Selection of a niche system within an existing medical records environment: an academic ophthalmology department experience

The publication of To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century by the Institute of Medicine has increase the pressure to implement computerized records systems in health care delivery organizations across the nation. The acquisition and installation of integrated commercial systems is one method used to create an enterprise electronic medical record. However, because of the complexity found in most large academic clinical delivery systems, there are specialized documentation requirements that cannot be met by a single electronic medical records vendor. Niche or best of breed" systems, readily available in the marketplace, are often requested to meet these specialized needs. The purpose of this project was to select an ophthalmology outpatient records system (OOR) to meet the specialized needs of the ophthalmology practice at Moran Eye Center and Community Clinics, while simultaneously complementing the Cerner Millennium system selected for installation at the University Hospitals and Clinics. A list of unique features of ophthalmic documentation and practice developed by the Moran Eye Center and key technical requirement to determine system compatibility and interface potential from the Health Sciences Information Technology Service were used to limit the number of vendors evaluated by the selection committee. Only a small number of vendors with a high potential for successful implementation received a request for proposal. After an evaluation process two vendors were selected for final evaluation. Even though the process used successfully identified vendors who met both the critical ophthalmology documentation features and key technical requirements of the University Health Sciences Information Technology Service, the project was terminated and failed to reach its objective due to changing financial priorities and senior management commitment in the Department of Ophthalmology and Visual Sciences. This process, with minor modification, can be used for evaluating and selecting other niche systems, which will inevitably be requested in the future.