Electronic Medical Records (EMR) / Electronic Health Records (EHR) Replacement Challenges
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The document discusses the challenges of migrating from one electronic medical records (EMR) system to another, emphasizing the complexities involved in data extraction and conversion due to proprietary technologies. It highlights the urgency created by federal incentives for 'meaningful use' compliance, prompting practices to upgrade their systems. Solutions for smoother migrations include better communication between technical teams, detailed documentation of EMR formats, and the use of expert services like those offered by Ellkay for effective data management.
Electronic Medical Records (EMR) / Electronic Health Records (EHR) Replacement Challenges
- 1. ELLKAY Connecting physicians,patients,and labs Prepared by Kamal Patel, Co-founder & CIO Michael Fishweicher , VP of Business Development © ELLKAY LLC. All rights reserved. The challenges involved in moving to a new EMR/EHR Switching your EMR?
- 2. Challenges involvedin movingto a new EMR/EHR- Whitepaper TABLE OFCONTENTS Challenges in MigratingBetween Electronic MedicalRecords.................................................................3 CurrentSolutionsandLimitations...........................................................................................................3 Discretevs. Non-discrete........................................................................................................................4 Challenges in Extraction..........................................................................................................................4 Challenges in Conversion........................................................................................................................5 Solving theChallenge ofEMR Migration.................................................................................................6 Partnerwiththe leader inEMR conversion.............................................................................................. 7 Copyright© 2011 ELLKAY,LLC.Allrightsreserved. Page2
- 3. Challenges involvedin movingto a new EMR/EHR- Whitepaper Challenges in Migrating Between Electronic Medical Records Electronic medical records(EMR) haverevolutionizedthehealth careindustryover thepast twodecades. Like all informationtechnology,however,thepaceofinnovationhasmeant thatEMR systems mustbe upgraded fromtime to time, orswitchedoutentirely in ordertotake advantageofimportant new featuresor programs. Inmost cases,upgradingtoa new version ofan EMRsystem fromthe same vendorcanbe accomplished relatively easily. However,movingdata froman existing EMRto a new EMR vendorhasprovento be an immense challenge. Despite an industry-wideattempttostandardize EMRdata formats,the reality is that each vendorusesproprietary technologiesandmarkupsthat make it difficulttomove fromone EMRformatto anotherwith completefidelity. The difficultyinherentin EMR migration stifles competition and precludesphysiciansfromchoosingthebest EMR system fortheir practice.A practiceorhospital may reluctantlyremain with anEMR system that doesnot meet its goalssimply becausemigratingto a competingvendorwouldprovetoodifficultandcostly. Recently, this issue hasbecomemore apparent as thefederal governmentoffersbillions of dollarsin incentive funding underthe ‘MeaningfulUse’ clause of the AmericanRecoveryandReinvestmentAct(ARRA).Practicesmeeting compliantEMR/EHR requirements will receive incentivesupto $44,000overa5-year period;hospitals can achieve significantlyhigherincentives between$2 million–$5 million. Non-compliantproviders,thosewhodo not demonstrate‘MeaningfulUse,’ will be penalized in the formofdeclining Medicarepayments. The government’s“carrotandstick”approachhascreatedurgencyinthe EMR/EHRmarketplace. Provider organizationsthatdonot have anEMR are actively interested in making a purchase,whileorganizationsthat have anexisting EMR are lookingto upgradeto a ‘MeaningfulUse’-compliantsystem.Hospitals andphysician practicesmustnow carefullyconsiderhow to movetheir critical patient data fromtheir old system to the new EMR.Increasingly,EMRvendorsare tasked with demonstratinga completemigration path forpatient medical data in orderto convincephysicianpracticestopurchasetheirEMRsystems. Current Solutions and Limitations There are twophases of migrating data froman existingEMR system toa new one.The first is extraction— ensuringthat all critical patient data canbe copiedoutofthe currentEMR.This processincludessuchvarious data elements as: Patient Demographics,Insurance,Appointments,PastMedicalHistory,FamilyHistory, Social History,SurgicalHistory,Medications,Allergies, Vitals, Immunizations,Images,ScannedDocuments, LabResults andEncounterNotes.These data elements ormodules will vary dependingonthe EMRsystem. There may be several data formats(databasefiles, text documents,photos,etc.) thatcompriseeachpatient medical record. The secondphaseis conversion.Oncethedatais extracted,it mustthen be convertedintoa formatreadable by thenew EMR.The EMRvendoroftenhas the oneroustaskof convertingmountainsofdata tomeet the technicalspecificationsofits ownformat.Conversionalsorequirescarefultesting toensure that all patient data displays accuratelyandcompletely in the new system. Dependingonthe amountof data, this processcantake Copyright© 2011 ELLKAY,LLC.Allrightsreserved. Page3
- 4. Challenges involvedin movingto a new EMR/EHR- Whitepaper several hourstoseveral weeks.The use of third-partyexpertsskilled in extractionand conversioncangreatly speed the entire process,butit requiresthe consentand supportofboththeEMR vendorandthe physician practice. Discrete vs. Non-discrete While most EMR vendorsoffersomeformof conversion,itis importantforproviderorganizationsto request detailed answersaboutwhichdatawill and will notbe converted.Anotherquestion toconsideris the type of conversionandtheintegrity of the dataelements in the new EMR.Specifically, providerorganizationsmust know whetherthey will receive discrete ornon-discrete conversions. The simplest conversion optionprovidedbyan EMR vendoris a non-discretescan,orPDF version,of apatient file. This means that the patient information is available, buta physicianmay have to read throughtheentire scanneddocumentjusttounderstand ifthepatient is allergic topenicillin. Asyou might imagine, the problem is quicklyamplified whenit applies to everyconverteddata element ormodule foran entire hospital of patient records. A discrete conversion,bycontrast,ensuresthatpatientdata is mapped withcomplete fidelity fromthe original electronic medical recordtothe corresponding moduleinthe new EMR.In thiscase, the physiciancansimply refer to theallergy section ofthe patient chartto checkifthe patient is allergic to penicillin. Discrete conversionsofferanotherclearadvantage:the data will be available forusewith the entire functionalityof the new EMR,includingfeatureslike text searches,analytics, reportinganddecision-making. This is notthe case whenoptingfora non-discrete,PDF conversion.Moreover,itisimportantto understand that non-discreteconversionsmaystandin the wayof compliancefor‘Meaningful Use.’ Challenges in Extraction Extractingdata froman existing EMRsystem is oftenlimited to the supportprovidedbythe existingEMR vendor.Becausethevendorhas noincentive tosimplify the processof movingdata to a competitor’ssystem, physicianpracticesoftenencounterdelaysand problems.The existing EMRvendormay not offerproper assistanceto understandtheformat,or may provideinadequate toolsto extractall patient data. Thiscanbe frustratingandprohibitive fora physicianpracticewhenconsideringtheswitchtoa new EMR system. Withoutvendorassistance,it is oftennecessaryto examine the EMRformatand develop anextractionplan. This crucialsteprequires connectingtotheexistingdatabase, analyzingdata, andidentifying test cases.The initial extraction analysis is limited by a numberof factors: Client availability:Hospitalsandpracticesarebusyenvironmentsand the propertechnicalsupport fromstaff may not be readily available. There may be multiple contactsorrolesto manage. Copyright© 2011 ELLKAY,LLC.Allrightsreserved. Page4
- 5. Challenges involvedin movingto a new EMR/EHR- Whitepaper Hardware/software limitations:Oldhardwarecanmakeit difficultforan extractionspecialist to accessthe databaseremotely. The technicalstaff at a hospital/practicemay also proveunwillingto providethe necessarypasswords. EMR vendor response:Withno incentiveto help,the existing EMRvendordoes notalways provide timely answerstotechnicalquestionsaboutthe format. Havingovercomethese challenges,accesstothe data typically reveals furthercomplications. Incomplete fields:Manydatapointsare left blank or incomplete,and thereforeimpossible to convert to the new format. Extractionfailures:Accessingthedatabasemay fail, orresult in incompletedata obtained. Inthese cases,help fromthe EMR vendorprovescritical. Otherunanticipatedissues typically arise duringthe extractionperiod.Insome cases,the scopeof workmay changeoncethe databaseis more thoroughlyexamined.Forthis reason, it is importantto identify the hospital’s EMRworkflow andthe modulesused ona daily basis. Oftenonly certainmodules needto be extracted,savingbothtime andmoney. Inothercases,specific and criticalworkflowsmustbe preserved, requiringadditional time andengineering. Ultimately, the successoftheextractionprocessrequirescooperation andopencommunication between physicians,technicalstaff,EMRvendors,andthe extractiontechnicalteam. Challenges in Conversion With mostof thepreparatory workaccomplishedduring theextractionphase,it might be assumedthat the conversionprocessismorestraightforward. Afterall,if all the data is extractedsuccessfully,itmustonly be organizedintothe properformatfor thenew EMRvendorand importedinto the system. Nevertheless, there are a numberof challengesand complicationsthatcanoccurinthe conversion processaswell. Typically, the extractionteam will runthe conversionona selected groupofpatientsand generate sample files forconfirmation.Here,the team verifies that all patient data is convertedcorrectlyandthatit is displaying accuratelyandas expectedin the new EMR system.Testing may uncoveranumberof issues orquestionsthat must be resolvedbeforethe full conversioncantakeplace. Forinstance,supposetheexisting EMRidentifies the marital statusofa patient as Single, Married, Divorced,orWidowed.The new EMRformatinstead displays optionsforUnmarried,Married, or Unknown.WhileSingle canlogically be mapped toUnmarried, a decision must be made forhow tomigrate the data pointsDivorced/Widowed.Theconversionteam,in discussionwith the medical staff,mustexamine the bestsolutions.These conversationsshouldoccur earlyinthe testing phase to precludedelays andproblems whenthe new EMRgoes live. Duringthe testingperiod, medical staff shouldalso goover their daily routineusingthe convertedsample files in orderto discovercommonplaceworkflow issues.Forinstance,thelisting of available medicationsin the existing EMRmight be differentthan inthe new one. Inorderto convertthese correctlytothe new system,the Copyright© 2011 ELLKAY,LLC.Allrightsreserved. Page5
- 6. Challenges involvedin movingto a new EMR/EHR- Whitepaper team must implement cross-referencemapping.Themostcommonmodulesrequiringcross-reference mappingincludemedications, immunizations, lab results,problem lists andallergies. Anotherfrequentcomplicationinvolvessourcedatathatis formatted differently. Thoughit addstime tothe job,the conversionprocessmayalsobe seen as an opportunityto“cleanup”the data. Forinstance,codes writteninconsistentlyas BCBS,BC/BS,BC‐BSandBCBSmay be normalizedto BCBS.Producingconsistent data is botha challenge andpossible added benefitof themigration process. Evenwith adequatetesting anditerating specificationdetails until all patient datatransfersover properly,there canbe unexpecteddelays. In somecases,conversionfails ortakes too long.This canoccurevenaftercopious testing, andmay be the resultof unorthodoxor inconsistentpatientrecords thatproduceerrorsduetovarious reasons. Conversionerrorscandelayimplementation andmust be resolved beforethe go-live date. Forthis reason, it is importantto have clear andrealistic timelines forextraction,testing,and conversion. Onefinal issue to noteis the possibility of unclearorunavailable technicalspecificationsregardingthenew EMR system.In thiscase,however,the EMRvendorhas every incentive tofacilitate the conversionprocessto expedite the use of its productwithanew client. Solving the Challenge of EMR Migration The challengesand potential solutionsdescribedhere demonstrate theneed fora competentextraction and conversionteamto facilitate themigration from oneEMR system toanother.Beyondtechnicalknowledge, subject-matterexpertise,projectmanagement,communication andcooperationareseen as critical componentsforasuccessfulandsafemigration of patient data. Eachof the followingstepscan alsohelp improve the migration process: Detailed documentation ofall EMRformatsinvolved Better communication betweentheconversionteam,providerorganizationsandEMRvendors Employing projectmanagerstofacilitate and manage expectationsforall parties Creatingrealistic timelines, anticipating delays and unexpectedissues Creatingworkflowsandchecklistsforthe EMRteam Regularmeetings to discussissuesand test sample conversions Withoutstandardization of the EMR format,the processof migratingfromone EMRvendorto anotherwill always be perceivedas a challenge.However,understandingthepotential issuesof extractionandconversion canmitigate the vastmajority ofthese issues andclear the obstaclestowardmigrating toa new EMRvendor. Employing a knowledgeableteam experiencedin extraction/conversion of variousEMRformatscanmakeit easier forEMRvendorstosell their services andforphysicianpracticesandhospitals toupgradeto the EMR system that best meets their needs. Copyright© 2011 ELLKAY,LLC.Allrightsreserved. Page6
- 7. Challenges involvedin movingto a new EMR/EHR- Whitepaper Overall, expediting the EMR migration process will help patients, physicians, and the industry as a whole. It is the key toward enabling provider organizations to move to new EMR systems qualifying under the ‘Meaningful Use’ requirement of the federal government’s HITECH program, and ultimately will assist in the national goal of cutting health care costs. Copyright© 2011 ELLKAY,LLC.Allrightsreserved. Page7 Partner with the leader in EMR conversion Benefit fromthe industry’smostexperiencedEMR extractionandconversion team. Hospitals andpracticeswill feel secureknowingallpatient data will transferover safely anddiscretely to the new EMRsystem. Proven andcost-effective Conversioninfrastructure ELLKAYspecializesinextracting, ELLKAYperformshundredsof analyzingand convertingclinical conversionseachmonthandoffers data onlarge volumes thatresults tools forcross-referencemapping, in a cost-effectivesolution. testing andprojectmanagement. Worry-free Specializedexpertise Let ELLKAYworkwithyourteam ELLKAY’sin-depthknowledgeand to doall the heavylifting and experienceincludesconversion successfullymeetthe go-live date, modulesfor specialties suchas while you focusonimplementation cardiology,pediatrics,andmore. and training. Call us today (201) 791-0606 EMRConversions@ELLKAY.com View all ourservicesfor physicians,hospitals,and laboratories: www.ELLKAY.com