Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital.

The experience of Mount Sinai Hospital is representative of the challenges and problems facing large academic medical centers in selecting an ambulatory EMR. The facility successfully revived a stalled process in a challenging financial climate, using a framework of science and rigorous investigation. The process incorporated several innovations: 1) There was a thorough review of medical informatics literature to develop a mission statement, determine practical objectives and guide the demonstration process; 2) The process involved rigorous investigation of vendor statements, industry statements and other institution's views of vendors; 3) The initiative focused on user-centric selection, and the survey instrument was scientifically and specifically designed to assess user feedback; 4) There was scientific analysis of validated findings and survey results at all steering meetings; 5) The process included an assessment of vendors' ability to support research by identifying funded and published research; 6) Selection involved meticulous total cost of ownership analysis to assess and compare real costs of implementing a vendor solution; and finally, 7) There were iterative meetings with stakeholders, executives and users to understand needs, address concerns and communicate the vision.