Clinicians, execs team up in system selection - Mercy Healthcare Sacramento employees participate in vendor-selection process

Health Management Technology, Sept, 1995 by Adrienne M. Edens

A number of healthcare providers in California have been through earthquakes, fires and floods in the past couple of years. We at Mercy Healthcare Sacramento (MHS) have gone through a different kind of shaking, but one that will benefit our new information systems (I/S) strategy.

The role of accurate, integrated medical information has become more important in the past few years, particularly in California's rapid transition to managed care and capitation. Being almost completely managed care (MHS handles only 5 percent fee for service), MHS found it necessary to replace its existing system to deliver the capabilities to track patient-care information for MHS' 400,000 members. MHS needed a system that could be integrated to produce seamless patient records across MHS' entire Greater Sacramento regional network.

MHS is a division of Catholic Healthcare West (CHW), a multicongregational healthcare. system headquartered in San Francisco. MHS has multiple care locations and business units that include four acute-care facilities spread over five campuses as well as a number of ambulatory facilities and affiliations with acute-care and physician associations.

With $17 million being spent for new clinical systems, including the cost of software, it was important to make the right decision the first time. MHS could have created a mosaic of different products, but would have run the risk of building a Winchester Mystery House with stairways that lead nowhere and doors that opened into walls.

Unfortunately, when individual departments or work groups select systems, the results are often difficult to integrate. Users may do some window shopping, get excited about jazzy displays or unduly focus on the department-specific functionality without considering integration factors.

Any system selection approach had to be tied in with MHS' five-year business strategy. By taking a strategic approach, it was of utmost importance to get broad representation from MHS' regional network. To accomplish this, a selection team of 15 representatives was selected, each assisted by a task force of representatives from all MHS facilities and departments. The selection team met for a full day each week during the 7-month process.

Following the weekly meeting, the 15 selection team members went back to their task forces and discussed system requirements and system process scenarios. Some task forces contained as many as 25 people. In all, 150 of MHS' 5,000 employees were directly involved in the system selection.

It was also clear that the doctors had to be involved. Many information systems are designed with the business in mind, but not the caregiver. To gain the physician's perspective, MHS recruited Larry Lieb, M.D., to form the Physician Review Group - a subgroup of physicians that developed their own requirements for the system. Lieb is a retired pathologist and former chief of staff at Mercy San Juan.

RFI, RFP process

MHS sent out requests for information (RFI) with 10 mandatory criteria and 40 other weighted criteria. It was made clear that if a vendor did not meet any one of the mandatory criteria, the vendor would be eliminated from any further consideration.

After receiving the responses to the RFI, the selection team met, scored the weighted criteria and decided the cutoff point to invite vendors to Sacramento for conferences and demonstrations. Within the RFI responses, the MHS task forces looked for vendors that had:

* systems presently being used in the healthcare industry that had multiple-facility processing capabilities, * products with the ability to interface with existing systems, * at least a 3-year track record of providing solutions to the healthcare industry, * a relatively large number of system users at integrated delivery systems, * the ability to support a clinical database and clinical decision-support system.

Skipping RFPs

By spending so much energy on the RFI, the selection team felt it was unnecessary to send out requests for proposals (RFP). If we didn't know enough about these vendors from the RFI, an RFP wouldn't give us any incremental benefit. The task forces were eager to get on with the demonstration step because they already knew what they were looking for - it was now just a matter of recognizing it.

During the demonstrations from four vendors, a technical review containing another 50 technical questions was conducted. Task force members spent the day in conferences with vendors to validate that their architectures would work. We wanted integrated functionality first, but also wanted to make sure the architecture would support what the users thought they were getting. Two key requirements were a graphical user interface (GUI) and the ability to create a master member index to track members throughout the enterprise.

Final Selection

The provider we chose - Seattle-based Phamis Inc. - had the system that fit MHS' needs. Phamis' Lastword product scored the highest in the functional requirements of the RFI. Phamis representatives could articulate their approach to providing a master member index (something the other vendors could not), and they had a GUI front end installed and operating. Phamis demonstrated that what MHS wanted was actually Phamis' product.