ARRA guidance, a part of CITIA-SC’s charter is to identify several of the best electronic health record (EHR) products, in an open and unbiased manner, and to negotiate the best deals for CITIA-SC’s target customers (primary health care practitioners throughout the State of South Carolina). This session covers the specifics of the vendor selection and group purchasing (VSGP) process that CITIA-SC has undertaken in order to find the best EHR products and to negotiate the best deals for its customers. The talk also outlines the extensive efforts of the VSGP Committee in order to select the best products and the lessons learned from this process and the plan going forward to ensure that the products offered to CITIA-SC’s customers remain the best available at the lowest total cost of ownership over time.

American Recovery and Reinvestment Act of 2009, Title XIII - Health Information Technology, Subtitle B—Incentives for the Use of Health Information Technology, Section 3012, Health Information Technology Implementation Assistance Health Information Technology Extension Program: Regional Centers Cooperative Agreement Program

Funding Opportunity Announcement and Grant Application Instructions

Vendor Selection and Group Purchasing (from ONC Guidance) Vendor Selection & Group Purchasing - This includes assistance in assessing the health IT needs of priority primary-care providers, and selecting and negotiating contracts with vendors or resellers (of EHR systems, hardware and network infrastructure, and IT services). Regional Centers should assist providers in holding vendors accountable for adhering to service level agreements. Regional Centers are expected to design group purchasing plans to leverage volume discounts and assure a high level of service for their providers. Support should specifically focus on helping providers select the highest-value option, defined as that which offers the greatest opportunity to achieve and maintain meaningful use of EHRs and improved quality of care at the most favorable cost of ownership and operation, including both the initial acquisition of the technology, cost of implementation, and ongoing maintenance and predictable needed upgrades over time. Each Regional Center will offer unbiased advice on the systems and services best suited to enable the priority primary-care providers to become meaningful users of EHRs. Regional Centers will avoid entering into business arrangements creating an actual or apparent conflict of interest with the Regional Center’s obligation to act solely in the best interests of advancing meaningful use of certified health IT by the providers it serves. Regional Centers that choose to offer group purchasing of EHR software, IT support services, and/or hardware must provide a choice of offerings. The selection process for these vendors must be open and competitive; the selection committee must include representatives of the priority primary-care providers actively practicing within the Regional Center’s geographic service area.

Vendor Selection and Group Purchasing (from ONC Guidance) •Assistance in assessing the health IT needs of priority primary-care providers •Selecting and negotiating contracts with vendors or resellers •Regional Centers are expected to design group purchasing plans •Help providers select the highest-value option to obtain

and maintain meaningful use of EHRs at the most favorable cost of ownership. •Each Regional Center will offer unbiased advice •Must provide a choice of offerings •Selection process must be open and competitive •Selection committee must include representatives of the priority primary-care providers

Center for Information Technology Implementation


CITIA-SC Brings Value • Extensive research of available EHR systems • Extensive evaluation and vetting of available EHR systems • Detailed negotiation to achieve lowest possible cost of ownership • Implementation assistance • Training assistance • Meaningful Use • Access to data/information

• Free! • www.CITIASC.org

Center for Information Technology Implementation Assistance Project Director: Dr. Todd Thornburg Health Sciences South Carolina (HSSC), in conjunction with partner organizations, will establish South Carolina's regional extension center to assist implementation of electronic health record (EHR) systems in primary care practices throughout the state of South Carolina. The regional extension center system will be called CITIA-SC (Center for Information Technology Implementation Assistance in South Carolina) and will be organized per ONC Guidance CFDA 93.718. CITIA-SC has started the processes of Vendor Selection and Group Purchasing as outlined in the guidance. In order to be considered for this exercise, candidate EHR vendors MUST fill in an electronic Vendor Input form.

Using a $5.6 million grant from the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services, CITIA-SC will be assisting the state’s primary care physicians with the selection of appropriate electronic health records systems and then supporting the implementation of those systems into their practices. This will include training medical and administrative staff on the use of the systems to maximize utilization in terms of improved patient care, safety, and operating efficiency.

VSGP Committee (THANKS!)

All Current CITIA-SC VSGP Committee Members have Successfully Completed a CoI Survey

VSGP Process: From MANY to a Select Few >98 Stage 1 19 Stage 2 9

R o u n d

R o u n d



Stage 3

~5 Stage 4

Round 1 Process Group Purchasing & Vendor Selection Plan Flow Diagram


Stage 1

~12-16 Vendors

Open to All Vendors Review Literature

Vendor Input

EHR Expert Inputs

Jan 1, 2010 through March 31, 2010 April 29, 2010

Stage 2

~12-16 Vendors

Vendor Proposals

Vendor Demos


Group Purchasing Negotiations September 22, 2010

March 31, 2010 April 29, 2010 through June 30, 2010

Stage 3

August 31, 2010, 3 -8 Vendors November 15, 2010

March 31, 2010 April 29, 2010 ~3-8 Vendors Vendor Recommend ations Plan

July 31, 2010 September 22, 2010


Vendors Selected Group Purchasing Agreements in Place

Vendor Short List

Stage 4 Rollout

What we have done so far • • •

Agreed on Approach Formed VSGP Committee Provided input for Grant Application

Stage 1

– Granted $5.6MM

• • • • • • • • • • • • • • •

Generated Vendor Input forms Compiled Vendor List Announced Vendor Solicitation Solicited Vendors Gathered Literature Held Stage 1 Vote Solicited Stage 2 Input Established wiki site for vendor documents Stage 2 Established CITIA-SC and associated website Held Stage 2 Demonstrations Established CoI Survey and held survey for committee members Scored Vendors Gathered More Vendor Data Gathered Preliminary Voting Data (Electronic) Stage 2 Voting

What we have done so far (cont.) • Constructed Stage 3 Survey

Stage 3

• Solicited Input to Stage 3 Survey

• Requested and Received Customer Lists (SC) • Review Stage 3 Inputs Complete WIP or ToDo

• Request Contract Proposals • Review Proposals

• Negotiate Proposals • Finalize Contracts for CITIA-SC Customers Stage 4

• Roll Out Recommended Products/Offers

Stage 1

Provided input for Grant Application

Granted $5.6MM Example of how SC wins via collaboration

Generated Vendor Input forms •Start with HRSA recommended Input Matrix •Committee Revisions (~6)

•Resulting form too large (564 Questions) •Split into two stages •154 Questions

•Available at www.HEALTHSCIENCESSC.org HRSA Input Matrix Committee Name Andrew Hamilton, RN Kaytura Felix-Aaron, MD Matt King, MD Norma Lopez, MD Sarah Chouinard, MD Susan Chauvie, RN Mike Lardiere

Position Director of Operations, Clinical Informatics Chief, Clinical Quality Data Branch Chief Medical Officer CMO/CMIO Medical Director Nurse Informaticist Director HIT, Sr. Advisor Behavioral Helth

Organization Alliance of Chicago HRSA Clinica Adelante, Inc Lynn Community Health Center Primary Care Systems, Inc. OCHIN NACHC

Staff Jeff Weinfeld, MD Will Gaud

Physician Informatics Advisor OHIT Consultant

HRSA Will Gaud & Associates

Compiled Vendor List •98 Initial Vendors/Products (168 R1+R2)

•Start with CCHIT 2008+ Certifications list •Solicit CI •Add to RedCAP survey system • https://sctr.musc.edu/index.php/researchtools/redcap

Announced Vendor Solicitation/Solicited Vendors •HSSC Website •RedCAP Survey (Electronic)

•April 17, 2010 deadline (5 pm Sept. 24, 2010 R2) •PDF Survey available on HSSC Website

Gathered Literature Maryland Health Care Commission http://mhcc.maryland.gov/electronichealth/cmsdemo/index.html http://mhcc.maryland.gov/electronichealth/ehr/cchitehrvendors.html

Certification Commission for Health Information Technology URL: www.cchit.org Cost: No charge. EMRConsultant.com URL: www.emrconsultant.com

EHR Scope URL: www.ehrscope.com Cost: No charge. CTSGuides.com URL: www.ctsguides.com/medical-method.asp Reports California Healthcare Foundation: EHR Selection Toolkit for Community Health Centers URL: www.chcf.org/topics/chronicdisease/index.cfm?itemID=133495 KLAS Report URL: www.klasresearch.com

Round 1: 98 direct RFIs, 40 Complete Responses ABEL Medical Software Inc. ABELMed EHR - EMR / PM v11 Agastha, Inc. Enterprise Healthcare Software v1.2

digiChart digichart eClinicalWorks eClinicalWorks EMR/PM Version 8.0

MCS-Medical Communication Systems, Inc. mMD.net mdTablet LLC mdTablet 5.0

Eclipsys Corporation Eclipsys PeakPractice 2010 R1

MedcomSoft MedcomSoft Record 4.6 ALERT Life Sciences Computing, Inc ALERT® PRIVATE PRACTICE version 2.5

EHS, Inc. CareRevolution v. 5.3

Allscripts Allscripts Professional EHR

e-MDs Solution Series 6.3.0

Allscripts Allscripts MyWay EHR 8.4

GE Healthcare Centricity Practice Solution version 9.0.1

Allscripts Allscripts Enterprise EHR v11

Electronic Health Network, LLC Patient OS 1.0

MedPlus, a Quest Diagnostics Company Care360 EHR Version 2009.4 Noteworthy Medical Systems, Inc. NetPracticeEHRweb 6.9.9

Amazing Charts Amazing Charts, Version 5

GE Healthcare Centricity Electronic Medical Record version 9.2

Sage Software Healthcare, LLC Sage Intergy Suite v6.0 (Practice Management and EHR)

American Medical Software

GE Healthcare MedPlexus EHR version 9.6

AssistMed Inc. AssistMed Trio v.


athenahealth, Inc. athenaClinicals 10.2

Greenway Medical Technologies PrimeSuite

SOWSiA in collaboration with Rackspace and MediSys Health Network Ondemand Healthcare uHPM7PM1 SuiteMed LLC. - Columbia, SC Distributor - Fox Meadows Software,LTD. SuiteMed IMS version 12.0.5

Cerner Corporation Cerner Ambulatory EHR. The current version was released in March 2010.

Healthland Healthland Clinical and Financial Applications 9.0.0 Integrated Healthcare Solutions Intelichart

TOI ezEMRxPrivate 7.00

Complete Medical Solutions My WinMed v 1.2 M.D. Web Solutions AMCIS Network, Version 57

Conceptual MindWorks, Inc. Sevocity v. 08 CureMD Corporation CureMD EHR v10

McKesson Provider Technologies Practice Partner 9.4, Medisoft Clinical V16, Lytec MD 2010

TransMed Network Inc / Transmed TransMed CS 3.0 and 5.0

From FPM Article

From FPM Article

From FPM Article

From KLAS Article

From KLAS Article

WHY ARE SOME EMRS BEING REPLACED? As the industry prepares for the crush of EMR adoption, a few sobering trends are emerging. All providers interviewed for this report are purchasing an EMR solution, but nearly one-third are actually replacing an existing EMR. Half of these are switching because their existing EMR lacks important functionality or certification—in short, because their current solutions are not viable goforward strategies in today’s ARRAfocused healthcare environment. Providers say they are replacing Misys EMR and MediNotes e (both acquired by other vendors) because neither solution is likely to see future development and neither will be certified. Additionally, while some providers are replacing noncompliant systems, 62 percent of providers switching EMRs from the past two years are replacing systems that are (or were) CCHIT certified. System certification, or even satisfaction of meaningful use, does not guarantee thatprovider needs are being met.

From KLAS Article

From KLAS Article

Vendor Input Results Summary

Vendor Input Results Summary

Vendor Input Results Summary

Vendor Input Results Summary

Vendor Input Results Summary

Vendor Input Results Summary

Summarized Data, Held meeting to Select “First Cut”

Round 1: • 98 direct RFIs • 44 Responses • 9 Advanced to Stage 2

Stage 2

Stage 2 – Established wikisite with all Stage 1 and Stage 2 data for Stage 2 Vendors – Stage 2 Vendor Inputs requested and received (RedCAP)

– Set up Vendor Demonstrations and scoring – Discussions regarding group purchasing agreements started

Other Information Available on wiki.HealthSciencesSC.org

Vendor Demonstrations – 2 hour demonstrations for each product – Scenarios and scoring sheets WIP • 6 Scenarios (WIP) • Emphasis on how the system works in actual applications

• How complicated • How easily one can meet MU criteria (reporting, etc.) • NIH Scoring • Scoring sheets entered into RedCAP for culmination/analysis

Stage 2: Demonstration Scenarios and Scoring Detail • 6 scenarios • Well Adult Visit • Well Child Visit • Sick Adult Visit • Sick Child Visit • Patient Information Double Click icon • Records Management • Input and U and A from VSGP Committee • NIH Scoring

to open


Scenario (suggested time to cover Description scenario) (Bolded sub-scenarios are a required part of vendor demonstration) 1. Well Adult Visit (10 minutes)

a-Comprehensive well female adult visit, with preventive care decision support built in b-40 yr old female visit for first trimester prenatal exam with a UTI c-57 yr old male new patient who has had no health maintenance who now has high blood pressure a-Comprehensive well male child visit, with age appropriate developmental assessment, immunization logs, growth curves, etc. b-5 year old male child visit complains of ear ache, visit also includes review of immunizations administered/review immunization history/review immunization due alerts, graph vitals (Ht, Wt, BMI and growth charts), show connectivity to a state’s immunization registry c-18 month well female child visit who also has a rash d-15 yr old who complains of back pain and needs sports physical

Clinical Support

2. Well Child Visit (15 minutes)

3. Sick Adult Visit (25 minutes)

a-Chronic disease visit for male adult with single and multiple chronic diseases. Include quality indicators built into template, and show how decision support is embedded within your system and how it utilizes evidence-based guidelines and generally accepted measures (e.g. HEDIS, etc.) b-Initial Visit for adult female with diabetes (chronic illness) not controlled: Show CPOE, order result tracking, reconciliation, and Diabetic Clinical Practice Guideline c-Follow up visit for diabetes (chronic illness), under control: demonstrate order sets, demonstrate the importing of HgbA1C lab result, demonstrate notification to ordering physician that lab results have been received. Include graphing of lab results for HgbA1C over 12 months time period e-Initial visit 57 year old male with multiple chronic illnesses and using multiple medications. Demonstrate medication reconciliation, medication alerts, generate clinical summary and demonstrate methods to export data (CDA clinical summary, etc). Demonstrate referral functionality to a specialty practitioner. d-22 yr old female who has asthma, follow up visit from ER visit the night prior. Patient needs asthma plan to prevent multiple ER visits. e-50 yr old male with hypertension and depression visits for follow up of those conditions and also complains of chest pain f-62 yr old male with HTN, Hypercholesterol, Diabetes who comes in for check up for all three problems and complains of foot pain g-65 yr old female visits for welcome to medicare physical. Patient also needs refills on blood pressure medicine and has COPD h-85 yr old male who complains of memory loss, dizziness and weakness and needs a mini mental status exam and DNR discussion

Reporting and Data Security

Clinical Support, Prevention and Usability

4. Sick Child/Adolescent Visit a-9 month old female visit with fever, child was delivered premature (10 minutes) b-11 year old male visit with chronic illness (sickle cell) 5. Patient Information (15 minutes) Note: These can be incorporated with any or all of Scenarios 1-4, but will be scored separately as a fifth scenario. In the case that scenarios are combined, please be sure to note which scenarios are being combined during your demonstration so that the scorers will know to score the scenario properly.

a-Demonstrate and review patient portal functionality. Demonstration of e-prescribing and e-visits, through secure web portal. b-Demonstrate the ability to create a personal health record for the patient c-Demonstate progress note templates – complaint or disease based d-Demonstrate appearance and utility of overall first window. Show patient information summary. Show key "drivers" page that includes (in addition to med and problem list) things such as advanced directives, allergies, contact information, etc. Show the number of "clicks" it takes to get through the summary reports to find comprehensive patient information. The demonstration includes acute care templates and is focused on common primary care problems (URI, UTI, Abdominal pain, Chest pain, headache, etc., etc.). e-Demonstration of reminder system for preventive services f-Demonstration of how problem list and medication list are integrated into the EHR, (in general and specifically related to the patient visit) g-Demonstation of prescription database and medication interaction functions h-Demonstration of the generation of billing codes recommendations i-Demonstration of eRx functionality: transmitting and receiving prescriptions (including formulary checking and medication history), internal messaging, meaningful use requirements j-Demonstration of tracking of lab, test and referral ordering showing how a practice can use the EHR to "close the loop" on all ordered tests and referrals - ensuring that the information came back and that the patient was notified/consulted. This includes referrals as necessary. k-Demonstration of tracking consults, labs, and other ancillary functions. l-Demonstration of usability scenarios showing system adaptability m-Demonstration of ease of use (average number of clicks to get to needed patient information, level of intuitiveness of software, etc.) 6. Records Management a-Ability to easily produce quality reports by provider and practice out of the EMR system to meet meaningful use requirements (Run a report to identify all patients that are (15 minutes) women over 50 years old who have not had mammography screening. Run a report on demand to find all diabetic patients who have not had HgbA1C in 90 days. Note: These can be Demonstrate the ability to filter data by age, gender, race, etc. Run a health maintenance report to identify all female patients who are due for their pap smear and incorporated with any or all demonstrate the mail merge letter functionality or other functionality to notify patients. Run a report that lists all patients with systolic blood pressure > 160). of Scenarios 1-4, but will be b-Demonstrate ability to generate custom reports like the above, showing limitations of custom reporting function and level of sophistation required to generate custom scored separately as a sixth reports. scenario. In the case that c-Demonstration of ability to import/export data for various purposes (audits, reports, etc.) scenarios are combined, d-Demonstration of ability to interface with HIEs in general and SCHIEx in particular for interchange of information please be sure to note which e-Demonstration of the ability of system to achieve a bidirectional interface with laboratories and other data sources for 2 way interchange of information including all scenarios are being capabilities and limitations combined during your f-Demonstration of how to run queries for reporting demonstration so that the g-Demonstration of all meanginful use measures with regard to required reports (also identify any MU reports cannot be generated to date and plan to address) scorers will know to score h-Demonstrate how the systems provides audit data at a transactional level the scenario properly. i-Demonstration of data recovery after a catastrophic event (at the practice, at the data center) j-Demonstration of how system meets all HIPAA and data security requirements k-Demonstrate the approach you would use to integrate the EHR system into existing providers offices that currently operate in paper. Demonstrate the approach that you would take to get this office to achieve all meaningful use requirements for 2011, 2013, 2015

Notes: Each vendor demonstration is 2 hours in duration including the above scenarios as well as 10 minutes for overview and set up, and 20 minutes for questions.

Scoring that will be used (adapted from NIH scoring system)

Stage 2: Conflict of Interest Survey 26 Inputs received All 26 no CoI

Stage 2: Demonstrations Scoring (Rank Ordered)

Process for determining percentile rank: • • • •

Raw NIH scores were averaged without the highest score and the lowest score. All NA values were excluded from calculations. Complementary NIH score calculated by subtracting the above average from 9 Normalized score calculated by setting complementary NIH score to 0% for a 0 and to 100% for an 8 Percentile calculated using Excel PERCENT RANK function • Top quartile = 75% and above • Second quartile = 50% to 75% • Third quartile = 25% to 50% • Fourth quartile = 0% to 25%

Stage 2 Scoring Summary

KLAS: Best in KLAS Awards

KLAS: Best in KLAS Awards

KLAS: Best in KLAS Awards

KLAS: Best in KLAS Awards

Stage 2 Voting Survey

Vote/Select Products to Advance to Stage 3

• 19 Products Considered • 9 Advanced to Stage 3

• Unanimous Committee Vote

Stage 3 • Group Purchasing negotiations • RedCAP Survey as Substrate for Contracts • Vetting at SC User References • IT Site Visits as Prudent

• Proposed Contract Submissions and Negotiations

Stage 3 Survey

Double Click Icon to Open

Stage 3 Progress • Constructed Stage 3 Survey • Solicited Input to Stage 3 Survey • Requested and Received Customer Lists (SC) • Review Stage 3 Inputs • Request Contract Proposals • Review Proposals • Negotiate Proposals • Finalize Contracts for CITIA-SC Customers • Target Completion Mid-November 2010 • Emphasis on Value/Functionality/Total Cost of Ownership

Complete WIP or ToDo

Round 2 •

Emphasis on filling in the gaps as well as Continuous Improvement •



Early 2011

From FPM Article Round 2? Some Potential Products of Interest

Round 2 Stage 1 Inputs Received 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Cerner Corporation Cerner PowerChart Ambulatory EHR. The current version was released in March 2010 ClearPractice,LLC CareSeries Connect(x) HealthWare LLC Chart(x) EHR & PACS Connexin Software, Inc. Office Practicum Version 8.1 DMBI ClinicSpectrum 7.0 gloStream, Inc gloEMR 5.05 HealthPort HealthPort EMR 9.0 Henry Schein Medical Systems MicroMD EMR ver. 7.0 IGI Health Orbit® 7.2 Ingenix, Inc. CareTracker version 7 INTIVIA, INC. Intivia InSync version 5.3 IOS Health Systems Medios EHR v4.6 MDLand International iClinic 11.2 MedcomSoft MedcomSoft Record Medical Informatics Engineering, Inc. WebChart EHR MedPlus, a Quest Diagnostics Company Care360 EHR Version 2010.1 NCG Medical Perfect Care EHR 4.0 Patagonia Health Patagonia Health EMR Praxis EMR (Infor-Med Corporation) Praxis v. 5.0 Pulse Systems, Inc. Patient Relationship Management 4.1.xx Sequel Systems, Inc. SequelMed EHR version 8.0 Soapware, Inc. SOAPware Clinical Suite 2010 Visionary HealthWare Alteer Office 8.0 WorkSmart MD, Inc OfficeEMR 2009

VSGP Lessons Learned • Very complicated process • Standardized process • Work closely with vendors • Collaborate with other RECs and resources • Emphasize performance and cost • MU and Certification are critical • Minimize Total Cost of Ownership • Contract is key • Unless you have a great deal of extra time, resources, and expertise in EHR, Contracts, IT, etc., don’t do this by yourself

CITIA-SC Value • CITIA-SC Provides Access to Valuable Information as Well as Implementation Assistance • KLAS • National HITRC • Wiki/RedCAP, Expert Vetting Process • CITIA-SC is Here to Help! We will do the Upfront Work as well as Implementation Assistance and Assistance in Achieving MU • Emphasis on Getting Customers the Best Value • CITIA-SC is Currently Free • Sign up at www.CITIASC.org

Summary • •

You Don’t Have to “Go This Alone” Nine Round 1 Products Have Advanced to Stage 3 • Final Vetting in Process • IT Site visits • SC Users as References • Contract negotiations in process • RedCAP Stage 3 Survey • Proposed Contracts • Negotiation • Final Contracts • Rollout to Occur Mid-November (target) Round 2 to Advance from Stage 1 to Stage 2 • Focus on Filling Gaps in Products and Offerings (Performance, Value Continuous Improvement)

Thank you!

HEALTH SCIENCES SOUTH CAROLINA 1320 Main Street Suite 625 Columbia, SC 29201 803.544.HSSC (4772) www.HealthSciencesSC.org