Finding the Right EHR

Selecting the best IT system is all about proper business alignment

As the healthcare industry becomes more reliant on information technology, organizations can expect to implement new IT systems at an increasingly rapid pace. The difficulty with the current environment is that the dollars available from the government through the American Recovery and Reinvestment Act of 2009 have created an overabundance of vendors looking for your business. How, then, will healthcare organizations be able to distinguish between the systems that will help improve their ability to provide quality care and those that look promising because they are supported by good salespeople and colorful advertising campaigns?

The answer to this question all comes down to using a structured process to find a system that will work the way that you work. The following is an introduction to a systematic approach that SimiTree Afia Analytics has used with community mental health organizations to be successful with the selection, implementation, and adoption of new health information technology systems.

The SimiTree Model

The SimiTree model of IT system selection leads an organization through seven distinct stages to properly select new technology solutions. The stages are: 

  • Establish the Vision 
  • Gather Requirements
  • Apply Knockout Criteria 
  • RFI/RFP 
  • Demonstrations 
  • Procurement 
  • Implementation and Adoption

This model was created to help organizational leaders understand and communicate the important connection between business requirements and the technical functions of health information technology systems. When taken into account while looking for a new IT system, the SimiTree model will greatly improve an organization’s successful selection and adoption of new technology solutions.

Establish the Vision

The first step in selecting a new IT system is to determine an executive vision that will help guide all the design and implementation decisions made by the organization. There are three major areas to consider when creating this vision: 

  • Current and future business needs 
  • Organizational pain points 
  • Measurable business goals

Addressing each of these areas with the executive team and then dispensing the information to the front-line staff will help to create a single, shared vision for the new IT system. This will perpetuate a strong sense of buy-in from the staff while also ensuring that the system is able to achieve the specific goals that will determine the success of the new system implementation.

Gather Requirements

An integral piece of choosing an IT system that will properly support the workflow of a healthcare organization is to create a list of specific functional requirements. This list will be used to determine the proper scope for the new system while also ensuring an accurate quote for system procurement. A factor to keep in mind when creating this list is that the requirements should all be business requirements and not mandates on how the requirement should be implemented.

That way, you are defining what the system needs to be able to do, not necessarily how it would do it (vendors will offer implementation suggestions in a later step). The most effective way to define the necessary requirements for the system is to conduct individual interviews, group interviews, and shadowing sessions with staff from every part of the organization that will interact with the new system.

During these interviews, it’s important to map the process flows of how staff are currently completing daily tasks and the inefficiencies that are a part of these processes. This will give your organization the opportunity to determine ways to improve the workflow with the new system instead of just automating existing inefficient processes.

Apply Knockout Criteria

Once the requirements have been created, there will be a small subset of criteria that will stand out as “showstoppers” for the system. These are features that the system absolutely needs to have to make it an effective solution for your organization. An example could include that the system must be web-based. By comparing these criteria to the features offered by different systems, the list of possible vendors will immediately be narrowed down to a more manageable level. This will save a tremendous amount of time for your selection team by eliminating vendors before getting to more time consuming analyses of their systems.


The creation of business requirements, application of the knockout criteria, and the full list of behavioral healthcare EHR vendors help develop a more directed approach to the RFI/RFP process. At this point, there will only be a small handful of vendors left that have systems that could possibly meet your needs. These are the vendors that will receive the RFI/ RFP for consideration. The business requirements and executive vision will now be utilized to create a packet of information informing the vendors of the type of services your organization provides, as well as the exact specifications needed to effectively support the business functions of your organization — now and well into the future. The most important part of the RFI/RFP is clearly organizing the information so that the vendors know exactly what is expected of their response and of the system itself. This will guarantee that a vendor’s response will be easy to compare to your requirements so that you can quickly determine if it could be a good fit for your organization. When the vendors return their proposals, it is essential to utilize a system to objectively “score” the proposals, which will allow you to narrow down the field to approximately three vendors to continue on to system demonstrations.

System Demonstrations

The system demonstrations are an important factor in the decision-making process because they give your end-users the opportunity to see firsthand how the systems will support their daily activities. Staff has the opportunity to identify how intuitive the system is, how many clicks it takes to do the tasks that they are frequently completing, and whether the system will actually improve the areas with inefficiencies. Breaking the demos down into blocks of time (clinical, financial, administrative) will help to direct the information toward specific groups of staff and will once again help with the overall staff buy-in for the new system by making them part of the selection process. After the system demonstrations, the list of vendors can be narrowed further to the final one or two that best meet the organization’s needs.


Once the final system is selected, it will be time to utilize all of the knowledge that has been gained throughout the vendor selection process to guarantee a successful contract negotiation. For example, the requirement list that was previously created should become part of the contract that the vendor needs to sign off on. This is a way to guarantee that the vendor will deliver the exact specifications that you’ve come to expect throughout the system definition and RFI/RFP response process. It is important to ensure that the interests of the organization are best represented through terms such as payments tied to milestones reached, acceptance testing, and guaranteed response times. This is the part of the process where organizations can guarantee a successful implementation by securing specific results in writing from the vendor.

Implement and Adopt

Finding the correct system is a great accomplishment, but without a detailed plan for successful system adoption, the entire selection process will be for not. Some of the important aspects of the implementation plan include conducting gap analyses, determining the hardware requirements for the servers and the users, creating an implementation timeline, and communicating with the entire staff throughout the process.

These steps will again help to ensure a strong staff buy-in and readiness as the new EHR system prepares to go live.

Keys to Success

Create an Electronic Health Record Committee to oversee the selection process.

Involve as many end users as possible from the organization to create buy-in.

Assemble a team of experts to perform the work. The team should consist of project leaders who can envision new ways of doing things and also understand the clinical, administrative, financial, and technical aspects of an EHR system.

flow chart of the EHR vendor selection process


While the SimiTree model of IT system selection may sound daunting, it is absolutely imperative in finding the system that will best fit the current and future needs of your organization. Too many times, organizations implement a very expensive EHR only to discover that it falls short of supporting all of its business functions and goals.

Using the SimiTree approach, you’ll not only give yourself the best chance of finding a system to make your organization more effective clinically and administratively, but it will also allow you to grow over time within an ever-changing healthcare environment.

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