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Assume that you have been asked to procure a new integrated software application

for patient records management. Describe the process you would follow to shortlist
suppliers for this purpose. How will you determine if the supplier is an
approved National Health Service (NHS) supplier?
Note: The NHS refers to the set of public healthcare systems within the UK.
Your answer should discuss the following points:

How would you determine requirements? For example: How would

you determine what capabilities the software application is required
to have?

When we talk about having our RFP written down, we will need to look at the
deliverables, timeline, budget etc. in order to scope the initiative properly. As a
person who receives too many RFPs every day, I can clearly state that none of
them come in their true form. Its usually not a final list but a beginning of

What criteria would you use to select the suppliers?

Cite two different approaches that you can use to make your
decision. Compare and contrast these approaches, identifying their
strengths and weaknesses. Which one would you choose and why?

Basic Scoring
Assigning score based on the suppliers criteria is one of the most simplistic method
of measuring RFP scores. The approach is done by assuming equal scores for all the
questions. The negative aspect of this method is that all of its mentioned criteria
contribute equal value to the scores in total. This assumes that all the questions are
equally important which we know is not the case most of the time. In reality the
evaluation criteria of some are always higher than the others and its very important
that it has to be reflected on the scoring.
Combined Score + Weightings
This method gives importance separately to each criteria so that the different
questions can be scored on different or more fare approach scale. Thus theirs a
combination between the buyers weight and supplier score. With the help of this
method a better insight can be gained through the RFP scaling. This method too has
some limitation as the allocation of the scores needs to be marked separately for
each question which might cause for errors or confusions. Moreover the method
puts forward some limitations to the flexibility due to various priorities and parties,
impacting the decision making and evaluation.

When we talk about integrated software application for patient records

management, we will come across more than 100 companies claiming to provide
the service. We feel so overwhelmed before we barley start getting into the market.
The very next step is choosing the very few suppliers who are registered in the NHS
whom you might have heard or read about and they usually introduce their system
by arranging a demo.
Systems like patient record management will have impact on the practices at the
installed location. A mistake in the decision process wont be acceptable. Only by
adhering to systematic and logical selection process will we be able to make better
decisions about what to choose.
Step 1: Identification of decision makers
In case of solo practice the method is very easy, otherwise a group/ committee
needs to be carefully selected. As the software is just record management related IT
and Procurement would be enough. As these kind of softwares are generally time
consuming during decision, it has to be made sure that few influential people
related to these system are in the selection committee. Like managers, nurse,
receptionist etc. Also we need to remember that the titles does not mean that they
are influential.
Step 2: Goal Clarification
In order to have a better goal the limitations and inefficiencies has to be listed out
from the current practice, and should identify on what do we hope to accomplish
with the system? Is so many time wasted on looking for records? How bad is access
to information? Is the team ready for electronic advancements? Etc. As you begin to
prioritize your needs the list of functionalities may appear as a useful tool.
Step 3: The RFP
The step is a necessary step even though its so tedious. In the RFP information can
be added to inform the vendor about the system, priorities, resources etc. with
regards to the functionality. The more detailed the RFP is usually you tend to
receive more detailed comparative responses from the suppliers. The more time
that we give to the vendor the better the output they come up with usually.

Step 4: RFP recipient Selection

As we mentioned before there are so many brands available in the market. So,
when we talk about criteria we need to look into their history with similar product,
will it fit with our capacity requirements, its ratings etc.
We need to look into our requirements basics like data sharing possibilities,
interconnecting of softwares, avoiding double entries etc. The software should be
something thats easily usable and upgradable. When we order softwares like these
the good company usually notify us about every year updates.

Step 5: RFPs Review and narrowing the field

The goal is to pick the best contenders so that they can come visit and give us the
presentation. Its better to have these presentations with all the selection
committee present so that we can have a fair comparisons. The demos are usually
time consuming when it goes up to 4 or 5 bidders.
Reliability This is one of the first and foremost fact as if the selected supplier let us
down, we end up in letting the customer down as well.
Quality The suppliers quality has to be consistent as, if the quality delivered is
poor its generally considered to be a flaw in procurement. Directly or indirectly
from a customers perspective its you who are to be blamed and not the supplier.
Value for money Always going for the low value of money is not a healthy option. If
we are willing to have product or service at a standard quality and reliability from
the suppliers we will have to be sure on our willingness to pay so that a balance can
be struck between service, quality, reliability and cost.
Strong service and clear communication Timely delivery is a very important fact
and honest response in case of delays are very important. The best suppliers
usually sends us continuous update regarding the delivery time and they usually
always look forward to ways how they can serve us better.
Financial security Good suppliers with sufficient cash flow are very comfortable to
deal with as they dont demand most of the time advance payment or doesnt make
any delays in their ordering as well u can usually expect a smooth flow. And these
companies usually stay strong and long term in the market and are always there for
you when you need them the most.

Step 6: Vendor Ranking

Now that you've reviewed the RFPs, seen the demos and done the reference checks,
it's time to rank the vendors and narrow the field to two or three vendors for site
visits. Given the time and resources involved, doing more than three visits is
impractical. Even one visit could be a challenge for a busy solo physician.

Before you rank the vendors, you should formally weigh your priorities in the
following areas:

Functionality. How well does the product perform your desired functions?

Total cost. How much will the product cost, including hardware, software,
support, etc.?

Vendor characteristics. Does the vendor offer excellent service, training and
implementation support, and are they financially secure?

Most physicians tend to put too much emphasis on functionality and cost while
ignoring the critical nature of service, training, implementation support and the
long-term viability of the vendor and product. If the system is not effectively
implemented or maintained, it will not achieve its desired potential. And it will be
more than a small inconvenience if the vendor you know and love goes bankrupt.
We put a 40-percent emphasis on vendor characteristics, 40 percent on
functionality and 20 percent on cost. The sample vendor rating tool below breaks
the selection criteria into these same three categories. (For another example, go
to http://www.chcf.org/topics/view.cfm?itemID=21520.)
Cost estimates can be tricky. Vendors tend to present these in a way that makes
side-by-side comparisons difficult, and they focus only on software costs. Be sure to
do a comparative spreadsheet that captures all associated costs over the first five
years including new hardware costs, new IT personnel, network upgrades, extra
licenses and annual service and maintenance. [One such spreadsheet can be
downloaded from the FPM Web site
athttp://www.aafp.org/fpm/20020400/57howm.html#1.] When we did this for our
top four choices, we found the costs to be surprisingly similar.
Step 9: Conduct site visits
Once you've selected your final contenders, plan site visits to see how the systems
perform. Go to practices that are similar in size and configuration to yours. If
possible, go to one that is using the same PMS that you are using. Bring at least one
physician and the most senior management person that will be responsible for the
EHR purchase. Plan to visit with physicians and observe them with patients. Also
talk to back-office personnel, relevant management and the practice's key IT
personnel. Take notes. Use the visit to confirm or contradict your expectations of the
product based on what you learned through the RFP, demo and references.
Step 10: Select a finalist
After each site visit, go back to your vendor ranking and see if it still holds. Select
your top contender and a runner-up. If negotiations don't go well with your number
one choice, you may want to fall back on number two. Also, having a serious backup choice will give you more leverage in the negotiation process.
Step 11: Solidify organizational commitment

Now that you have picked the vendor you'd like to do business with, it's time to
make sure the rest of the practice is with you. If you're in a small practice, hopefully
you've involved all the key decision makers in the process to this point. If so, you
can skip this step.
If you're in a larger practice, or one that has some potential naysayers, discuss your
selection committee's recommendations with all the relevant stakeholders. Be
prepared to sell your group on the EHR concept and this particular vendor. Invite
the vendor to give another demo to the practice as a whole and be prepared to
address a slew of questions and concerns. If significant concerns come to light that
your committee didn't address previously (if you did your homework, that's
unlikely), be prepared to drop back to step seven and repeat any steps necessary to
solidify your practice's commitment to the EHR.
Step 12: Negotiate a contract
Typical EHR contracts span from 10 years to lifetime. If the contract is to terminate
in 10 years, be sure you know what happens after that. Current and future costs
should be spelled out, as should the role the vendor will play and the amount of
time the vendor will commit to the implementation process. Be sure to consider the
possibility that the vendor could go out of business before you do. Request that the
vendor's source code be put into escrow, and clarify the circumstances under which
you could get access to it. Have a lawyer experienced in software contracts help
with this step.
Final note
The EHR selection process is time consuming, but for a decision as important as this
one, it's necessary. You can't afford to purchase an EHR impulsively, and you want
to make sure your practice is with you. The entire process can take from six months
to two years. Our group took 13 months, which I suspect is about average. If your
selection process is methodical, critical and inquisitive, you will undoubtedly be
happy with your final EHR choice. Good luck on your quest.
Dr. Adler is a family physician in full-time clinical practice in Tucson, Ariz. He has a
Master of Medical Management degree from Tulane University and a Certificate in
Healthcare Information Technology from the University of Connecticut