Monday, March 21, 2011

What Are the Old EHR to New EHR Conversion Issues?

Data conversion from an old EHR to a new EHR is challenging and problematic.  In most cases, old contracts (and unfortunately many new contracts) do not obligate the current EHR vendor to provide the patient’s data or support the conversion.  Indeed, many practices are left to deal with the data that the current vendor “can” provide and the loading of data that the new vendor is ”willing”  to support. 

The gap between the old EHR information and the new system could pose a variety of operational issues and call into question continuity of patient care and even your stewardship of the patient medical record.  Indeed, contextual issues due to missing information and placement in the new EHR may complicate clinical decision making.

As difficult, some practices have an old EHR that was only partially used or used on an inconsistent basis.  In these situations, data conversion may be hampered with patient information split between paper records and one or more electronic repositories of patient information.

EHR conversion should be based on a diligent analysis of your current EHR information as well as any supporting or supplemental paper based patient information that makes up your patient record.  Your conversion strategy should address the following questions for 3 key conversion components to adequately frame and support your conversion effort:

Data Analysis – In most cases, practices cede control and influence over the EHR conversion to the vendors.  Unfortunately, a technically driven approach may not properly prioritize the conversion of the information or apply resources to yield the most appropriate conversion strategy.  For example, a basic immunization record from an old EHR was abandoned when moving to a new EHR.  Similarly, all of the images in an old EHR were abandoned since the new vendor lacked the expertise to convert image formats.

What accommodations for data analysis and conversion were provided in the contract?  Note that many organizations do not adequately define the conversion strategy in the EHR contract.

What analysis was performed to assess the plan to move the data from the old EHR to the new EHR?

Did the data analysis allow for maintaining the complete array of old EHR data in the new EHR?  If not, what accommodations were made to maintain the integrity of each patient medical record?

What data matching problems were uncovered and how were the problems addressed?

What old EHR data abandoned due to the differences in structure between the old EHR and the new EHR?

What compensating procedures were developed to address data matching issues or abandoned data?

What documents the data analysis effort and how was the document used for the data conversion effort?   

Data Conversion – The actual conversion of EHR data is typically hampered by the lack of formal documentation and planning.  Indeed, many EHR conversions proceed without a specific data conversion plan, or process.  The data conversion process should be a structured effort with ample opportunities for the doctors and clinical staff to verify and check that the old EHR information was appropriately converted.

Was there a test conversion to verify that the converted data was available in context in the new EHR?  Note that test conversions are also useful to determine the timing and staging of the Go Live conversion.

How did the practice verify that each class of information (Ex. Prescriptions, allergies, specific information, notes, etc.) was properly converted?

How did the practice verify that the converted data operated effectively with the new EHR as well as with new information entered into the EHR?

What problems were encountered during the test conversion and what were the solutions to conversion issues?

How was the new EHR database and data affected by data conversions that took place while the new EHR was in use to treat patients?  For example, many data conversion efforts take a week or more to complete while the practice is still seeing patients and recording patient information.

How was the break in service between the old EHR and new EHR handled?  For example, orders in the old EHR may have results recorded in the new EHR before the old EHR data has been converted to the new EHR.

What was the procedure used to capture information during the break in service between the old and new EHRs?

Does the converted patient information function in the new EHR natively?  For example, did previous procedures and conditions get properly coded to trigger health maintenance items?

What was the state of information that was converted in light of the dates of service and relevant audit trails?  For example, some data conversion efforts post all information in the new EHR as if the information was entered on the date of conversion.

Use of Old EHR Data in the New EHR – Old EHR data may be impacted by a variety of issues including the structural differences between EHRs, converted data presentation and manipulation of the old EHR data into the new EHR structure.  Manipulations could be quite basic such as format or presentation changes.  However, dramatic changes could include moving information from the old EHR the face page to an image that is now buried in a list of old EHR information or even recoding information from the old EHR codes to the new EHR coding system.

What procedures and policies were established to address the status and reliability of the information state and the audit trails for converted patient information?  For example, the old EHR may track the state (Ex. Received, pending, reviewed, completed) of information in a message while the new EHR may track state in the audit trail.

What training was performed to educate doctors and employees on the disposition of the old EHR data in the new EHR?

What training was performed to educate doctors and employees on compensating for the converted data and abandoned data?

What quality assurance measures are in place to insure that compensating strategies are used on a continuing basis?  For example, some practices may have a protocol to record information from the old EHR to the new EHR medical record structure on the patient’s first visit with the new EHR.  A first visit could occur more than a year from the new EHR Go Live date.  

Does the practice have access to the old EHR data through the old EHR system?  (Note that some EHR licenses and ASP/SaaS EHRs require continuing payments to make the patient records available through the old EHR.)

Conversion of old EHR information is necessary to support continuity of care, and preserve the patient’s medical record.  Failure to adequately analyze, and design old EHR conversions could inhibit patient care and undermine the efficacy of your patient medical record.  Your efforts to effectively design, implement and prove the patient information conversion effort are critical components for your transition from an old EHR to a new EHR.

© Sterling Solutions, Ltd., 2011

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