Migration strategies (getting your information into your new EMR)
Hi Everyone,
We had our training on eClinicalWorks about 3 weeks ago and were allowed to dabble in it prior to our official "go-live" earlier this week. We had talked quite a bit about how to get the information from the paper chart into the EMR and I came upon a terrific resource from the California Health Care Foundation (a great resource, more information and sign up for a very good newsletter at http://www.chcf.org/ )
This document has been very helpful in considering the different strategies one might use and is available at http://www.chcf.org/publications/2010/03/chart-abstraction-ehr-deployment-techniques (also attached). I strongly recommend that you take a look at this before deciding how you will populate your EMR when you are ready to jump in.
I had previously decided to make the investment in voice recognition and had to upgrade to the medical version (worth the (hefty) investment as it is so much faster than typing).
I've found that just populating the medical chart with a) the problem list and b) the medication list prior to the visit has been enough to let me have an effective and efficient visit with the patient and to document the visit electronically. I anticipate one more visit with the paper chart to "flesh out" the electronic database but then to be purely electronic.
I've also decided to not really scan anything at first from the historical chart, but our staff is scanning everything that comes in now everyday. By the next visit, almost all of the patients will have accumulated a rich stock of consultant letters, labs and test results.
Tom et al reinforce what I consider to be the best advice that I received pre-implementation. There is no need to scan the entire paper record into the EMR. It's expensive, it's labor intensive, and it doesn't facilitate the transition to and use of the EMR.
Flagging things that you know you'll need, scanning those items, and retiring the paper chart after a visit or two worked very well. Offsite storage of paper charts is not that expensive and the number of times that you retrieve charts is very low if you do things right.
Using an EHR? Yes - eClinicalWorks
Disclosure: Shareholder of Coastal Medical, Inc.
The information provided in this discussion looks very helpful. We also pre-filled problem lists/med lists/allergies/immunizations before the visits as they were scheduled. We had the paper records for one electronic visit, flagged whatever key pieces of info would be worth scanning on a case by case basis, then essentially never needed the paper record again.
For the adult patients, I would suggest scanning advanced directives/power of attorney paperwork as well. It is much safer having it available electronically (including remotely if on call) rather than buried in the basement on a shelf somewhere.
Using an EHR? Yes - eClinicalWorks
Disclosure: Owner/practicing partner of Aquidneck Medical Associates, Inc. Contracted as the Case Management Physician Advisor at Newport Hospital (a Lifespan affiliate) and as an advisor for BCBS of RI to help facilitate HIT integration in community practices
I would add a variation on Tom's method of data migration which also has the benefit of providing opportunities for staff training. We went live on our EMR (NextGen) about three years ago. The practice reached a consensus that four elements of the record would be migrated from paper to the EMR. These were medications, chronic problems, immunizations (because of the number of Peds patients), and allergies. We felt that these four items would be significant items for the Clinician to validate at the first electronic visit.
The data entry was done by LPN and NP staff. Charts were selected based on upcoming appointments and were done in a similiar fashion after a Same Day visit.
Because of our strong belief in structured data and standard templates we use very little typing and therefore did not investigate voice recognition systems. Data entry is generally by mouse or touchscreen.
We elected to have the paper chart available only at the first electronic visit.
Using an EHR? Yes - NextGen EHR, EPM and EDR
Disclosure: No ownership or interest in any related business or association