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March 2020

EHR Insider: Smooth Data Migration Boosts EHR Implementation
By Joe Benardello
For The Record
Vol. 32 No. 2 P. 8

Ten years ago, health care organizations rushed to implement EHRs to earn meaningful use incentive payments. Because these technologies have, in some ways, failed to fully deliver on expectations or are not being utilized to their full potential, today’s facilities are still trying to find what works best. In fact, organizations report EHRs have caused a host of problems, including patient safety issues, revenue challenges, and increased provider stress and burnout.

Meanwhile, organizations without the experience or knowledge of how to implement an EHR started off their technology journey in less than ideal conditions, namely without data standardization and comprehensive rules to provide them with stability.

Given the range of issues, it’s no surprise that some organizations are opting to swap out their current EHR for a different look. While this strategy has the potential to alleviate current problems, without sufficient planning the new technology may be only a Band-Aid for existing concerns, or worse, leave the organization stranded without access to the legacy data it relies on to conduct business and provide quality care.

The Cornerstone of Success
As a first step when moving to a new EHR, organizations should look to establish the protocols and structure that will enable better decision making, optimize revenue, support quality reporting, and avoid errors. To generate a comprehensive source of truth, organizations must ensure all relevant legacy data are transferred into the right location within the new system as well as any integrated solutions, making them easily accessible to providers.

EHRs don’t make it easy for data to be removed, translated, and placed elsewhere. Proper data migration involves more than merely using data migration software and hoping for the best. Data migration software works in theory when organizations have rigorous and standardized protocols in place that are communicated, updated, and adhered to during the life of the technology.

When used alone, such solutions often lose, misplace, or garble data, so they are not readily available in the new system, a situation that can have significant consequences. For example, clinical staff productivity drops when providers try to find the relevant information from the legacy system and redirect it to the right place. The risk for patient safety issues also increases as providers address data gaps on the fly or don’t realize the system is missing key information needed for patient care.

As a result, after moving to a new EHR, physicians must spend extra minutes during each patient visit updating information on problem lists, allergies, medications, and immunization (often called PAMI), as well as social, family, and surgical histories. These challenges drive up the cost of system implementation, increase risk, and lead to further provider frustration and burnout. In fact, the largest expense in implementing a new EHR is often the decrease in productivity in the months after go-live, a cost that is several times larger than the price of the software itself.

Moreover, when it becomes apparent that the new system still has data consistency and accessibility problems, it can color how providers feel about the technology, leading them to form negative impressions of its value and usefulness that can be difficult, if not impossible, to overcome.

Embracing a Strategic Approach
A data migration tactic that yields a more reliable clinical source of truth involves marrying technology with human expertise. In this strategy, an organization uses data migration technology prior to go-live to initially move the data. It would then tap clinical experts to review each record to ensure critical information found in the legacy system, such as patient allergies, test results, current medications, and medical history, are accurately and completely housed in the appropriate fields in the new solution.

Although an organization can recruit its own clinical experts for this work, it’s a costly proposition in terms of staff time, bandwidth, and burden. Facilities opting for this approach should allow enough time for staff to dig through the data.

Another option is to leverage external resources to verify complete data migration from the old system to the new. The Physicians Organization of Massachusetts General Hospital opted for this route when it moved to its new EHR, partnering with a vendor to ensure all relevant data were correctly transferred for its 1,500 physicians.

Since using an automated solution alone was ruled out due to high error rates, Mass General and its partner worked to implement a centralized and standardized solution using trained pharmacists and physicians externally to convert and transfer legacy medication lists in advance of scheduled visits. To guide the effort, a detailed medication transfer protocol was developed, regulatory and technical hurdles involved with handling hundreds of thousands of patient records across 12 time zones were overcome, and a queueing algorithm to identify patient medication lists was created.

The external clinicians compared medication data from the old and new systems, making any appropriate corrections and adjustments. The project, which was piloted and operationalized within a few months, saved Mass General 30,000 staff hours as compared with its sister organization, which relied on technology and internal staff alone. Mass General’s quality reviews revealed the clinical data migration project achieved an accuracy rate of 99.88%.

In 2018, Brigham Women’s Physicians Organization (BWPO) employed a similar data migration strategy. When other Brigham practices moved to a new EHR in 2015, the organization saw a drastic decline in productivity, with physicians spending upward of four minutes per patient record when migrating to the new EHR.

By using external clinical resources in conjunction with technology, BWPO saved more than 6,000 physician hours across the organization. Teams reviewed a provider’s schedule for the week and prioritized the charts to edit based on which patients would be coming in. The methodical process allowed the thoughtful transfer of data, provided side-by-side record reviews of the old and the new to ensure accuracy, and delivered patient information to providers in advance of their appointments.

Course Correction Is Possible
By using a combination of technology and human expertise to facilitate data migration, organizations can mitigate the risks involved in implementing EHRs, improving patient care and saving valuable clinician time in the long run. Furthermore, quickly implementing new technology can alleviate the access issues, cost implications, and quality of care concerns that can linger infinitely for less thoughtful organizations.

This approach is crucial for any health care organization, whether it is introducing new technology or onboarding newly acquired practices and hospitals and converting them to existing solutions. Not only will this approach streamline the migration process and lift some of the burden from staff, but it can also be used as a tool to ease transitions as health care organizations combine. More importantly, this process can finally help organizations establish a valuable clinical tool that meets the initial goals of EHRs: to facilitate safe and reliable patient care.

— Joe Benardello is chief strategy officer and cofounder of IKS Health.