Selecting electronic health record systems: development of a framework for testing candidate systems.

The process of selecting electronic health record systems is one of the most critical decisions in the journey towards automating and improving healthcare using information technology. However, there are a wide variety of problems associated with system selection and procurement processes in healthcare. Indeed the literature contains numerous examples of systems that were purchased and customized that failed to meet user needs, were implemented well behind schedule, which cost much more than expected and which in some cases failed completely. In this paper we describe a framework which we have developed and have begun to apply in considering key processes in the selection of electronic health records - i.e. the testing of potential candidate systems to determine if they meet user and institutional needs. The objective of our work is to improve our understanding of and the effectiveness of this critical decision making aspect of health informatics. In our work we consider system selection in terms of strength of evidence obtained from testing candidate systems.