As the manager of CTU Health Care Systems, you have done your research on three vendors to which you would like to outsource the implementation of the electronic health records (EHRs) for the clinics. As the manager, you have a number of critical decisions regarding the electronic medical record systems. At first, you thought you could either implement the existing EHR system at the other acute care organization or implement an entirely new EHR in both facilities.

You met with your staff, and after researching several companies that offered both products and services, you have solicited request for proposals (RFPs) from the following three companies:

- ABC Systems Consulting, the leading company in health care systems integration services, refused to bid on the systems integration required for bringing the current EHR system into the other organization. This was because of the risks and time requirements for designing, implementing, and testing the large number of interfaces required and the required time line for the completion of the project as identified by the client.

- XYZ EHR Systems proposed that its new, recently redeveloped EHR be implemented in both facilities, which included a computerized physician order entry (CPOE) module, standardized drug interaction alert functionality, and customizable clinical alert functionality. It estimated that the merged entity would get a much better price than $50 million for purchasing this new system. Unfortunately, XYZ was unable to provide evidence of successful installation of its recently redeveloped EHR system at a similarly large delivery network or anywhere.

- QRS EHR Systems, a leading provider of EHR systems for large acute care facilities, proposed that its EHR be installed in both acute care organizations with a $50-60 million price tag. QRS included a CPOE module, standardized drug interaction alert functionality, as well as evidence-based clinical alert functionality. QRS also had a physician office EHR system with an embedded patient registration system; however, QRS has had minimal experience with integrating the physician office registration system with the acute care (hospital) registration system-an integration feature that was a priority for this project based on the client's information technology (IT) strategic plan.

The stakes surrounding your recommendation to the chief information officer (CIO) and chief executive officer (CEO) could not be higher in terms of dollars and your career.