​The search for a new electronic health record (EHR) is a real puzzle for healthcare institutions. Hospital network ZNA (Ziekenhuisnetwerk Antwerp) and hospital organisation GZA (GasthuisZusters Antwerp) experienced this first-hand; their search involved an extensive selection process. The process was based on the organisational goals and targets that the EHR would need to help realise.

Wouter de Ploey (CEO of ZNA), Annick Wauters (Managing Director Quality & Innovation at ZNA), Jan Witters (Director Process and Innovation at GZA), and Steven de Baere (CNIO at GZA) explain how this process led to the choice for HiX.

Why an EHR?

For a healthcare organisation, the electronic health record is the foundation of the management of patient and health records throughout the entire care process. This makes it difficult to overestimate its importance. Like ZNA and GZA, many healthcare organisations work with up to hundreds of separate solutions or even (mainly) on paper, making the implementation of a fully integrated EHR a major step on the road to uniformity and digitalisation. Additionally, integrating all care-related registrations into a single record, accessible via a single software package, also greatly benefits workflow efficiency.

Witters: 'The new EHR should help allow us to work as uniformly as possible. The application must be innovative and must account for the ever-changing healthcare landscape. For example, we would like to address the wish of patients to participate in decisions regarding their care and are looking for a system with integrated smart solutions.'

Joint digitalisation within a single record

Hospital network partners ZNA and GZA deliberately opted for a joint tender and a shared health record. The two organisations are working ever more closely together. As part of this, the two view the implementation of a common platform as the perfect opportunity to shape the way in which to exchange data. Wauters explains: 'It will greatly facilitate cooperation, as every care provider with a treatment relationship is able to view the same patient data, regardless of where the patient is being treated.'

The project outlined by the hospitals was named 'EHR²'. 'The idea is for both organisations to reinforce each other, with the result being the product of the efforts of both parties', De Ploey explains. 'It's our hope and ambition that, together, we'll be able to work towards digitalisation more quickly and more successfully.'

EHR to realise organisation goals 

Any healthcare organisation has certain expectations and goals with regard to acquiring and implementing an integrated medical record. These are defined at the start of the process and play a crucial role in the tender. ZNA and GZA agreed on a number of common goals for the EHR project. 

'One of our common goals is to improve the quality of care and ensure patient safety, which is facilitated by an EHR that actively supports the care provider', says De Ploey. 'Another topic is efficiency and productivity; the EHR must be intuitive. When a user sits behind their PC or workstation, we want the system to guide them through their work and not require the user to navigate a dozen menus and sub-menus. This will ensure that the system complements our strategic goals.'

Clear selection criteria

The organisations' vision and project goals are translated into the criteria formulated by the hospitals for the selection of their new EHR. Throughout the process, these essential principles are assessed and reviewed continuously. De Baere: 'The key condition for the new EHR was that it had to be available and effective as broadly as possible. We wanted, and still want, the EHR to support as many uniform care processes as possible across both organisations. What we're striving for is one-off initial registration and subsequent reuse of these data'. Wauters adds: 'First and foremost, we're looking for a fully integrated health record that combines all patient information into a single place, allowing care providers quick access to all required information.'

The shared history of the organisations also played a role in deciding on the selection criteria. Wauters: 'Because of a previous, failed implementation attempt, it was important that the supplier of our new system had a proven implementation strategy and was able to assure that we would receive the product within the agreed-upon time frame and budget.'

Selection process: supplier first, product second

The tender for a new EHR consists of a series of standard stages, which may vary slightly according to the wishes and preferences of a particular organisation. The first stage is market orientation, followed by listing interested potential suppliers. Then, a number of shortlist candidates are selected from this list and invited to the (first) tender round. For the initial stages, ZNA and GZA both applied their own selection criteria and especially focused on the suppliers' references. The organisations then invited the shortlist candidates for further discussion and coordination.

Witters: 'We initially focused on the supplier. We were looking for a supplier with experience in the Belgian market and with complex implementations, who would be able to support us in this transformation within ZNA and GZA. Only after we reviewed the suppliers we looked at the system itself, and assessed whether it would be broadly usable across our various sites. As we also greatly value user experience and satisfaction, we then analysed the experiences of our staff with the EHR. The end users, from physicians and nurses to administrative staff, were involved in scoring the system.'

'For the final decision, five criteria played a role, of which three were make-or-break. The first criterion was the implementation competence of the supplier, the second was the functionality of the product, in part showcased during various demo sessions, and the third key criterion was the price. At the end of the process, ChipSoft's software product HiX scored best out of all systems. Both ChipSoft's implementation methodology and HiX' functionalities were a fair balance with regard to the price of the solution'. De Ploey adds: 'HiX will be able to best assure harmony and uniformity in processes across both hospital groups. Its standardised package provides us with all the functionalities we need.'

What lies ahead

The decision for HiX marks the first milestone in the process. Now, the hospitals and the supplier can get started on the required preparations for the implementation. Each component of the project is a building block towards achieving the desired goals, which are always on the mind of the project team. The hospitals' IT partner advises and guides the hospitals in every step to ensure that the project proceeds efficiently and effectively. De Ploey: 'Working with ChipSoft is a positive and open experience. Our cooperation is transparent, which, I believe, is the key to success.'

'The implementation of HiX will undoubtedly be a challenge, but it'll be worth it in the end, as the available functionalities and technologies will help us in providing the best possible care for the patients.' De Baere concludes: 'The EHR is invaluable to the care providers in NZA and GZA. It'll be our most important instrument for the next fifteen years, and will be used in all aspects of patient care.'

The next step in the EHR project is the preparation, during which the hospitals will lay the groundwork for the implementation. This preparation stage will be discussed extensively in a future article.