Is it advisable to hire an IT/EHR consultant while going through the selection process for an electronic health record system? I'm thinking of this question in terms of practicality, legal aspects, and financial constraints.

The most direct response would be "who's asking?".  The magnitude of value that follows from an EHR implementation is mostly determined by the qualities of the organization undertaking it rather than on the product itself.   An organization that finds a way to be successful at those things that are asked of it will do well with an EHR.   An organization that managed to get in its own way in nearly everything it does can come close to a major lapse of organizational continuity during an EHR implementation.   So, you have to ask different things of your consultant depending on the strengths and shortfalls you have going in.  If you have a good staff and good cash flow, your emphasis is likely to be on how to multiply the advantages of an EHR.   You will be giving your forward looking staff who are ambitious for your success the tools to take a step up in providing services.   An organization that is having trouble putting a legacy of 'making do' in the past will have a different agenda.   An organization cluttered with rework  badly needs for things to 'just work'.  The consultant for that engagement would need to deal decisively with distractions to hold focus on the opportunity an EHR provides.  If that is your need, attend to the consultant's problem solving skills and then select a product that your organization can handle.  Most EHR vendors do well with companies that are successful and forward looking.  Fewer  do well with customers who are going to have to work hard to preserve the opportunity an EHR represents.  Choose your partners accordingly.      

Thanks for your response, Charles. I agree that it depends entirely on the organization - what its goals are, how it is structured, its financial situation, etc.  Some organizations seem to take on this project without the help of a consultant and do fine, but others do the same and do not achieve the results they wanted. It all seems to come down to the preparedness of the agency as a whole. 

Also, you bring up a good point that consultants should be chosen based on the organization's needs. I would imagine there are thousands of them out there. Do you - or anyone else - have any tips on finding the right one?

It is much easier to find some firm who will help you do an RFP process in the grande manner than someone who will make sure you get where you should.  The rolodex gets very thin on that end of the continuum.  All you need do to get confirmation of this is to google "behavioral healthcare consulting".  Pickings are slim, but such as they are, real.   

This was a question I was wondering as well. There are both pros and cons for hiring a consultant to help with an EHR project, but one thing is certain -  it should not be a decision an organization makes hastily.

As I see it, a consultant’s experience and expertise provide a good framework for gathering requirements, but he also does not fully understand the organization. In addition to paying consulting fees, this requires a lot of work and time on the organization’s end.  

EHR projects are a huge endeavor that some organizations are either unprepared for or do not know how to ask for the right components. I see this as another reason to enlist the help of a consultant. He can make sure all ideas are brought to the table and then help sort out needs and wants.  

I think it is also important to note that a consultant should not take the place of an in-house champion for the project. Whether or not an agency hires a consultant to help with the project, everyone still has to be on board with the consultant and be willing to put in the same thorough effort as the consultant to achieve the best possible results. Consultants may know the best way to negotiate a strong contract or how to stick to timelines, but only staff members know the ins and outs of their organization. They are the ones who will have the ultimate say on the application, and they are the ultimate users of the system.      

I agree with others in that "it depends" but would expand the answer in the following way:

A. These projects have several key phases so you have to begin with a bit of a breakdown. Some consultants are experts in one or another area. Some of your needs may be very specific to one or another area. Sometimes, you need a consultant who is equipped to take you through the entire life-cycle of the project. This is a safe breakdown:

1. Strategic Planning
2. Needs Assessment and Gap Analysis
3. Business Process Analysis
4. Requirements Documentation
5. Vendor Identification and Evaluation
6. Vendor Contracting
7. Implementation Oversight

B. The steps above involve quite different skill sets and subject matter expertise (emphasis? expertise!):

1. Facilitation
2. Deep understanding of behavioral health operations and administration
3. Deep knowledge of clinical operations
4. knowledge of payer operations and process
5. knowledge of electronic data interchange or EDI requirements
6. knowledge of HIPAA security and privacy
7. knowledge of CCHIT certification requirements
8. knowledge of interoperability requirements
9. system architecture and infrastructure requirements (hardware, software and networking)
10. Vendor contracting (maintenance, support, help-desk, upgrades, disaster recovery, ASP options, "patches" and new releases, etc.)
11. Training
12. Project Management

C. Projects of this sort also require consultants with demonstrable:

1. Approaches
2. Methodology
3. Tools
4. References

The notion here is to understand what you need by understanding where you are in the "adoption curve" and being realistic about internal competencies and resources as well as budget. You can pay way too much and you can try to skimp and throw your money away.

Best advice? Ask those who have gone ahead of you. Ask for real references via word of mouth. Ask your local clinic, primary care doc, or hospital for references to PROVEN consultants they know and trust. They'll help you!