L. Blair Heath--HIM: L. Blair Heath--HIM

Herding Cats
The story is about a certain medical center selecting an electronic medical record (EMR) vendor and all the challenges that are involved.


Fletcher Allen Health Care (FAHC) has interfaces to current technology systems such as IDX-Rad in radiology and SunQuest in the laboratory. They are both highly interfaced and poorly integrated. The system is highly manual and very redundant. There is no computer-based clinical documentation system for outpatient care. There is only a semi-automated system for inpatient care.


The first goal is to select an appropriate vendor that will provide the core clinical systems necessary for FAHC to achieve : supporting the work of FAHC clinicians and non-clinicians, supporting the Vermont community with a statewide patient healthcare record. The second goal was to create an enterprise clinical patient record. The third goal was to initiate a change management process within the clinical arena. The medical center does “not want to simply replicate the existing paper processes on the computer.”


They both established a team/committee. They both take a step of defining or selecting criteria, and then they both set goals or developed a strategy. The steps in chapter 6 involve exploring other options, conducting cost-benefit analysis, and contract negotiations—which the author did not include in his system acquisition. Both Chapter 6 and the authors of the article include distributing request for RFP, evaluating vendor proposals, and recommendations in their steps of system acquisition.


The 5 significant lessons that were learned include:
1. The initiative was established as a project, it was actually a discovery and a learning process.
2. “Although there was acceptance of the evaluation criteria at the beginning of the project, it would have been beneficial to have formal corporate buy-in of the criteria right from the start.”
3. “Consensus may not occur.”
4. “The initial goal was to discriminate the best vendor from the others. Eventually the goal was expanded to identify the vendor that was least risky…”
5. “Begin the contract development and negotiation during the sales process. This is when the vendor is willing to make commitments to gain new business.”