How to do an RFP for an EHR (Medical Economics Special Section)

August 1, 2007

By using this formal fact-finding process-the "request for proposal"-you can make picking a system a swan dive instead of a belly-flop.

Not long ago, urologist Donald L. Spicer and his four partners decided it was time for an electronic health record. Not only was their staff spending more and more time tracking down charts, but growing documentation demands had dramatically increased dictation costs. In fact, the Paducah, Ky., group had to outsource the function. Besides, storing and managing an expanding mountain of records was getting ever more expensive.

The most computer-savvy member of his group, Spicer took up the challenge of selecting an EHR. The group's manager, Rosie Ryan, took the lead in selecting a new practice management program, because the group's existing one needed replacement.

Spicer started by looking at EHRs that local physicians in other specialties were using. While the approach yielded useful information, it also solidified Spicer's impression that he needed professional help-and a structured selection process-to make an informed decision.

Spicer sought advice from consultant Jeffery Daigrepont, a principal with The Coker Group in Alpharetta, Ga., who specializes in EHR selection and implementation. With Daigrepont's help, Spicer developed and executed a structured "request for proposal" (usually referred to as an "RFP").

An RFP is a standardized list of questions you submit to all vendors competing for your business. The goal is to acquire all the information you need to make apples-to-apples comparisons of the costs and capabilities of the EHRs you're considering. "It adds some objectivity to what otherwise tends to be a very emotional decision," says Rosemarie Nelson, an MGMA consultant based in Syracuse, NY. Another function of an RFP: Once you select a vendor, the answers it provided on the RFP should become an objective list of deliverables that are incorporated into the contract you sign. This process forces the vendor to commit to pricing and follow-up services.

The RFP process helped Spicer and his partners winnow a mass of confusing choices down to one integrated practice management and EHR system that met the practice's immediate and future needs. We'll look at Spicer's group's experience to learn how to prepare an RFP and what it should consist of.

Start the RFP processby defining your needs

The first step is to identify what functions your practice needs the EHR to perform, Daigrepont says. Once you understand this, you can create a prioritized list of requirements. Make sure the list includes both clinical and business needs. Incompatible practice management and EHR systems have been at the heart of many failed installations, Daigrepont points out. This list then becomes the basis for the information you ask each vendor to provide in the RFP.

Develop your list by soliciting input from physicians and staffers who will be using the EHR, Daigrepont advises. Pay particular attention to workflow issues, says Nelson, such as whether the physicians in your practice would be able to manually enter information directly into the system, or whether they'd need to dictate their notes and then have a staffer enter them into the computer.

Spicer involved his partners and office staff. He also put together a team that included the front office supervisor, the billing supervisor, and a clinical assistant to review a select group of products. "Their input greatly influenced the final decision," he says.

Winnow the vendors before you do an RFP

For RFPs to be truly useful, you have to use them sparingly. Daigrepont warns against soliciting complete RFPs from every potential vendor. "If you have 20 questions that you ask each of five vendors, that's 100 responses you'll have to plow through. It gets overwhelming in a hurry."