EHR Demo Interoperability

Electronic Health Record
(EHR) Demonstration
Scenario, Evaluation, and
Vendor Questions
Toolkit
June 2016 • Version 2.0

DESCRIPTION & INSTRUCTIONS
This toolkit is intended to aid providers and health IT implementers when selecting or upgrading to a
certified EHR vendor to understand the vendor capabilities through established scenarios.
To use this toolkit, provide the vendor with the patient information pre-populated and use the same
information for each vendor for comparison purposes. Use the evaluation matrix in Section 5 to evaluate
the vendors. Additionally, Section 1 provides a list of questions to ask the vendor during your vendor
selection process.
June 2016 • Version 2.0 ii

TABLE OF CONTENTS
1 Questions for EHR Vendors ................................................................................................................... 1
1.1 Questions about the company ........................................................................................................ 1
1.2 Questions about the product .......................................................................................................... 1
1.3 Pricing questions: ........................................................................................................................... 2
1.4 Interface questions ......................................................................................................................... 2
1.5 Implementation questions............................................................................................................... 2
1.6 Ongoing support questions............................................................................................................. 3
1.7 Technical/maintenance questions .................................................................................................. 3
2 Tips on Scheduling Vendor Demonstrations .......................................................................................... 3
3 Scenario to Provide the Vendor .............................................................................................................. 5
4 Information to Be Entered During Demonstration .................................................................................. 6
5 Evaluating the Scenario .......................................................................................................................... 7
LIST OF EXHIBITS
Exhibit 1 Scenario to Provide Vendor ........................................................................................................... 5
Exhibit 2 Information to Be Entered During Demonstration .......................................................................... 6
Exhibit 3 Scenario Evaluation ....................................................................................................................... 7
Exhibit 4 Additional Questions .................................................................................................................... 13
June 2016 • Version 2.0 iii

1 Questions for EHR Vendors
The questions below address important baseline information that is important to ask early in the vendor
selection process, and others may be more appropriate to ask when choosing between two or three
vendors.
 Vendor Name: Click here to enter text.

 Date of Meeting: Click here to enter a date.
 Name of Sales Contact: Click here to enter text.
1.1 QUESTIONS ABOUT THE COMPANY

1. How long has your company been in business? How many employees do you have?
Click here to enter text.
2. Of those employees, how many are dedicated to research of new products, sales, and ongoing
support? What is the research and development budget?
3. How long has the EHR product been offered? Was it bought from another company? Was the
Practice Management System (PMS) bought from another company?
4. What were your total sales last year? Last quarter? How many salespeople and trainers are assigned
to this region?
5. What is your total customer base? Of those, how many are new within the last year?
6. Does the company hold regular user meetings?
7. Is your company involved now in any litigation with a customer? Has your company been fired from a
job in the past 3 years?
1.2 QUESTIONS ABOUT THE PRODUCT

1. Is your software sold modularly or does it need to be purchased as a complete package? What
functions are available? Can you add functionality as the need grows?
☐ Practice Management
☐ Inter-office messaging
☐ E-prescribing
☐ Lab viewing/reporting/graphing
☐ Other:
2. What operating platform does the product work on?
3. Is the product used anywhere in a multisite implementation?
June 2016 • Version 2.0 1

4. Will your company guarantee in the contract that the software will comply with all current and future
Federal and State mandates? Health Insurance Portability and Accountability Act (HIPAA)? Does the
software have a Health Level 7 lab interface?
1.3 PRICING QUESTIONS:

1. How are the licenses issued? Concurrent user versus per practitioner?
2. What is the cost per practitioner (or concurrent user), for the entire package?
3. What does the price include?
☐ Software
☐ Hardware
☐ Training
☐ Maintenance
☐ Upgrades/further training/maintenance
☐ Travel for your employees
☐ Other
4. How much will ongoing maintenance and upgrades cost?
1.4 INTERFACE QUESTIONS

1. Can your software interface with a PMS? Lab systems? Is there an added cost for these interfaces?
2. What existing interfaces are up and running?
3. Can I speak with a provider or administrator of a clinic presently using these interfaces?
1.5 IMPLEMENTATION QUESTIONS

1. Will your company assume all aspects of implementation (i.e., hardware and software)?
2. Does the training occur onsite or at your facilities? Is this training included in the overall cost?
3. Are you willing to be flexible with your training methods (e.g., individual versus group training based
on our needs)?
4. Is your software tailored for physician specialties (e.g., OB/GYN)? What sort of customization, if any,
is needed for specialties?
5. Describe the process of transition to EHR. What are some of the difficulties? What can I expect?
6. (If interested in voice recognition) Describe how your voice-activated system works. How easy or
difficult is the transition? Will I need to have an “auditor” for some time after I move to voice-activated
notes?

7. At what point in the process does the salesperson transition to implementation specialist?
8. How often will a support person(s) be available once the system goes “live,” in case of any system
difficulties?
1.6 ONGOING SUPPORT QUESTIONS

1. What is the frequency and depth of upgrades?
2. What is your process for enhancement requests?
3. What happens if the system fails? How do I reach you, and how accessible is your decision support?
1.7 TECHNICAL/MAINTENANCE QUESTIONS

1. What personnel and qualifications do I need to support and operate this system?
2. Does your system include any database reporting tools or special links to popular reporting products
that run under Windows? Which ones?
3. Does this system work over the Internet or do I need to purchase a server?
4. Does the system require regularly scheduled (e.g., daily, monthly) downtime for backups, system
maintenance, etc.? Briefly explain.
5. What safeguards (e.g., fault tolerance, hardware redundancy) are included to eliminate unplanned
downtime?
6. What are your data retention capabilities, if any, and recommendations for maintaining history online?
2 Tips on Scheduling Vendor Demonstrations

The focus of the system selection phase for EHR implementation should be vendor demonstrations.
Vendor demos provide the chance to see the look and functionality of an EHR application. The purpose of
the demo is to get an overview of the application and to ask the vendor questions.
Once you have an idea of your practice, select about 5–10 different vendors for the demos. In selecting
vendors for the demos, focus on EHR applications that meet the needs of your practice. Talk to other
practices in the area similar to yours to find out what EHRs they use and to check the software provider's
credentials and certificates.
Once you have an idea of what your practice needs are, select about 5-10 different vendors for the
demos. In selecting vendors for the demos focus on EHR applications that meet the needs of your
practice. Talk to other practices in the area similar to yours to find out what EHRs they use and check the
software provider's credentials and certificates.
This document provides helpful hints on planning and attending EHR application demonstrations .

1. A good number of demos to request is somewhere between 5 and 10 different vendors.
With fewer than five, you probably will not see enough vendors to get a feel for the functionality
that exists in the market. With more than 10, you will probably lose track of the subtle differences
among vendors.
We recommend attending the demos of 5 to 10 vendors, and if you still do not have a good
feeling about any of the products, select another group of 5 to 10 and repeat the process.
Attending demos can be a tedious process. Pace yourself, and try not to see all of the demos in
the same week.
2. When the vendor contacts you to set up the demo, be clear about which products you would
like to see—EHR or EHR and PMS.
3. The vendor will offer either an onsite demo or a Web-based demo.

For an onsite demo, you will usually need an Internet connection and a screen or some way for
the vendor to present the demo. Be sure to ask the vendor what equipment is needed for the
demo.
For a Web-based demo, you will need a telephone with speakerphone, a computer that is
connected to the Internet, and a screen or some way for everyone to view the demo.
4. Practices vary on which staff members are invited to the vendor demos. At a minimum, the
physician champion and practice manager should attend. Ideally, the entire implementation
team would be invited to attend the demo. It is important to engage practicing physicians, nurses,
and care team members in the demo and implementation process.
5. The demo should last approximately 1–1.5 hours for the EHR portion. Allow more time for a demo
of the EHR and the PMS together. Come prepared with a list of questions for the vendor (see
Section 1 for model questions).
 Ask each vendor the same questions to get a feel for how different EHRs compare.
 Come prepared with some clinical scenarios or specific workflows for the vendor to “walk
through.” The scenarios will give you a chance to see the EHR in action.
 Ask the vendor to show how certain reporting tasks would be possible. For example, how
does the application report on patients with a particular disease, medication, or lab result?
 Ask questions with multiple search parameters; for example, how does the application report
on patients with diabetes who, within the past year, have had a HgbA1c > 9.0 percent?
6. During the demo, try not to interrupt the vendor with questions too often. It is sometimes
hard not to ask everything that comes to mind, but the vendor will need to pace the demo within
the allocated time so you can view all the information. Write down your questions throughout the
demo and make sure you ask all your questions, but you may want to see a particular function all
the way through and then ask questions at the end.
7. After seeing all the vendor demos and narrowing your choices down to the serious contenders,
request references from each of the vendors. These references will be other customers who
use the EHR product and can communicate their experiences. Your implementation team can
schedule phone call interviews with these references to get an idea of their experiences.
8. After the product demos and reference phone calls, you will be able to further narrow your list of
EHR vendors. Experts say to enter contract negotiations with at least two vendors to provide
the necessary leverage to get the best deal. For these remaining few vendors, request references
from these vendors for practices that you can visit onsite. These may or may not be the same
references called previously for telephone interviews.

3 Scenario to Provide the Vendor
The information in Exhibit 1 is a sample scenario that can be provided to the vendor to pre-populate prior
to the demonstration.
The purpose of this demonstration is to get a good idea of the workflow capabilities and efficiency of the
program to meet your practice needs. It is important to ask the vendor to highlight how their product will
assist with ease of documentation, generating actionable reports, and the tracking quality measurement.
This will also be helpful for quality improvement programs such as Meaningful Use and the Physician
Quality Reporting System. Additional key capabilities to discuss and demo include patient engagement
functionality, population health management tools, care management, and care coordination functionality,
as well as tools to fit your practice, specialty, and patient population specific needs. Key additional
questions to ask are in Exhibit 4.
Exhibit 1 Scenario to Provide Vendor1

Item Scenario
Patient  Daisy Duck, DOB 1/4/40
 Married, mother of 3, retired
 HIPAA form signed 5/1/06
Problems  Hypertension
 Diabetes Type II
 Esophageal Reflux
Medications  HTCZ 12.5 mg qid
 Lopressor 100 mg bid
 Prevacid 30mg hs
 Metformin 500mg bid
Allergies  Penicillin>urticaria
PMH/PSH/FH/Soc.Hx.  Diabetes
 Hypertension
 GERD
Other  Three normal, spontaneous vaginal deliveries
 Hospitalized once for Pneumonia in 1998
 Nonsmoker
 Last Tetanus 1998
 Influenza vaccine 10/04
 Pneumovax 1999
 Mammography 1999
1 Information included in this scenario may appear to contain personally identifiable data; however, these data are
representational only. No personally identifiable information (PII) or protected health information (PHI) is contained
herein.

4 Information to Be Entered During
Demonstration
Do not provide this information to the vendor prior to the demonstration. Have them enter it during the
demonstration to see how the system handles it.
Exhibit 2 Information to Be Entered During Demonstration2

Item Scenario
Complaint  Follow-up care to patient for diabetes, hypertension, and reflux. Patient states FBS
elevated at home.
PE  Weight: 180; Height: 5'9"
 BP: 180/95, repeat 130/78
 P: 89
 R: 28 regular unlabored
 T: 97.6 F
 General: no distress noted
 HEENT: nasal congestion
 Lungs: clear to auscultation
 Abd: soft on palpation, nontender
 Neuro: alert, orientated x3
 Foot exam: (visual) normal
Lab  Accuchek in office 220
 Urine for microalbumin: negative
 Previous lab (> 6 mos ago) HgbA1c: 8
 Lipid Profile (fasting)
 HgbA1c
 Referral to Dr. Mickey Mouse for dilated eye exam
 Referral to Dr. Olive Oil for Pap smear
Assessment  Hypertension, controlled
 Diabetes Type II
 GERD
 Pt to call back in 1 month if no improvement in FBS
 Diabetic teaching reinforced in regards to diet and home monitoring of blood sugars
 Patient Instructions provided
 Health Summary provided
 F/U in 3 months
Plan  Rx
 HCTZ 12.5 mg qd x 6 months
 Lopressor 100mg bid x 6 months
 Prevacid 30mg q HS x 6 months
 Discontinue: Metformin 500mg bid x 3 months
 Add: Actos 10mg daily
2 Information included in this scenario may appear to contain personally identifiable data; however, these data are
representational only. No PII or PHI is contained herein.

5 Evaluating the Scenario
Use the evaluation matrix to evaluate how each vendor does with the scenario.
Vendors should be able to walk through these scenarios once they have entered the background data provided. Allot time for the vendor
to demonstrate other features of interest after the scenario is completed.
Instructions: Note difficulties in performing the documentation tasks, and score the ease of each task from 1 (very difficult or time-
consuming) to 5 (easy and quick). Make sure to pay attention to the number of mouse clicks and screen changes it takes to complete one
task and check for visibility of key information and the intuitiveness of the user interface.
Exhibit 3 Scenario Evaluation3

Duty Task Notes Score
(1–5)
Receptionist Patient calls in to schedule a follow-up appointment for  Scheduling of patient. Click
diabetes, HTN, GERD.  Documentation of visit reason. here to
 Health maintenance prompts. enter
 Ability to auto-confirm appointments. text.
 Prompts to remind patient to fast due to fasting blood
sugar.
Receptionist Patient comes in for appointment.  Insurance information entered/Insurance card Click
scanned. here to
 Signed HIPAA release. enter
 Eligibility checked electronically. text.
 Health history gathered?
 Patient checked in/Alert to MA that patient is in
waiting room.
MA MA sees alert and rooms the patient.  Patient identified. Click
 Patient visit status updated. here to
 Patient’s chart pulled up. enter
text.
MA MA reviews visit reason and patient’s chart.  Patient’s chart. Click
 Easily identify visit reason. here to
 Preventive care prompts and action. enter
text.
3Information included in this scenario may appear to contain personally identifiable data; however, these data are representational only. No PII or PHI is
contained herein.

(1–5)
MA MA documents chief complaints: Diabetes, HTN, GERD.  Multiple chief complaints. Click
 Entered in a note template or in MA view. here to
enter
text.
MA MA Documents:  BP: lying, sitting, standing (Prompts for out of range). Click
 Weight: 180  Pulse: oral, radial, pedal, femoral. here to
 Height: 5'9"  Temperature: Fahrenheit, Celsius. enter
 BP: 180/95  Height: feet/inches, centimeters. text.
 Pulse: 89  Calculates and displays BMI.
 Temp: 97.6F  Allergy documentation: food, drug, environment.
 How are medications updated?
MA Reviews:
 Allergies: Penicillin>urticarial.
 Medication List: HCTZ 12.5mg.qid, Lopressor 100mg
bid, Prevacid 30mg.
 hs: Metformin 500mg bid.
MA MA Reviews:  Content specific to each Hx item. Click
 PMH: Diabetes, Type II, Hypertension, GERD.  Ease of documenting year and relationship to patient. here to
 Surg/Hosp Hx: hospitalized pneumonia 1998.  PQRI prompt for smoking status. enter
 Family Hx: mother L & W, father dec. CHF. text.
 3 children normal vag. deliveries.
 Social Hx: nonsmoker, retired.
 Immunizations: Tetanus 98, flu 10/04, Pneumovax 99.
 Advanced Directive: signed 1/3/02.
 Preventative Care: mammogram 99.
MA completes entry.
Physician Physician is prompted that patient is ready.  Physician prompt easily identified. Click
 Identify correct patients chart. here to
 Patient’s chart/medical Hx easily accessible. enter
text.
Physician Physician looks at CC, PMH, and past visit.  Chief complaint entered by MA visible/can it be Click
edited. here to
 Option to default PMH into note. enter
 Ease of viewing past visit. text.
 Alerts reminders when a note is opened.

(1–5)
Physician Physician opens Follow-up diabetes, hypertension, Click here to enter text. Click
new note and GERD. Patient states here to
documents HPI. experiencing elevated fasting enter
blood sugar at home. text.
Physician Physician Diabetes Type II, Hypertension, Click here to enter text. Click
reviews/updates GERD here to
PMH/PSH/FH/Med. enter
list/Soc. text.
Hx/Allergies/
Immunizations.
Meds: HTCZ 12.5mg qid, Click here to enter text. Click
Lopressor 100mg bid, Prevacid here to
30mg hs, Metformin 500mg bid. enter
text.
Allergies: Penicillin>urticara. Click here to enter text. Click
here to
enter
text.
Three normal, spontaneous Click here to enter text. Click
vaginal deliveries. here to
enter
text.
Hospitalized once for Pneumonia Click here to enter text. Click
in 1998. here to
enter
text.
Nonsmoker. Click here to enter text. Click
here to
enter
text.
Last Tetanus 1998. Click here to enter text. Click
here to
enter
text.
Influenza vaccine 10/04. Click here to enter text. Click
here to
enter
text.

(1–5)
Pneumovax 1999. Click here to enter text. Click
here to
enter
text.
Mammography 1999. Click here to enter text. Click
here to
enter
text.
Physician Physician Resp. 28 regular and unlabored. Click here to enter text. Click
documents the here to
physical exam. enter
text.
Repeat B/P: 130/78. Click here to enter text. Click
here to
enter
text.
General: no distress noted. Click here to enter text. Click
here to
enter
text.
HEENT: nasal congestion. Click here to enter text. Click
here to
enter
text.
Lungs: clear to auscultation. Click here to enter text. Click
here to
enter
text.
Abd: soft on palpation, nontender. Click here to enter text. Click
here to
enter
text.
Neuro: Alert, oriented x3. Click here to enter text. Click
here to
enter
text.

(1–5)
Foot exam: (visual) normal. Click here to enter text. Click
here to
enter
text.
Physician Physician Accuchek in office 220. Click here to enter text. Click
documents lab here to
enter
text.
Urine for microalbumin: negative. Click here to enter text. Click
here to
enter
text.
Previous lab (>6 mos ago). Click here to enter text. Click
HgbA1c: 8. here to
enter
text.
Physician Physician Viral URI. Click here to enter text. Click
documents here to
assessment enter
text.
Hypertension, controlled. Click here to enter text. Click

here to
enter
text.
Diabetes Type II. Click here to enter text. Click
here to
enter
text.
GERD. Click here to enter text. Click
here to
enter
text.
Physician Physician Rx: HCTZ 12.5mg qd x 6 months, Click here to enter text. Click
documents plan Lopressor 100mg bid x 6 months, here to
Prevacid 30mg q HS x 6 months, enter
Discontinue: Metformin 500mg text.
Add: Actos 10mg daily

(1–5)
Lipid Profile (fasting), HgbA1c, Click here to enter text. Click
Referral to Dr. Mickey Mouse for here to
dilated eye exam. Referral to Dr. enter
Olive Oil for Pap smear. text.
Patient to call back in 30 days if Click here to enter text. Click
no improvement in fasting blood here to
sugar. Routine follow-up in 3 mo. enter
text.
Physician Physician chooses charge level  Current diagnosis and procedure codes built-in. Click
 E&M coding advice to providers based on here to
documentation. enter
 Data validation procedure to diagnosis, text.
procedure/diagnosis to patient age and gender.
 Billing/coding interface.
Physician Physician completes and signs note  Prompts unfinished patient chart documentation. Click
 Spellchecking. here to
 Provider alerts for missing charting elements. enter
 Records locked after signature. text.
 Ability to make amendment to record.
 Option to put note on hold.
Biller Billing  Invoice creation. Click
 Claim scrubbing. here to
 Electronically submit claim. enter
 Payments received distributed with adjustments. text.
 Electronic remittance advice.
 Collections.

Exhibit 4 Additional Questions
Questions Answers Score (1–5)
Click here to enter text. Click here to enter
Can you submit insurance claims electronically? text.

Can you provide patient health status on request? text.

Can you provide clinical summaries per visit? text.

How do you provide care summaries for referrals? text.

Can you provide data exchange with immunization text.
registries?

Can you provide surveillance data to public text.
agencies?

Can you report quality measures to the Centers for text.
Medicare & Medicaid Services?

Do you have a relationship with any health text.
information exchanges?
(Note: See also the Vendor Comparison and Matrix Tool).

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Electronic Health Record

June 2016 • Version 2.0

June 2016 • Version 2.0 ii

June 2016 • Version 2.0 iii

 Vendor Name: Click here to enter text.

1.1 QUESTIONS ABOUT THE COMPANY

1.2 QUESTIONS ABOUT THE PRODUCT

June 2016 • Version 2.0 1

1.3 PRICING QUESTIONS:

1.4 INTERFACE QUESTIONS

1.5 IMPLEMENTATION QUESTIONS

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1.6 ONGOING SUPPORT QUESTIONS

1.7 TECHNICAL/MAINTENANCE QUESTIONS

2 Tips on Scheduling Vendor Demonstrations

June 2016 • Version 2.0 3

3. The vendor will offer either an onsite demo or a Web-based demo.

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Exhibit 1 Scenario to Provide Vendor1

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Exhibit 2 Information to Be Entered During Demonstration2

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Exhibit 3 Scenario Evaluation3

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June 2016 • Version 2.0 10

Hypertension, controlled. Click here to enter text. Click

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June 2016 • Version 2.0 12

Click here to enter text. Click here to enter

Click here to enter text. Click here to enter

Click here to enter text. Click here to enter

Click here to enter text. Click here to enter

Click here to enter text. Click here to enter

Click here to enter text. Click here to enter

Click here to enter text. Click here to enter

(Note: See also the Vendor Comparison and Matrix Tool).

June 2016 • Version 2.0 13

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