Commonly,
the administrators, clinicians, and technicians involved do not understand the vast
complexity and huge potential costs of mid-stream changes trigger. Often, a
major issue that arises is the generally encountered requirement that providers
maintain records for at least 7 years.
The
Strategies for Switching or Merging EHRs by
Shannon Firth makes many reasonable suggestions on how to approach this
transition with wisdom. Here are some essentials that the author suggests you
think about:
·
Ask: What data do you absolutely
have to have in your new system and what's negotiable? One has to decide what
data to mine actively and what just to store. You might decide to input data on
active patients only, while placing the rest in an accessible database. While
you do not want to load up the new system with data you will never use, you
also want access to historical data in some cases, should patients reappear
(which of course they often tend to do).
·
Consider: Will you choose to load
data manually or digitally? Digital loading is extremely expensive. A commonly
employed solution is to scan potentially needed old data into a server from
which the new system can retrieve. A provider can then access and utilize the previous
data. This tends to work for both paper and digital records. You might be safer
trying to resist any urge to move all the data all at once. That becomes a mountainous
task. Instead, you might be able scan key documents for regular patients when
it gets closer to their next appointment. What should you do about problem
lists and medications? One approach is to treat patient as if new to the
practice, and update the system with a clean slate using the scanned documents
as the basis for doing so. This may sound onerous at first, but consider a)
problem lists and medication lists frequently become outdated and need a
regular “spring cleaning” anyway, 2) you would do this for any new patient
anyway and probably correct many erroneous data points in the process.
·
Think About: What data will be
archived and how will you find it in a timely way? Have a coherent plan to archive
all the data but do not use unless needed. You can then decide what to scan
into the new EHR. Medication lists, problem lists, last complete history and
physical, and pertinent lab and x-ray data are high on the list, especially for
current active patients. Routine follow-up checks can be accessed through the
database if necessary.
·
Ponder: Will you maintain your old
system? If so, for how long and how much will it cost? What will be the cost to
maintain access? Will you have to pay
your old vendor support and updates?.
All this will depend on your changed contract with the previous vendor,
and and the price to maintain it on a server, yours (preferably) or theirs. Remember
that sever costs are based on amount of data. The author recommended a year.
·
Give thought to: How will new data
(laboratory tests, consults etc.) be received? In most cases, this should be
done by accepting data into the new EHR automatically using HL7 standard
interfaces.
·
Spend time considering: What forms
looked like in the old system (especially those for each visit) and how will
they look in the new one. This will affect workflow dramatically. Too much
change at one time, even if perceived by you as an improvement, is rarely well
received. Gradual change is better. Try to pick an EHR that is end-user
oriented, with excellent graphic interfaces, and easy navigation. The end-user
will reward such efforts with increased satisfaction and potentially increased
productivity.
·
Think through: What is the workflow
for each type of visit and what forms are used? You might find it best to use a
template driven system for quality control and consistency.
A
transition of this sort is in no way an easy task, even in the slightest. An
important goal, naturally, is to minimize pain and cost. Remember what we have
discusses so far does not even begin to examine what many consider to be the
more important, and trickier, transitions of practice management and billing.
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