Electronic Medical Records (EMR) / Electronic Health Records (EHR) Replacement Challenges by Michael Fishweicher

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