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Inside or Out

October 27, 2009
by Daphne Lawrence
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When it comes to clinical implementation project staffing, think twice before automatically turning to your vendor

Enterprise EMR implementations are long and complicated, usually taking place over the course of a few years. Though vendors provide project management staff to work onsite during implementations, some hospitals choose to augment, or even forego that talent in favor of a consulting firm. Others rely more on their in-house staff. For EMR implementations, does staffing come down to cost, experience, or a mix of both?

Most agree that when it comes to implementation staffing, there is no such thing as one size fits all and that the most important factor is the system itself. According to Vince Ciotti, principal with Santa Fe, N.M.-based HIS Professionals, the EMR selection should determine subsequent staffing selection. There are many pitfalls in this first step, not the least of which is staffing for the RFP itself, he says. “Most hospitals get seduced by a giant consulting firm that leads them down the rosy path of the biggest possible implementation.”

Guide to Need for “Consultant” Implementation Assistance, by Vendor Size

Representative Vendors

Typical Client Bed Size

Ballpark Price (Capital)

Typical Client IT Department FTEs

“Build” Effort

User Department FTEs

Need For Implementation “Consultants”

Consultant Implementation Fees

Courtesy of HIS Professionals


Cerner, Epic, Eclipsys, Siemens' Soarian, McKesson's Horizon

300+ Beds




Full-time CMIO, several RN informaticists

Mandatory: large workflow redesign needed to achieve ROI

Seven figures


Meditech, McKesson's Paragon, QuadraMed, Siemens' Medseries4, IntraNexus, Keane

100-300 beds




½-1 FTE CMIO, 1-2 RN Informaticists

Mainly Meditech, which “specialty” firms augment well

Six figures


CPSI, HMS, Healthland

Under 100 Beds




1 RN Informaticist



Clinical Only (EMR/CPOE)

Opus, MedSphere

Under 200 Beds




Part-time CMIO, 1 RN Informaticist



Neal Ganguly

Neal Ganguly

Buying an EMR that doesn't correlate with the size of the hospital can have serious consequences when it comes to staffing (see the chart below). “High-end vendors will try to sell to the mid-range and smaller hospitals that may not think of the staffing needs created by that implementation,” Ciotti says. “It's like buying a Ferrari and forgetting that the tune-up costs $5,000.”

Ciotti says that if the same consulting firm is hired for both the RFP and the implementation itself, it can lead to a serious conflict of interest as the firm may push for a larger and more costly system than is necessary.

At Wheeling Hospital in Wheeling, W.Va., David Rapp, CIO and vice president, supply chain, decided to forego a consulting firm for his EMR RFP, and spent a year digging through the weeds with an in-house comprehensive vendor analysis (he ended up selecting Eclipsys). “We didn't use a consulting firm for the RFP,” he says. “We didn't want to be in the position of saying, ‘The high-powered consultant said it was a good choice.'”

That was a smart move, according to Ciotti, who says that consulting firms have a quota just like vendors. “They aren't your partner,” he says. “Hospitals have to be very suspicious of consultants and vendors equally. They're both in league to suck money out of the hospitals - that's how they make a profit.”

His advice? If using a consulting firm to help select an enterprise EMR, use a separate consulting firm for implementation.

At Wheeling, Rapp kept staffing front and center in contract negotiations with Eclipsys. “We pushed very hard for that - to meet and review candidates,” he says. “We wanted them to be seasoned veterans, and that was part of the negotiation.”

Project staff salaries can also be part of those contract negotiations. Neal Ganguly, vice president and CIO at Freehold, N.J.-based CentraState Healthcare System, says there were two staffing elements in the negotiated price of his Siemens (Malvern, Pa.) Soarian EMR. The first was selecting vendor project staff as part of the standard application, and the second was for additional Siemens staff he might need in the future for an order build or on a tight deadline. Ganguly says he negotiated a discounted rate upfront for the additional personnel.