Hit Selecting An EHR Vendor - MSMS
Michigan State Medical SocietyHIT Alert“Selecting an HIT/EHR Vendor that willMeet the Needs of Your Practice”By Henry L. Mayers, MCP, PMP, CPHIMS, President, ReliaTech Consulting, LLCA. Context for this DocumentThere are many that would argue that the work to secure a health informationtechnology (HIT) vendor is the first step in the implementation of any kind ofHIT in the practice. Fair enough. However, the perspective of this paper is thatit is the last preparatory step because one can turn back up to the moment ofcontract signature with little or no disruption to the practice.The reader will find a number of points in this document where it refers to thepreparatory tasks elaborated in the Getting Ready Part 1 document, “Decidingon What HIT/EHRs Must Do for Your Practice.” It is not essential that thatearlier material be understood or completed for this material to be of value. Thismaterial will prove to be quite informative and valuable to any practice that feelsthat (1) it already knows what it is looking for in an EHR , and (2) is ready togo into the market and select a vendor product.One final point: This material is based on a time-tested procurement process usedto secure a variety of HIT technologies and services. It can be used to secure acombined Patient Management (PM) - Electronic Medical Record (EMR) system,a separate EMR system, or a package of linked point solutions.To simplify references, we will be referring to HIT as the term for the generalmarket of all IT technologies that are available to a physician practice.It is acknowledged that some practices may start with very modest HIT goals, suchas implementing an e-Prescribing product, or using a Patient Registry. Purchasinglimited-scope HIT/EHR products such as those will not require the procurementprocess complexities that are described in this paper. The objective of this paperis to help a practice procure more complex HIT offerings such as an EMR.Finally, many practices are seeking these HIT solutions in response of the federalEHR Incentives, it is recognized that not all interested practices will be eligiblefor the federal incentives. These latter practices should find these time-testedprocurement processes equally applicable to their HIT initiatives as well.B. Nature of the Request Documentwww.msms.org517-337-1351There are a variety of vendor solicitation documents that exist in the procurementworld. The most typical are described in the following table.
ProcurementDocumentCharacteristic or GoalRequest for ProposalThe practice describes its general needs or the problem for which it isasking the vendor to propose a solution. Generally, there is very littlefunctionality requirements elaborated in this. It is common to havesignificant negotiations with RFPs, resulting in a Best and Final Offer.Winning proposals are usually incorporated into the actual contract with thevendor.RFPRequest for InformationRFIRequest for QuotationRFQRequest for BidRFBThe practice would use this method to inquire of a wide range of potentialvendors and inform them of what is being sought. Requirements aregenerally more specifically described in this document. The intent is toascertain which (or if any) vendors would be capable of providing theservices or products needed by the practice. This is often used for R&Dgrade projects. Vendor prices submitted in their responses do not have tobe competitive and are often list prices to provide an outside estimate touse for planning by the requestor.The practice would use this document to request competitive prices or ratesfor easily defined or commonly understood products in the market. Usually,the quoted prices are final.This document would be used by a practice that can describe its needs orrequirements in considerable detail. This document can also be used, evenin the same RFB, to secure products or services for which the practicedesires bidder proposals. The prices submitted with these bids areexpected to be competitive. Winning bids are usually incorporated into theactual contract with the vendor.As will be seen later, we are recommending that the RFB process be used. This isbecause,for someof recommendingthe request, thethatpracticewill haveconsiderabledetailonAswill be seenlater,partswe arethe RFBprocessbe used. Thisis nt.Yet,therearealsoanumberfor some parts of the request, the practice will have considerable detail on whatofit isservicesandthatcanwillpresentlikely beit requestedfrom theYet,biddersthat the ofbidderexplainseekingas a requirement.therethatarerequirealso a numberservicesthatHOW those services will be delivered. The provision of that ‘how’ information willwilllikelythebe practicerequestedfromthebiddersinsightthat requirethe experiencebidder explainthoseprovidewithveryvaluableon the thatrelativeandHOWcapabilityserviceswill be(anddelivered.provision of that‘how’willbid).providethebepracticeof the bidderany of Thethe subcontractorsthatmayinformationbe part of theAs willwithverythatvaluableinsighton the relativeexperienceandpracticecapabilitythe yprovides thewithofinformationfacilitatesmaking the finalthatchoiceamongthe bid).bidders.anyof the subcontractorsmayfrombe partof theAs will be shown, that additionalinformation frequently provides the practice with information that facilitates making thefiC.nalContentchoice fromthe bidders.of amongthe RequestDocument (the RFB)C. Content of the Request Document (the RFB)The information contained inthis publication is furnishedfor informational purposes andshould not be construed orrelied upon as legal advice.Thefollowingfollowing listThelist sectionsofofaaRFB.RFB.1. Purpose and Overview of the Bid1. Purpose and Overview of the Bid2. Administrative Details2.3. AdministrativeDetailsStatement of Scopeand Requirements3. Statement of Scope and Requirements24. Bidder Response Additional Expectations5. Guidelines for Bid Preparation6. Bid Evaluation Process and Factors for Selection7. Special Terms & ConditionsRFB Section 1 - Purpose and Overview of the Bidwww.msms.org517-337-1351This section provides the bidders with a high level understanding of what the practicehopes to accomplish with the products and services that are being requested. This sectioncan also be used to describe the business drivers that have led to the creation of the projectand the bid. It should also provide an explanation of the larger context for the project,
as well as the changes or longer ranged goals for the practice for which the project is tobe an enabling event.This is also a good place for the practice to describe the nature and philosophy of thepractice.This kind of information will enable the bidder to structure their solution and theirimplementation strategy in a manner that will best harmonize with both the characterand the needs of the practice.Finally, this section should be used to summarize the products and services that are beingsought within the bid. This would be a high-level description. For instance, if the practicewishes to outsource coding and claims to a clearing house service, this is the place topoint that out.This is also a good place to clarify what are the acceptable solution architecture(s) thatthe bidders can propose. By this, we are referring to whether the practice chose duringits planning activities (discussed in our companion document, “Getting Ready - Part 1”)to pursue: a locally-hosted solution (at the practice), or a portal-based package of “point” solutions, or an application service provider ASP/SaaS who will provide an integrated solutionaccessible by the internet.RFB Section 2 - Administrative DetailsThis section provides summary information on the practice. For instance, the followinginformation would be provided: The name of the practice and the location(s) where its services are provided Description of the practice as a legal entity, whether it is owned in part or whole byother entities or parties Names of the individual(s) who can legally bind the practice The nature of the specialty/services that the practice provides Information on the size of the practiceo Number of medical/clinical staff (including mid levels)o Number of clerical/supportive staffo Number of patients in active panelo Listing of major payers and % of billingso Average number of patients seen in a day per practitioner Average high and low daily ranges of volume of patients seen External locations where practice care is deliveredo Patient homes, rehabilitation centers, assisted living centers, nursing homes, etc.o Rounds at acute care hospitalswww.msms.org517-337-1351
RFB Section 3 - Statement of Scope and RequirementsThis is one of the most important sections in the RFB, as this is one of the sections inwhich the practice informs potential bidders of what it expects to accomplish from thebidder in terms of products and services that it will deliver to satisfy those expectations.A. Scope StatementThe purpose of the scope statement is to provide a bidder with an understanding ofthe overall purpose for this procurement. This is also the section in which the practicecan lay out its views on the essential components that must be part of a sufficient bid.Similarly, the practice describes its vision and how the winning vendor’s services areexpected to further it. If the reader followed the processes in Part 1, the results fromthe Visioning and the Business Objectives are essentially transferred to this sectionof the RFB.One of the values of this kind of broad description is that it will enable to the bidderto consider its entire range of capabilities, and be able to describe them in ways thatmay help the practice envision broader values from this investment than have beenconsidered to date. There should always be an opportunity for a bidder to exceed theexpectations of the practice.The scope statement is also a good place to present the preferred project approach. Thisis where the practice presents its views on whether it is open to a “big bang” approachto implementation of the overall solution, or whether it prefers an incrementalimplementation approach.This is also the area where the practice describes the current goals of the practice andmentions any related initiatives to which the bidder’s solution is expected to positivelycontribute. This information can be used to explain any preliminary notions that thepractice may have regarding desirable implementation sequencing of features withina complex solution such as an EMR. The bidder should be asked to consider thisinformation as part of its implementation strategy recommendations in Section 4J.B. RequirementsThis is the section in the RFB where the practice lays out the things that are mandatoryfor a bid to be considered. Any failure by the bidder to comply with any item in thissection is risking a preemptory rejection of its bid. As a result, it is important that theitems that are listed in this section be as specific as possible. This allows the bidderto decide if its products and services align sufficiently to invest the time and moneyto prepare a bid. If the reader followed the processes in Getting Ready - Part 1, theresults from the Functional Analysis would be transferred to this section. The PreferredTechnical Architecture analysis results would also presented in this section.1. GeneralThis section begins with any general expectations that are mandatory. Forinstance, any practice that expects to be eligible for the federal EHR Incentive,and wishes to achieve the terms of Meaningful Use, should clearly state that itwill only consider vendors whose products have been certified as meeting the finalpublished criteria for Stage 1.2. Functionality & Featureswww.msms.org517-337-1351This is the section in which the practice delineates the things that the product isexpected to do, in terms of practice administrative, financial, and clinical activities.As this is usually the most extensive part of the bid, it is important to present these
requirements in an organized and easy to comprehend manner. The objective forthe practice, with this information, is to help the bidder truly understand whatthe practice expects from the bidder’s products and services. This is an essentialstep/tool in avoiding later disappointment by practice staff.Like the earlier Functional Assessment process, the delineation of the functionalityshould reflect a logical progression of the process or events that make up patientcare. This will assure that the final listing of functionality is complete and coversthe entire range of practice objectives. It will also increase the probability thatthe vendor will readily understand what is being required.If the purpose of the RFB is to get an integrated practice product that includesPractice Management (PM) functions, the functional requirements need toinclude all the primary “back office” business and financial functions that thePM product is to handle.It is also important that the requirements are equally described. Generally, it is agood idea to use multi-variable tables to present this information. This approachgenerally guarantees that the bidders do not miss some of the requirements.The second value of multi-variable tables is that they can be used to help theThebidderssecondprovidevalue clearerof multi-variableis that theycanbe usedoftothishelpresponse to tablesthe requirements.Anillustrationkindthe llustrationofof table is presented below.this kind of table is presented below.Patient Registration/Check-In Functional RequirementsRefRequirementA-1Provides patient selfservice methods toupdate its demographicand financial data atcheck-inVendor feature that isavailable at no cost.ResponseConformsScheduledDoes NotStaff can select a print out of the patientinformation to be corroborated/corrected by thepatient while in the waiting roomConformsScheduledDoes NotOur product Fancy Notes, includes an internetaccessible patient portal. Patients can access itfrom home and can update their records anytime,including before their next office visit.Patient Encounter Functional RequirementsE-1www.msms.org517-337-1351Can print out theConformsScheduledDoes Nothistory, with graphics, of This feature is now on the prioritized developmentlab test result values for list for release on 12/2010any result for use duringpatient encounterTo makeit easierthe biddersuse this format,To makeit foreasierfor thetobiddersto use thethisdetailedformat,requirementsthe detailedtable should berequirementstable shouldbeRFB.providedas an shouldAttachmentA to thethebidderRFB. to it.providedas an AttachmentA to theThis sectionsimply referThis section should simply refer the bidder to it.As we will see later, this table will come in handy in simplifying the task of scoring andAs we vendorwill seebids.later, this table will come in handy in simplifying the task ofcomparingscoring and comparing vendor bids.3. Usability RequirementsThis section would cite high-level capabilities that would be expected for
3. Usability RequirementsThis section would cite high-level capabilities that would be expected for all areas of theproduct. The following list touches on some of the more prevalently-desired usabilitycharacteristics. Universally-available report and letter templates that reflect the mark or graphicsof the practice which can be invoked in any area of the product Support of various methods of data entryo Keyboardo Mouse or screen pointer selection of datao Speech and pattern recognitiono Hand writing/character recognition Automatic code translation of data for patient-use documents Automatic data loading of national standards-based data that is electronicallyreceived Includes a workflow engine that can route, any communication, document, ortransaction generated internally or externally4. General Process Support Features Consolidated work/task lists with aging control Work routing engines and workflow controls Chart analysis/deficiency management Coding/Abstracting Release of information controls Disclosure management Forms management5. Systems Management Features User administration Access privilege controls Logging capabilities Auditing capabilities Digital signature capabilities Archiving facilities Support for back-up/recovery6. Security & Privacy (HIPAA) standards compliance relative to: Roles-based definition of user accesswww.msms.org517-337-1351 Encryption or security of such external communications as email with other providersand patients
Data base encryption Data de-identification Record access reporting for patients7. Performance & Availability Requirements Maximum acceptable elapsed time between data entry and screen response, or nextscreen ready Reporting or query processing at any time of the day without system degradation 24/7 availability for physician anywhere via web access using a PC or PDA8. Technology Integration Requirements Inbound and outbound fax gateway option for all document exchanges andtransactions with imbedded directory service Practice email ISP system is integrated with workflow control and communicationsfacilities of the vendor product Can integrate with and handle existing data exchanges with Disease and PatientRegistries, and PQRI reporting hubs (these should be specified) E-Prescribing activity with PBM is done within the vendor’s product Clinical/computerized decision support tools are fully integrated into the vendor’sproducts Can electronically exchange (2-way) information with major commercial patientportals, such as Microsoft’s HealthVault, and Googlehealth. Has the ability to exchange (2-way) data with the Michigan Care ImprovementRegistry Has the ability to exchange (2-way) eligibility and coverage information with suchmajor players as BCBSM (web-Denis), Medicare, Medicaid (CHAMPS), UnitedHealth, etc, using CORE or other national standards (these should be specified) File electronic claims with such major payers as BCBSM (web-Denis), Medicare(1500), Medicaid (CHAMPS), etc (these should be specified) If an existing Patient Management System (locally, or through a remote clearinghouseservice) is in place and will stay so, the EMR product must fully integrate with thePMS relative to: (1) patient scheduling, (2) billing and claims, and (3) eligibilitydetermination and care authorization Electronic data recording from on-premises patient-testing devices Integrates with local or regional HIEs and product exports CCD (or other nationalstandard) encounter summaries, and can retrieve available patient information viarecord locator services9. Accountability RequirementsThe bidders must be told that they are expected to designate a single individual whowill be available to the practice and accountable for all bidder tasks. That accountabilitymust also include overseeing the work of any subcontractors.www.msms.org517-337-1351The bidders should also be told that all work that must be performed by ANY party,
in the course of installing and implementing the bid products and services, must beplanned and scheduled via a published project schedule. Such a schedule will clearlyindicate the party responsible for individual activities/tasks on that schedule. Further,that schedule must be updated when project events require schedule adjustments.10. Sample of Bidders/Vendor’s Warranty(ies) & Terms &Conditions (Ts&Cs)The bidder should be told to provide a copy of the terms of the warranties that willapply to the bid products and services. In the same fashion, the bidder should be toldto provide their Ts&Cs that will apply to their bid products and services.RFB Section 4 - Bidder Response to Additional ExpectationsThis section of the RFB document is used to present additional concerns or expectationsof the practice. Generally, these items are less specific, and call for the bidder to elaborateon the approach and methods that will be used to meet these expectationsA. Vendor Competitive ProvisionsThe definition of what are needed HIT/EHR features and capabilities for physicianpractices, and how all of these technologies are going to integrate or exchangeinformation is a very dynamic matter right now. And it will remain that way for theforeseeable future. For that reason, a practice wants to select a vendor that is adaptiveand in the market for the long haul. The best evidence of that is the trend and extentof R&D investment by the company. The bidder should be asked to describe theircurrent R&D investment and their strategic partnerships. They should also describetheir current product enhancement plans.B. Status of Federal ONC CertificationEven if the requester does not intend to seek the CMS EHR Incentive, this questionhas great value. If a vendor’s product has been certified, then a minimum level offunctionality has been validated by an external party. The bidder should describe anycertification from or certification application before the CCHIT.C. Product(s) Technology Base & Practice Hardware Platform RequiredThe vendor should be asked to describe its database, server architecture, operatingsystem, and networking base upon which their products are built. If the intent is tolocally host the products at the practice, the bidders should also be asked to specifythe level of all processing devices (servers), networking devices (and WAN serviceproviders), user devices, and such output devices as printers and the like. The biddersshould be told to assume that the practice has no HIT devices, and to provide acomplete hardware listing required to operate their products at the practice site withthe staffing levels and patient loads that were described in Section 2 of the RFB.D. Installation ServicesFor practices that already have an IT services firm handling the maintenance oftheir current HIT devices, it is suggested that they ask their bidders to describe thenecessary installation tasks to bring the bidder’s products on-line and ready to beginthe development and implementation process. The bidder’s description should beexpected to clarify which tasks will be handled by the bidder’s staff, and which thebidder will expect the practice’s IT services firm to handle.www.msms.org517-337-1351
E. Build & Training PlatformThe bidder should be asked to describe what methods, or alternate platforms willbe available to be used during build experiments or user training so that the preproduction system will not be inadvertently compromised with faulty build items orbogus data from training exercisesF. Data Acquisition & Loading Services & ApproachThe bidder should be asked to describe all of the classes of data that will be required tobe entered into their product(s) for the solution to operate satisfactorily and fulfill theearlier requirements. The bidder should be asked to address both patient information(demographic, financial, and clinical) and configuration data.The bidders should also be asked to provide recommendations as to the methodsused for the following tasks that have proven to be the most successful and leastburdensome for their clients. Data captureo Patient data from paper chartso Extraction and conversion from pre-existing PMs, registries, or otherautomated practice sourceso Claims histories from payers Data cleansing Data Loading and validationG. User TrainingThe bidders should be asked to describe the training approaches that they normallyuse. They should also be asked to describe any departures that they are suggestingto respond to the overall implementation program that was presented in the ScopeSection (#3).The bidders should be encouraged to provide samples of their training related materials(manuals, user aids, etc.) that reflect the training program that they suggested above.Bidders should also be encouraged to provide a URL to their web site that wouldprovide samples of this kind of deliverable.Bidders should also be asked to estimate the hours of training that a typical user willneed to absorb the instruction material. Such estimates should be provided on atraining module basis – not the overall program.H. Interface(s) Implementation ApproachThe bidders should be asked to describe the methods that they use to install,implement, and validate external interfaces. The bidders should also clearly describeany tasking that they expect the practice to perform, or tasking for which the bidderexpects the practice to arrange external resources.The RFB should include a listing of the required electronic interfaces in AttachmentB. To assist the bidders in costing the configuration or development of these interfaces,the following information should be provided: Interface namewww.msms.org517-337-1351 Name of external entity that needs to be linked
Location of the external entity’s access point Technical description of the interface technology used and made available by theexternal entity, including product vendor name if possible Clarification if the interface is uni or bi-directionalI. Configurable Features of the Product(s)The bidders should be asked to describe those elements or features of the product(s)that most clients choose to configure or customize. Regardless of the number of readyto-use components that are available, it is important to expect the bidder to addressthis matter. Many vendors will claim, with accuracy, that nearly every aspect of theirproduct can be customized. What the practice needs to know is which features areusually configured and/or customized by their clients. This information will give thepractice an early indication of the level of effort that will be invested to make thevendor product truly useful.J. Recommended Implementation StrategiesThe bidders should be asked to provide initial suggestions on how they foresee the“phasing” of the implementation project. They should be told that the practice isespecially interested to understand the bidders views on the optimum approach toachieve the goals and prioritizations described in the Overview Section and ScopeSections of the RFB.K. Go-Live SupportThe bidders should be asked to describe the services they offer to have their experts onsite during the go-live to quickly address user problems. They should also be asked fortheir general guidance for how long to expect this period to last. The bidders shouldbe reminded to consider the phasing strategy that was described in the Overview andScope Sections.It is important to inform the bidders that the practice considers it an important factorthat the bidder staff, which helped the practice with its build phase, be the individualswho will be on site. Finally, the bidders should be reminded that the practice will makethe final selection of the vendor staff who will work on site.L. Bidder Help Desk/ User Support ServiceThe bidders should be asked to describe the program they have in place to helptheir customers to get prompt help with problems that will arise during live systemuse. There should be a single number to call to reach their help desk, though somevendors require that the request be placed into a web site for scheduling and triage.The help desk should be a 1st level service and should be able to respond to eitheruser confusion or some kind of system failure. The bidders should explain the hoursof operation of their help desk, and how off-hour services are handled.The bidders should be asked to provide information on the service levels that theyguarantee with these services. The bidders should describe how they triage defectcalls, and how they handle getting back to the caller.The bidders should also be asked to describe when and how the implementation staffwill transition the handling of support calls from them to the Help Desk.M. User Community Programwww.msms.org517-337-1351The bidders should be asked to describe their ongoing communications and education
program for their customers. What is sought here is to determine if the vendor providesencouragement and/or facilitates communications between their customers on the useof their product. The usual method is the annual users’ conference. But increasingly,the vendors are encouraging list servers and groupware systems that allow users toengage in subject-based discussion groups, etc. It is not uncommon to find such usergroups have come to life on their own. In any event, it is important to see if there aresuch groups or services.N. Maintenance Services & VARsMost HIT vendors (especially within the practice EMR segment) are establishingnetworks of value added re-sellers (VARs) who can be contracted to provide supportservices. It is important to ask the bidder to list the currently-available VARs who arewithin a reasonably short drive from the practice location(s). The bidders should beasked to differentiate between the maintenance services provided by their VAR, andthe maintenance services that they have reserved for themselves.If the practice has not needed general information technology (IT) support servicesup to this time, one of the bidder’s VARs may be a very good source to receive bothgeneral IT services and bidder product maintenance and support services.The bidder should be asked if their product is capable of being remotely systemmonitored for pro-active maintenance services.It is also important to ask the bidder to describe the different level of maintenanceservices (their costs will vary accordingly, and should be clarified in the Cost Modelpresented in Section 5B of the RFB instructions).O. Product Upgrade & Fix ProgramThe bidders should be asked to describe how they handle upgrades to their softwareproducts. It is important to ask the bidders to describe how this process has actuallybeen handled over the past 18-24 months. The bidder should be asked to identifythe upgrades that have been released in that past window. They should also be askedto list the software fixes (and da
"Selecting an HIT/EHR Vendor that will Meet the Needs of Your Practice" www.msms.org 517-337-1351 A. Context for this Document There are many that would argue that the work to secure a health information technology (HIT) vendor is the fi rst step in the implementation of any kind of HIT in the practice. Fair enough.
Hilti HIT-HY 200 con HIT-V Hilti HIT-HY 200-A con HIT-V Sistema di ancoraggio chimico Vantaggi S - adatta per calcestruz ef Hilti HIT- HY 200-A cartucce da 330 ml e 500 ml Hilti HIT- HY 200-A cartucce da 330 ml e 500 ml Miscelatore Barre HIT-V Barre HIT-V-R Barre HIT-V-HCR - adatta per calcestruzzo fessurato e non fessurato, da C 20/25 a
HIT-HY 200-A HIT-HY 200-R V3 HIT-HY 200-A HIT-HY 200-R V3 HVU2 HVU2 HVU2 HVU2 HIT-HY 170 HIT-HY 170 HIT-HY 170 HIT-MM Plus HIT-MM Plus HIT-MM Plus HIT-1 HIT-1 HIT-1 T 0 00 55 ZZ.hilti.sk Vždy postupujte podľa návodu na použitie SYSTÉM CHEMICKÝCH KOTIEV 6 VŔTANIE DIAMANTOM ALEBO KOTVENIE POD VODOU? Žiadny problém pre Hilti chemické kotvy
Professional EHR - An EHR catered towards small-mid sized healthcare providers, offering an easy to use interface. TouchWorks EHR - Touchworks EHR software is a product from Allscripts, a vendor that provides multi-site and specialty support as well as configurable desktop. Sunrise EHR - A comprehensive EHR system for large clinical enterprises.
EHR Replacement EHR replacement - Do it right! 1 In good company! (EHR replacement is popular) About the author. A letter from Dr. Gary. 2 Decision: Replace the EHR. Now what? 3 EHR replacement: Do it right! 4 Project manage. Manage change. 5 Select the right EHR solution. 6 Get the right EHR support at the right time.
HIT-V / HAS HIT HIS 03 / 2015 1 Manuale di tecnologia del fissaggio Hilti HIT-HY 170 con -V-(R)N 03 / 2015. Hilti HIT-HY 170 con barra HIT-V 2 03 / 2015 . Hilti HIT-HY 170 con HIT-V . Sistema di ancoraggio chimico a iniezione Vantaggi Hilti HIT-HY 170 cartuccia da 500 ml (disponibile anche il formato da 330 ml) -Miscelatore statico Barre HIT-V .
Hilti HIT-RE 500-SD mit Ankerstange HIT-V 1.6-1.8 Hilti HIT-RE 500-SD mit Innengewindehülse HIS 1.10-1.11 Hilti HIT-HY 200-A / HIT HY 200-R mit Ankerstange HIT-V 1.12-1.13 Hilti HIT-HY 200-A / 200-R mit Ankerstange HIT-Z 1.14-1.15 Hilti HIT-HY 70 mit Ankerstange HIT-V, HIT-IC 1.16-1.17
evaluating HIT/EHR vendor contracts. This checklist should not be used as a substitute for engaging competent legal counsel. Physicians are strongly encouraged to contact legal counsel for a review of any HIT/EHR vendor contract prior to its execution. We hope you find this checklist helpful. If you would like additional
behavior, including all bodily postures, movements, and processes that are involved in the behavior; an aspect of every behavior is that it involves the occurrence of physical processes, which processes can in principle be described at any level of analysis appropriate to the describer’s needs, ranging from the very molar to the very molecular (e.g., Peter’s grasping and moving the rook .
