Unless you work with a knowledgeable and experienced technology provider, outfitting your facility with new enterprise software or the latest EMR can be an intimidating process. Ask yourself the following questions to help ensure you install software solutions optimal for your facility's specific needs.

1. Is the vendor reliable?
Conduct software demos and consultations at similar facilities that have implemented the software systems you're considering to get a feel for a vendor's stability and the reliability of its products and services. Ask vendors for customer lists or check their Web sites for facilities already using their software. Talk with established customers without vendors present so you can get honest feedback about the steps to install the software, the step-by-step schedule and the time frame needed for full implementation. Ask how successful vendor reps were in working around normal staff workflow during installation and how effective the vendor's training was in getting users quickly up to speed.

Review vendor contracts for language that absolves the vendor from system errors that can jeopardize patient safety (see "Who's At Fault When Software Glitches Jeopardize Patient Safety?" on page 88). These clauses are hot-button topics, and as they garner more public scrutiny you might be able to push vendors to omit the terms from sales contracts.

2. Will the software match your work style?
Even the most powerful and sophisticated software program will be a poor fit for your facility if it doesn't match your staff's specific needs and workflow. While feedback from the front line is essential when making any large purchase, matching a software program's functions to the skills, abilities and routines of your staff is paramount. Meet with your clinical team and business office workers before deciding on which new technology to implement. Are they skilled typists or would they prefer working with a system that features a graphic interface?

Keep in mind that technology may change how your staff interacts with patients. For example, inputting data into an EMR at the patient's bedside in the pre-op or post-op areas can increase efficiencies, but some clinicians and patients might feel a disconnect with each other when clicking through menus or typing in data on a computer screen. Make sure you understand how those changes can impact your clinical team and ensure they're onboard with how technology might alter patient care routines.

Check online resources to help you define your facility's software needs and staff workflows. The Healthcare Information and Management Systems Society (www.himss.org) and the Agency for Healthcare Research and Quality (www.ahrq.gov) provide various checklists and workflow documentation aids that can assist you in picking the right system for your facility. HIMSS also sponsors the Davies Awards (www.himss.org/davies), given to facilities that exhibit excellence in the implementation of and value from health information technologies. Review the case studies of Davies winners to see how facilities went about choosing and implementing software systems, and the benefits they realized.

3. How much support and training will you need?
Check out a vendor's willingness and capacity to provide support during initial implementation of new technology and follow-up training after a system's up and running. In addition to initial training, vendors should also provide useful leave-behind educational materials like reminder cards or cheat sheets for the most-often-used software functions. Those resources are invaluable when staff learns a new system; they also provide constant reminders for those who may not use the software as often as others.

When software systems fail, your clinical and business capabilities will also grind to a halt. You need to work with a vendor who offers timely help when things go wrong, whether that support comes from experts manning a 24-hour hotline, through emergency visits from service reps or via online help tools if you have working computers to get them. Keep in mind that the funds made available through the stimulus package for EMR adoption as well as a federal mandate that healthcare facilities adopt the technology by 2014 will likely lead to the creation of an increasing number of businesses specializing in tech support. That means you'll have a growing number of local support options that might be able to service your facility if larger vendors can't provide the quick-response, customized care you desire.

4. How do you prefer to enter data?
The way data is entered on the front end directly affects your staff's ease of use with the system and how easily data is retrieved on the back end. Look at the pros and cons of free text and standard formats when selecting which data entry form is right for your staff. Free text formats — entering notes in open-ended text boxes — let your staff and physicians word things as they choose and update medical forms in their own way, including relevant details about a case that might not be included in standardized checklists. However, the ability to input individualized information means you can't easily organize and extract data once it's entered into the system. And all that text has to be typed by someone.

On the other hand, entering information in a standardized format facilitates data extraction and lets you easily generate trend reports with just a few clicks of the mouse. Checklists can also increase your clinical efficiencies (and prod your memory) as long as you limit the number of lists to be completed and the series of screens to toggle through when entering data for each patient. Standardized formats should match the steps your staff takes to work through a case. Work with vendors to customize your order sets and create menu choices that match the typical patient you care for (a checklist that records the administration of your standard post-op pain regimen, for example).

5. What's the system's upgrade schedule?
Changes will need to be made over time to the software solution you buy, no matter how powerful its current capabilities. Be wary of long lapses between new program releases. Not having to deal with frequent and potentially disruptive software upgrades might sound enticing, but your system's capabilities can quickly become outdated, leaving your staff slogging through their daily responsibilities with a slow-acting system that counteracts the efficiencies it was designed to enhance. On the other hand, too frequent updates will become burdensome.

Regardless of how often system improvements need to be performed, be sure you understand what each upgrade entails before committing to a software system. Are upgrades performed remotely by linking to the vendor's server or through your software's operating system? Will a vendor rep visit your facility to ensure transitions go smoothly? Will you have to shut down your entire system when upgrades are performed? How easily can already installed data migrate from the outdated system to the updated software?

You also need to consider what you'll do in case the system isn't working because of a power outage, security breach or other problem. And, of course, you'll need to be able to easily make backups of your data and easily reinstate them when needed.

Change for the better
Any software solution installed in your facility will alter the daily responsibilities of those who use it. Your staff's job titles will remain intact, but the expectations associated with certain job descriptions might shift. Work closely with your frontline users to implement new technology and be aware of the inevitable changes to their established routines. Be ready to adapt to unexpected challenges. Most importantly, offer your support during the transition. The pains are well worth the benefits of having a well-designed system working smoothly in your facility.