Thinking of Switching EHRs? Read This First

Ronald B. Sterling, MBA, CPA

Disclosures

December 11, 2018

In This Article

Managing Conversion of Patient Information

A variety of federal, state, and professional standards require healthcare organizations to maintain a patient record throughout the time the patient is treated and for 7 years after the last patient contact (and longer for pediatric patients). In some cases, practices have patient records spanning a legacy paper record plus two or more EHRs. This creates problems for patient services, financial management, and operational efficiency, including:

  • Key historic information may not be present in the new EHR but are available through the legacy EHR or paper record.

  • The practice may have to continue to pay for access to the legacy EHR that is not being used for new information. Costs may include hardware and software maintenance.

  • Information may have to be brought over into the new system to properly track pending patient care issues, such as colonoscopies, continuing treatment, and allergies, while the supporting records remain in the legacy system.

Understanding and managing patient care may require contextual information that could span years and several different patient record systems. Practice staff will need to maintain access to and knowledge of each system's patient records. Split patient records in more than one place or EHR can complicate care and take extra time to make sure that the appropriate patient information is considered in care decisions.

Transitioning patient information from the current EHR to the new EHR is a major challenge.

One of the key technical challenges is that each EHR manages data differently. Also, the legacy and new EHR vendors may not have enough information about each other's product, and your use of the current product, to fully design and execute a conversion of information to the new EHR. For example, many EHRs have programmatic workarounds to deal with changes in the healthcare system that may complicate the conversion process for historic ICD-9 codes, non-National Drug Code prescriptions, or obsolete Current Procedural Terminology codes in the old patient records.

Because the organization or practice is responsible for the patient record, the practice can't leave the data transition decisions to either the current or future EHR vendors or the EHR vendor technical staffs.

Eight Strategies to Effectively Move Patient Data

The key issue is, what—if any—patient data should be converted from the legacy EHR to the new EHR? This is a serious issue that requires careful analysis to ensure that the patient records are maintained and available to care for patients in the new EHR. To analyze this, you'd want to do the following:

  • Inventory the clinical information in the current system, such as prescriptions, office notes, telephone messages, diagnostic images, and procedure checklists.

  • Inventory the clinical information and features of the new EHR, with special attention to new features you'd want to capitalize on in the new EHR.

  • Map the existing patient information from the current EHR to the clinical information and features in the new EHR, using a table that lists the current information and the destination feature in the new EHR.

  • For new EHR features that are not in use, review the information and workflows needed to use the new features.

  • Get the data conversion standard from the current vendor, and verify that all patient information used is included in the vendor's data conversion standard. If information that the practice uses is not on the current vendor's list, amend the plan to include all your information.

  • Meet with the new EHR technical team to discuss the data from the current system and where the existing data will be loaded into the new EHR.

  • Design the data remediation strategy for the organization or practice to address any information that needs to be manually entered for patient records to properly display and work in the new EHR.

  • Include the data conversion information and data remediation requirements in user training.

The decision to convert records from an existing system is difficult and costly now but could pose a whole range of medical professional liability, practice disruptions, and compliance risks in the future. For example:

  • Declining to transfer your patient health information to a future EHR could prevent you from producing appropriate patient lists that meet a clinical criteria or care management program.

  • The practice will not be able to let patients access their health information on the patient portal if information from the current EHR is not available in the new EHR.

  • Maintaining the patient record and optimal management of the patient may not be possible without contextual information of the patient's situation in the current EHR that may be critical for care decisions. For example, reactions to a treatment on the current EHR may pose a serious risk for patients if the information is not properly displayed in the new EHR.

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