Guest post by Calvin Chock, vice president, product management and engineering, McKesson Specialty Health.
Switching from one electronic health record (EHR) system to another is no small task. One of the biggest hurdles is the transition of legacy data to the new system, but good understanding of the process and a strong technology vendor relationship can help overcome this challenge and lead to a successful EHR migration.
Many practices are currently confronted with the need to change EHR systems. In some cases, their current system is simply outdated or may not be certified to meet Meaningful Use requirements. Others need an option that will satisfy their needs to support value-based care models. Whatever the reason, all practices want to find a solution that not only meets their operational and patient care needs, but also minimizes disruption to the practice during the transition.
Conceptually, most EHRs capture the same types of information, however, when EHRs were first introduced, there was no standard industry terminology for diagnoses, regimens or allergies. Each system created its own logical categories or terms, which makes it difficult to automatically map data from one system to another.
As an example, many older EHRs have a category for patients with seafood allergies. In EHRs today, that allergy is more accurately broken down as either a shellfish or non-shellfish allergy. During a data migration, this difference means the allergy information cannot be automatically synced to the new system. It requires someone to review the information and make a decision about how to categorize it.
Oncology EHRs are quite extensive because of the complexity of the diseases and treatments. There may be as many as 50 different categories into which varying types of data is stored, which means when categories cannot be automatically mapped by the IT team, extensive manual labor is required by the practice’s staff to make sure data has transferred correctly and to re-categorize data that doesn’t neatly fit into a category in the new system.
In broad terms there are three types of data migrations. The first, migration to a newer generation of an EHR system already in use, is the easiest to complete. If, for example, a practice is upgrading to a newer version of their current EHR system, chances are much of the legacy data could be automatically mapped to the new version. This type of migration can often occur over a weekend with minimal down time and disruption to patient care.
The second type is migration to an EHR of a cooperating vendor. Although migration from one vendor’s EHR system to another’s is more complicated, if the original EHR’s vendor is willing to share information about their data with the new vendor, much of the mapping process can be finalized before the actual migration occurs.
The third, and most difficult, type is migration to an EHR without vendor cooperation. When the vendor of the current EMR system is not willing to share information about how data is stored, the new vendor must figure out how to interpret the data before any mapping can be done – a task made even more challenging when the older EHR system is not able to export data so that it can be read.
Practices making the third type of transition should allot many additional months to work with the new vendor’s IT staff as they determine how to pull the data. Further, the practice must be aware that the transition will require a much higher investment of practice staff time for the data to be consumed and reconciled. This type of transition can take years to complete.
If upgrading to a newer version of a current EHR is not a viable option, a practice should follow these general guidelines for a successful transition to a new system:
- Find an experienced vendor partner.
In addition to finding a system that meets your practice’s needs, find a partner with experience migrating data from your current type of EHR. Also, make sure the vendor understands the various workflows in your practice – billing, scheduling, pharmacist, physicians, etc. and that the new system can absorb data from your old system.
- Create an internal implementation team with a blended skill set.
The best EHR transitions occur in practices that assemble an internal team with members representing all disciplines within the organization. This team will be instrumental in working closely with the vendor, fostering good communication throughout the practice, gathering data and other important tasks.
- Change one system at a time.
It’s common for practices to also change Practice Management Systems when changing EHR systems. In these situations, it’s best to stagger the transitions and implement the PM system first, followed by the EHR system. This allows time for staff to assimilate to one system before overloading them with too many new workflows.
- Be prepared to devote significant staff time.
Migrating data is a huge job. Data that automatically maps must be verified, and data that did not needs to be manually reviewed and decisions made on what to do with it. We recommend a practice decreases patient loads and increases staffing during the first few weeks of the go live, if possible,
- Be patient.
Even well planned and executed migrations require a period of transition for practice staff to learn how to use a new system and implement a new workflow. Plan to allocate approximately 6 – 8 weeks to do all the manual checks, create new orders and become comfortable with the new system.
- Make training a priority.
Some practices find it challenging to convince all physicians and staff to attend training sessions for the new system, but training must be mandatory. Fully training one or more power users of the new EHR at each location prior to going live can help decrease anxiety levels by giving staff a go to person for questions.
- Schedule regular communication with new EHR vendor.
Have a daily meeting with the new EHR vendor during the first 2-3 weeks after going live to cover any issues and questions that arise. Regular communication can reduce the duration of issues and shorten the adoption period.
- Measure revenue.
Perform a weekly or monthly financial reconciliation as a measure of success. EHR technology issues, staff training issues or workflow issues that might not be apparent at first will show up in the bottom line. Frequently measuring revenue is a good early indicator of whether the new EHR adoption is successful or if there are major problems.
Modern EHR systems can greatly enhance a practice’s ability to deliver quality patient care. A strong vendor partner, diligent preparation and selecting a system with a robust migration process can minimize disruption in a practice and result in very little overlap time when information has to be entered into both systems.