You have selected a vendor for your new cardiovascular information system (CVIS) or PACS. Congratulations. Most likely you conducted a formal selection process or perhaps a request for proposal (RFP). Now you have identified a vendor of choice. If you are diligent in your work, you have conducted a very careful contracting phase that has dissected the verbiage in your contract line-by-line to safeguard your organization from failure. You have also put in safeguards to ensure the vendor will be held accountable for milestones and timelines, and perhaps even resource accessibility. While prudent, all too often everything done to this point has minimal impact on the actual execution of the implementation.
In my career I have participated in more than 100 health information technology (HIT) project implementations and these are the things I think every buyer/provider should know and execute upon.
1. Do not kick-off a project until you have a project plan with resources assigned.
Vendors love to kick-off projects. It typically means revenue — so they are motivated to get the project going. The problem is their resources are allocated across multiple conflicting projects. As a result, buy-in from key vendor resources is absent at project kick-off. In addition, your vendor is burning project fuel post kick-off requesting resources and building a project plan that should be 75 percent boilerplate. You are expending internal resources, typically for months, waiting on your vendor when project work should start week 2 after the project kick-off. As well, you are losing the faith of your team while they observe very limited project activity. This is a terrible way to start an important project.
2. Expand your design phase by a multiple of 2 and require vendor engineering engagement.
There is a good possibility your vendor used creative wordplay regarding their capabilities in your RFP. You have no idea where those gaps lie until you vet the entire design of the solution within the context of the implementation. Some vendors spend very little time on design during the RFP, or even kick-off phase. This works to your disadvantage and will negatively impact your implementation and success. Your project requires sufficient design which means white boarding sessions, workflow and data flow diagrams, interface specifications, and desktop requirements and architecture details outlined. Any assumptions on your part will be your undoing.
3. Ensure your escalation path goes to the very top — quickly.
Vendors will provide escalation paths. Most lead to an account manager who has limited organizational authority. Your escalation path should lead, nearly directly, to someone with the authority to bind the company. If they are in the sales org-chart, you lose. You will, undoubtedly, escalate many times within the horizon of your project and if it leads to the wrong resource, you could lose weeks or months in delays.
4. Cancel any call that does not have the right resource allocated — or an agenda.
Every time your vendor attends a call without subject matter experts appropriate to the call agenda it is costing you in resources and project timeline. The telephone game is cute when you are in first grade, but when there are millions of dollars and, more importantly, improvements to your patient outcomes on the line, this is unacceptable. Get an agenda and a list of attendees before every call and if the right person is not in attendance within
5 minutes reschedule the call. Then escalate.
5. Plan for 25 percent cost overage — minimum.
Most vendors do not plan for contingencies. They bill for them. No matter how good your contract language is, your vendor will stumble upon functional requirements that were not clearly specified in the RFP and contract. You will get billed for this work. Budget for it or go back to the well. Your choice.
6. Refuse to move your go-live.
Go-live dates are always negotiable with vendors. Prepare to negotiate to get the resources allocated. Book the right people at a minimum four months in advance to ensure you are not left with a deficiency on your vendor’s team during your go-live.
7. Do not pay for service and support until you are live.
You have entered a long-term support contract that will provide years of annuity revenue to your vendor. This is fair. But avoid any hard dates for support prior to going live — until that point your interaction and costs should be associated solely with the implementation team that was quoted in your selection process.
8. Always be ready to start over with Vendor B.
Here is the hardest one of all, but is critical. I have seen many clients stick with a vendor that has been untruthful, unaccountable, disingenuous, unable to deliver and implementing a subpar solution that looks nothing like the product and service they sold in the RFP. The issue is always money and delivery. The cost of starting over seems too expensive. And the burning platform motivating the move to a new solution is too urgent. But the cost of staying with a difficult or unmanageable technology partner will ultimately cost you more.
About the author: Jef Williams is managing partner for Paragon Consulting Partners LLC, a Sacramento, Calif., based healthcare IT consulting group.
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