Surviving “Migration” To a New System

Many Practices are faced with the necessity of changing their Electronic Health Records vendor for a variety of reasons. These may include hospital buy-outs, marginal usability and/or poor performance of present EHR, political reasons, interoperability problems, cost, support, expansion, consolidation, and ownership personal preferences.

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 This may sound onerous at first, but consider a) problem lists and medication lists frequently become outdated and need a regular “spring cleaning” anyway, 2) you would do this for any new patient anyway and probably correct many erroneous data points in the process.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.