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Rural Implementation Steps

Step 3: Select a Certified EHR

Selecting an electronic health record (EHR) system is a critical decision and a significant planning task for rural health care organizations. There are different options regarding when the selection of an EHR system should be made. Some organizations go through the planning process and develop the selection criteria they wish to use. Other organizations begin by selecting an EHR system and then conduct planning to support the selected EHR system.  After establishing the organization’s objective(s) and planning how EHRs will affect workflows, the leadership team and staff can determine what to look for when selecting an EHR system. The following considerations may be helpful for an organization that is selecting or upgrading to a certified EHR.

Understanding Selection and the Marketplace

The process of selecting an EHR vendor includes many steps, but one of the most important steps is to understand the marketplace.   Your organization should plan to do a thorough vendor selection process to ensure that your clinical needs are met and that the product you buy enables you to meet your organizational objectives and desired strategic goals.  When researching potential vendors consult the Certified Health IT Product List (CHPL) for the authoritative, comprehensive listing of complete EHRs and EHR Modules that have been tested and certified under the Office of the National Coordinator for Health IT’s Certification Program.

RFP Development and Distribution

A Request for Proposals (RFP) is a formal request sent to a vendor or group of vendors for specific responses as to how their company, products, and services can meet your organization’s unique requirements.  An effective RFP is based on detailed planning and consideration of your organization's needs and goals in implementing an EHR system. This will lead to a detailed list of your organization's technical and functional requirements, priorities, and other considerations or criteria for a system. With these in place and a strong understanding of the EHR market place, you are ready to write the RFP.  Once the RFP is finalized, follow your organization’s guidelines to send out the RFP.  While awaiting response to your RFP, develop a plan for reviewing the RFP responses.

Due Diligence

Once you have narrowed your vendors to a select few that meet your organization’s requirements, it is important to do due diligence in carefully gathering additional information on each vendor.   This may include:

  • Developing demonstration scripts to ensure that vendors show how their product will address your organization’s goals
  • Performing a site visit to other critical access hospitals and small rural hospitals to see the vendor’s system in live environments
  • Ensuring the vendor is able to develop a separate test and training environment for your EHR implementation
  • Assessing implications of any third-party vendor requirements (e.g. interfacing with your billing system)
  • Performing a reference check

Identifying Vendor of Choice

The due diligence process of reviewing RFPs, holding demonstrations, conducting site visits, and making reference calls will help your organization narrow the field of vendors.   If there is not one vendor that stands out among the rest, you may find it helpful to develop a score card for ranking vendor pros and cons based on your organizational priorities (e.g., quality, efficiency, end-user satisfaction, usability, care coordination, support, and service).


Negotiating a favorable contract with your vendor is a critical step.  The point of contact (POC) from your organization that is charged with finalizing your contract should have prior experience in contract negotiation for information technology products and should be charged with developing a negotiation strategy and target timeframe.  If your POC is not experienced, you should seek out assistance from your local Regional Extension Center.

Communicating Final Selection Decision

Once your organization makes the final vendor selection and the contract is signed, it is important to communicate the selection. Follow your organization’s process for the dissemination of information to internal and external stakeholders.


Stratis Health Toolkit

Stratis Health developed a health IT tool kit providing resources and guidance to Critical Access and Small Hospitals. The following tools have been identified to help you with this step of EHR implementation: 

Health IT Code of Conduct

Vendor Selection and Understanding the Marketplace

Request for Proposal

RFP Analysis

Health Key Differentiators

Health Due Diligence: Demonstration Plan

Health Site Visit Plan

Health Reference Check Plan

Health Vendor of Choice

Contract Checklist

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