Buying a clinical information technology system challenges every organization’s senior management team. Unlike other administrative applications that help manage a facility, the clinical information technology system touches directly the lives of patients and the work flow of physicians, nurses, and other clinicians. Careers and entire organizations can be ruined by poor vendor choices and botched implementations (e.g., installation of the software and hardware) and deployments (e.g., introduction of applications to end users). Poorly chosen clinical information technology systems can drive physicians to competitor institutions, impact facility accreditation, and in some cases invite litigation due to unexpected morbidity or mortality.
As frightening as this task is, the best way to be successful is to be humble. Senior executives must accept the fact that full investigation of the features and functionality of clinical information technology systems before purchase is impossible. No individual or committee has the technical expertise and available time to effectively evaluate and fully review the capabilities of a comprehensive clinical information technology system. Therefore, organizations must base their decision to purchase systems on factors that function as surrogates for the usefulness and appropriateness of the systems in its institutions. These may include such items as the source of clinical content included with the system, list of organizations using the system, and perceived ease of use of the application.
Evaluate Live Systems
Although information technology vendors utilize demonstrations of their software to educate clients about their products, viewing working systems deployed in patient care areas offers the most valuable information. Unfortunately for both vendors and purchasers, the competitiveness of the healthcare information technology marketplace, couple with the complexity of these systems, encourages vendors to showcase software products during demonstrations that are either partially completed or are in beta version.
Therefore, often what is seen in these demonstrations does not accurately represent the features and functionality currently available. It is important to take vendors at their word when they declare that the demonstrated software is representative of features and functionality under development.
Focus on Deployed Working Systems Only
To increase the probability of purchasing a product that will satisfy the needs of an organization, institutions most focus on existing, working, deployed, and implemented versions of the applications being considered for purchase. The best way to evaluate current-state versions of applications is to visit current clients of each vendor and to witness the daily use of the various applications. Organizations must be patient and allocate adequate time to see the systems working under all conditions. This includes visiting multiple hospitals and various patient care areas throughout each hospital.
Forge Solid Vendor Relationships
For most organizations, it is more prudent to engage in relationships with vendors that have established working applications that can be immediately deployed and utilized. Although working, released software will have its inevitable share of problems, it is likely there will be fewer problems and solutions will be readily found.
In some cases, it may be advantageous to engage in relationships with vendors that are offering software that hast just been released or is under development. In these instances, organizations must enter the agreement recognizing the potential benefits from such arrangements but also the problems and delays in the software that may be associated with purchasing new, untested software. Organizations that do not have extensive information technology infrastructure and departments should be wary of entering into these types of arrangements.
The following sections outline a recommended process for choosing clinical information technology for an institution.
Review and Embrace Strategic Vision
The purchase of all clinical information technology tools must be driven by the clinical strategic vision of the organization. The strategic vision represents the views and aspirations of the board of directors, the medical staff, and other clinical professionals in the organization. Clearly, cost control is always a consideration, but the importance of patient safety and quality healthcare overwhelmingly drives decision making.
Broadly Explore Options
A high level of evaluation of your organization will quickly identify the potential suppliers of the application software required. In almost all cases, there will be a relatively small number of vendors who provide software that meets the needs of an organization. Identification of these vendors can be done through a request for information process ( RFI ), searching the Internet, and contacting colleagues at institutions similar to one’s own.
Understand the Vendor
As relationships with application vendors extend far beyond the implementation phase, a strong, open, and trusting relationship is necessary to be able to ensure that implemented software will deliver the expected results to an organization. Because problems will arise, a positive relationship is required to ensure that problems are resolved. A good relationship with a vendor, as exhibited by respectful an honest interactions with all representatives of the organization, unequivocally trumps perceived advantages in features and functionality that might be seen in other products.
Evaluate The Product
The best way to evaluate clinical information technology applications is to actually see them functioning in a real working environment. Unless an organization is working as a development partner with a vendor, various client organizations, comparable to the purchasing institution, should be available to be visited to observe the applications being used by clinical professionals.
Purchasing organizations must budget more than one day to visit these client organizations and see the applications being used at a variety of times during the day. Workloads vary, with morning physician rounds often presenting the greatest demands upon systems because of their high number of new patient orders and the need for patient care documentation. In addition, evening use represents a time when information technology staffing may be low or system maintenance may occur.
Organizations should request that their representatives be allowed to visit patient care areas unencumbered and be able to ask questions of the various users of the applications. The more institutions visited, the better the information that can be collected to evaluate the applications and the vendor.
Vendor pricing is greatly influenced by the level of ongoing maintenance payments, the strategic value of the organization to the vendor, and market forces. Therefore, in negotiating products with vendors, be sure to take a very broad and considered view of the products, services, and support being provided.
Cost of ownership includes not only the purchase price of the software but also the ongoing maintenance fee to the vendor and the cost of implementing, deploying, and maintaining the system during its life. Finally, the importance of the quality of the relationship with the vendor cannot be overemphasized, as it will have the greatest impact on the success of implementation and, eventually,clinician adoption.
Implementing clinical information technology without broad involvement and support by the clinical staff-requiring focus on all stakeholders, including physicians, nurses, pharmacists, and other health professionals-all but guarantees a failed and wasteful deployment. Clinical information technology systems alone do not fix clinical problems, advance safety, or reduce costs by themselves. These systems provide tools that can be used by clinicians to change how they deliver care. Only with clinician creativity, insight, and experience molding the implementation can new processes deployed with these tools deliver acceptable work flows and generate good outcomes.
If deployment is poor and disruptive, clinicians will create work-arounds to these failing system processes, a development that guarantees medical errors and unacceptable waste. By securing adoption, organizations can be assured of usable systems that are embraced by clinicians and that are able to deliver expected and much-needed clinical and financial outcomes.