How to switch from one EHR / EMR system to another

Implementation of Electronic Health Records (EHRs) in a medical practice is not an easy task – everything that touches a paper record in a medical office (or hospital) needs to be accounted for when transitioning to a new EHR, in order for the paper record to be successfully abandoned. We have commented previously on how web-based EHR options open up possibilities not previously practical for small and solo medical practices.

Most of our attention has been on moving a medical practice from paper to an EHR. After all, the majority of medical documentation in doctor’s offices is still on paper, even though an increasing number are in the process of evaluating and implementing the transition to an electronic platform. At Practice Fusion, we don’t tend to see our primary competition as coming from other EHR vendors – our primary competition is paper. The majority of our users who are in the stages of incorporating our EMR into their daily practices are doing so in order to move from paper to an e-platform.

However, as the EHR adoption landscape matures, and more and more practices have adopted some sort of electronic medical record-keeping (regardless of how limited in scope it may be), the emerging challenge we will face is helping practices move from one EHR system to another one. This is an even-more challenging process than moving from paper-to-EHR.

Moving data
In addition to workflow redesign, moving from one EHR system to another also involves the capture and transfer of legacy data, where possible. This is problematic, given that there is no standard way that EHR data is stored. Legacy systems were built to be all-inclusive but proprietary data silos, and how data is organized is far from standard. Medical data in a chart is extraordinarily complex, and there is no way to simply “dump” the chart data from, say, Kaiser’s well-functioning modified Epic system to into some other external clinic that has installed a NextGen system.

Pieces of data can be packaged up and moved from one system to another, however. Patient demographic information can be exported from one system and uploaded into another – at Practice Fusion, we do this regularly for new users who have their demographic information in a digital format (usually from a billing system).

Other pieces of chart data can be transferred also – such as appointment data, or diagnosis lists and medication lists. So long as these can be somehow exported into a table (an Excel file, or a .csv file), then transferring data from an “old” system into a “new” one can be done.

Chart note data is a bit more problematic, however, owing to differences in how chart note data is organized in different systems. Outputting a chart note to a .pdf and then uploading it to the new system is a possibility (which at least preserves the narrative, and serves as medico-legal documentation), but the ability to do data queries on that information is lost.

Summary information can be output to a standard-format file (a CCR or CCD document), assuming that the “old” system is capable of producing such things. This is a one-at-a-time process which might work in order to move data from an old system to a new one, accomplished incrementally as patients are seen over a transition period of time. This implies that there will be a period of time where both the “old” and the “new” system are used side-by-side. The transition from paper to electronics is often done this way, with the paper chart being used alongside a wireless notebook computer during patient encounters, old data then being pulled from the paper record as-you-go, and then the paper chart is then retired. Such a transition typically can be up to a year. A similar experience can be anticipated when moving from one EHR system to another one.

Re-working workflows
In addition to the challenges of moving data – a layer of effort not involved in going from paper to electronics – one also needs to re-address all of the workflows involved. This is the same list of items that is encountered in the paper-to-EMR transition, but the particulars are different.

Basically, every peripheral linkage to the “old” system – lab linkage, prescribing linkage, billing system linkage, for example – needs to be “unplugged” from the old connection and re-established with the new one. There may be an automated telephonic reminder service that plugs into the old calendar which needs to be re-done, or there may be a pharmacy-sampling kiosk system that links to the old system, or there may be a custom linkage with the local hospital that will need to be re-done – all the “peripheral connections” that have been plugged into the old system will need a strategy for transition.

In addition, the same 7 questions that pertain to paper-to-EMR also need to be addressed here: (1) how will the billing be done with the new system, making sure the biller knows how to get the information in the new way; (2) how the new schedule manager will work; (3) how in-house messaging will be done; (4) how chart note creation will happen, and how old data will be captured; (5) how refill requests will be handled; (6) how lab tests will be reviewed and entered into the record; and (7) how external correspondence will be incorporated into the new system.

Making the transition from an “old” EHR system to a “new” one presents some unique challenges that are different than going from paper-to-EMR. However, many physicians who have experienced an old, legacy “beast” of a system (often pushed out to them by a local hospital that made a big investment in one) are eager to move to something better. Many feel “trapped” and “stuck” in an old system, which might have been the best technology of the day (10 years ago), and are looking to move to something new – such as a web-based EHR (that relieves the burden of hosting a whole server system). An in particular, a web-based EHR, with meticulous attention to the user experience, can seem very appealing. The transition, though challenging, is certainly possible. And, in the end, well worth the effort.

Robert Rowley, MD
Chief Medical Officer, Practice Fusion, Inc