By Stephen Aleksza, PMP | Post-Acute EHR Advisory | In Partnership with HealthTECH
Most problems in a software implementation don’t start at go-live. They start the day the contract is signed.
I spent nearly 30 years in healthcare IT, most of it on the vendor implementation side. One of the first things my team did after a deal closed was sit down and compare three things: the contract, the client’s expectations, and the full catalog of what we had available to sell. The gaps between those three told us exactly where the hard conversations would come from. Scope disputes. Missing interfaces. Features the client saw in a demo that weren’t in their package. It happened more than anyone on the vendor side would like to admit.
You can run that same review yourself, before you sign, when changes are still easy to make.
Here are a few things to check.
Build a Three-Year TCO Model
Year-one pricing is rarely the full picture. Include implementation fees, training costs, interface build charges, and annual escalators. Then model what you’ll pay if you add users or modules in year two or three. The number that matters to your board or your CFO is the real three-year commitment, not the monthly per-user rate on the cover page.
Confirm That Every Critical Feature You Saw in the Demo Is in the Proposal
Demos showcase the product in its best configuration. Proposals reflect what’s actually included in your contract. Pull out your demo notes and review them line by line. If a workflow, report, or integration impressed you during the sales process, find it in writing before you sign. If it’s not there, ask why.
Ask What’s Not Included
This question opens more doors than almost any other. You’ll learn what adjacent modules exist, what other clients are buying, and occasionally what can be added at little or no cost before the deal closes. Vendors price proposals based on what they think you’ll accept. There’s often more flexibility than the document suggests.
Confirm Your Data Rights Now and at Every Renewal
You need the right to export your data in a usable, portable format at the end of any contract term, not just in a termination-for-cause scenario. Read the renewal language carefully. Rights in the initial contract can quietly narrow when the agreement auto-renews.
Ask About AI and Your Data
Ask whether your data will be used for AI training or for any internal business purpose outside your BAA. This is no longer a hypothetical concern. Vendors are building AI capabilities across their platforms, and the contract language has not always kept pace with what’s actually happening to client data. Ask the question directly. If the answer is vague or the rep has to check, that’s worth noting before you sign.
Then Ask About Price and Timing
Discounts, waived implementation fees, extended payment terms, and a phased go-live: whatever would make this work better for your organization. Vendors have more room to negotiate than the proposal suggests, and they rarely offer it unless asked.
A Real Example
I’ve seen this play out directly. A mid-sized post-acute organization was well into contract review when it asked its vendor about a care coordination module it had seen demonstrated twice during the sales process. It wasn’t in the proposal. The vendor offered it, but at a higher tier than what was quoted. A single question before signing saved the organization from a scope dispute six months into implementation.
Where I Help
I spent nearly 30 years on the vendor side of post-acute EHR. I’ve sat in the rooms where proposals were built, pricing was structured, and scope decisions were made. I know what gets included by default, what gets left out deliberately, and where the negotiation room actually is.
Today I work in partnership with HealthTECH Resources to help post-acute organizations navigate the vendor side of EHR decisions: evaluating proposals, pressure-testing scope and pricing, reviewing contract language, and making sure what you saw in the demo is what you’re actually buying. I also advise on implementation planning, training strategy, and ongoing optimization once the contract is signed.
If you’re in the middle of a vendor evaluation and want someone who’s been on the other side of the table, I’m happy to talk it through.
Connect with Stephen: saleksza@healthtech-resources.com
Contact HealthTECH Resources: healthtechresourcesinc.com/contact