You're finally finished. You've patiently listened to all the sales pitches, laboriously examined the lengthy requests for proposal responses, dutifully sat through product reference calls and vigilantly conducted site visits. Finally, you're ready to ink a contract for a certified electronic health records system.

Resting on your laurels now, however, would be a mistake but one that many health care executives unfortunately make. Why can't you take a minute or two to catch your breath? Because, it's now time to negotiate a Statement of Work (SOW) for your implementation--possibly the most important task on your whole EHR and meaningful use journey.

Generally left to the last minute and quickly glossed over in most instances--short-changing this step could cost you--big. A well-developed SOW is an ironclad representation of the scope, timing and outcome that you want to achieve with your software implementation. With the right SOW, however, you can take control of your implementation--and be on your way to meaningful use and improved care. Indeed, with the right SOW, you can specifically define the "who, what, when, where, why and how" associated with your software implementation.

Without a well-constructed SOW, you can consider yourself dead in the meaningful use water. Why? Most vendors will sell self-serving hourly service agreements that have little to do with your implementation and adoption goals. With these service agreements, vendors will have you spending money on routine tasks such as project management (frequently to coordinate their own internal resource scheduling and broken processes), technical project management, product installation, product training (what I like to refer to as "push here" training), expensive guidance on interfaces, conversions, testing and end-user training.

Then, your vendor might try to set up a timeline that matches up with the availability of their vendor implementation resources (yes, so they can work on multiple clients at one time) and not with your project goals. They drop in (but only as scheduled), conduct a session or two, judge the work that has or has not been completed since their last visit, plan group lunches with peers that they have not seen for a while, get to know each other if they have never worked together, make dinner plans and then leave with a great deal of clatter to catch their plane on Thursday (if you are lucky and they stayed that long).

With the emergence of BIG EHR vendors selling to small to mid-sized community hospitals, the contracted SOW becomes even more important. Here's why: Current vendor implementation methodologies have been designed for large project teams with rigid milestones, basic deliverables and pre-defined timelines over many phases. These methodologies may not come close to matching the approach that is right for your organization (don't even get me started on the big bang vs. phased approach to implementation, is a separate blog entry itself). Unfortunately, in the final analysis, these vendor-centric work plans do little to support the goals and objectives that you hold as a provider organization.

My succinct advice: Spend more time on the SOW than you do on the traditional vendor selection and contract negotiation components.

As you are spending time in this endeavor, consider some of my more detailed advice as well:

• Don't be strong-armed into accepting "required" services that you know you don't need.

• Buy just enough service to gain appropriate access to the vendor knowledge.

• Ask that resources actually roll up their sleeves and work beside you rather than standing on the sidelines directing you.

• Don't let the vendor sales team sell you implementation services, as they don't traditionally know the products or the details of delivery from their professional services organization.

• Dig deep; seek counsel from industry sources who have had measurable success in implementation and user adoption.

• Don't sign the contract until you know that your vendor will provide process-oriented clinical solutions and not just installation of software product.

As you wander the HIMSS floor next month with all its exhibitor excitement, ask the hard questions regarding implementation!  If a product interests you, ask to speak with implementation resources that can address your clinical and business requirements with first-hand experiences, knowledge, and skill.

Becky Quammen is the CEO at Quammen Health Care Consultants. During her 25-year career in health I.T. she's held senior management positions at large provider organizations and a major health care software vendor. She can be reached at


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