EHR Conversions: Are We There Yet?

Last week I had the pleasure of helping one of my kids move across the country. We spent quite a bit of windshield time together on this journey, solving the world’s problems as father and son will do on occasion. At some point during our time on the ”loneliest highway” it occurred to me that many similarities exist between moving and changing EHRs. I have spoken about this topic once before, but the analogy was hammered home during this recent experience.

 

As the EHR market matures, sales are increasingly made to practices replacing existing technology. Unlike the original scenario in which the practice moves from a paper chart to an electronic health record, replacements typically involve moving data from the old EHR to the new one. In the health IT world such a move is referred to as a conversion. Conversions involve the legacy EHR, referred to as the “source,” and the new EHR, referred to as the “target.” There are many parallels between EHR conversions and moving your residence (at least it seemed so as we were racing across the Nevada desert last week).

 

Planning

 

Planning the actual move began months before the car was packed. Where will you live in the new town? How much space will you need? What are your financial constraints? When will the move actually occur? Likewise, planning for an EHR conversion begins well in advance of the actual event. The conversion process must be carefully considered during the search for the new EHR. What are the technical capabilities of the source and the target? What are the financial constraints? What is the timeline? In addition, it needs to be very clear who is in charge of the conversion process. As with an EHR implementation, a conversion requires a champion within the practice working hand in hand with a point person at the target EHR.

 

The Move

 

The move physically began at my son’s dorm room, 200 square feet of pure chaos. What should we take and what should we leave behind? Our analogy breaks down slightly here because we cannot truly leave part of the medical record behind. I am not an attorney and State laws vary, but at a minimum providers are typically compelled to maintain a patient’s medical record for at least seven years following the last encounter with the patient. As with our move, the tough question is how much of the patients record to transfer from the source to the target during the conversion. Technical constraints are important to understand. It should come as no surprise that as the amount of data converted increases in complexity, the cost of the conversion and the time it will take to complete the conversion both increase. Generally speaking there are three broad approaches to consider:

1. Convert a minimum data set for every patient. Typically this will include items that are “codified,” they have a defined code set behind them and are captured as what is commonly referred to as discrete data. Examples include standard demographics, medication lists, mediation allergies, problem lists and occasionally lab results. This is the least expensive solution and also the fastest conversion to accomplish.
2. Convert the kitchen sink. Attempt to bring the entire legacy record into the new EHR. This frequently requires scanning or uploading unstructured data (like progress notes and images) and parking that data in a specific location within the target EHR. This is very expensive and time consuming.
3. A hybrid solution involves tackling what is defined in option 1 above and using an archiving solution for the remainder of the data in the source EHR. This solution is less expensive than option 2 as well as less time consuming. It is also the most viable approach in my experience.

 

Validation

 

There are some additional things to consider in a conversion that further support the moving analogy. When we arrived at my son’s new apartment, he and I quickly unloaded the car, purchased and assembled some furniture and other necessary items and, at the end of our time together, assigned his worldly possessions to new locations that met his needs. As part of an EHR conversion, you need to identify your clinical champion. That individual needs to be intimately involved in the validation step of the conversion. Make sure this individual has a chance to look at the output of the conversion before it actually takes place. Do not simply assume for example, that the problems and meds from the source are going to reside in the target where the technical folks think they should go. While there may not be much wiggle room here, it is always best for this validation step to occur before the data is converted. It is much more difficult to rearrange the deck chairs after you have bolted them to the deck. Also make sure the individual from the practice involved in this validation step is indeed the EHR champion within the practice. I shudder to think what my wife will say when she sees our son’s apartment next month!

 

EHR conversions will become increasingly common as the market matures. As with a cross-country move, a little bit of planning on the front end will substantially ease the pain of this change. If you are shopping around and contemplating a change, make sure you understand the conversion process.  Forgetting this important step may result in a suboptimal outcome.