Software contracts include a wide range of criteria far beyond the actual software to be purchased. Where can providers negotiate and influence the cost and quality of their EHR implementation during the contract stage?
First, the user license offers room for negotiation. Licenses are the right to use software, and can be bulk licenses (for a set of computers or users) or single licenses (for a single user). Sometimes licenses limit the number of users, sometimes the number of computers. Making sure you have enough licenses for your users is a key requirement; if your billing staff need to be able to see patient diagnoses, then the licensing agreement will need to cover those users as well.
Second, services around implementation like project management, training and data transformations may be offered by the vendor. These can take several forms, ranging from hourly costs to per project costs. A key part of this section of the contract is the timeline and responsibilities, along with steps for mitigating problems or handling them once they occur.
Third, service obligations by the vendor can dramatically change your user experience. Having access to technical support can be a key enabler of successful implementation. And vendors know it:
“It is not uncommon for maintenance and support to be as much as 20% to 30% of the original software purchase price.” (Neal, 2010)
The contract should specify the hours of support, mechanisms for getting that support, how long it will take for issues to be resolved, how maintenance and upgrades will be handled, and what to do if the vendor is negligent in any of these agreements. Being careful with this portion of the contract can save you much difficulty down the road.
Fourth, hardware choices and the interfaces that connect data across systems affect the price and usability. Buying directly from a vendor may not be the best financial choice, so compare hardware costs from multiple sources. Integration of data from devices like scanners, heart monitors, X-ray systems, etc should also be assigned to a responsible party. The device manufacturer may be responsible, or the vendor, or you. But that interface is a key reason to use the EHR, to integrate data, so ensuring it will be available and that you have steps to fix any problems is important.
Finally, Neal discusses the HI-TECH act. When reviewing a software contract, look for guarantees or wording about meaningful use. Check that wording against the latest federal documents, to ensure that you aren’t being offered something that is out-of-date.
Neal has a list of tips and best practices, and we highlight two of them here: (a) “Make sure any verbal agreements are backed up by a paper trail,” and (b) “Document any “what if” fees. For example, troubleshooting support, late payment fees, system upgrades, etc.” Negotiations can take quite a bit of time, so being careful that the language reflects your conversations is key. Also, anticipating and planning for problems is a good way to ready both sides for any difficulties that may arise.
- Specific responsibilities should be identified in the contract for data integration, data ownership, etc.
- The contract should lay out a plan to protect you in case the vendor does not meet scheduled or agreed-upon goals, or is negligent about service.
- Document the “what if” contingency plans.
- Investigate hardware prices from the vendor and from your usual sources.