Now that most providers have started using an EHR the single biggest obstacle to changing EHRs is often getting the patient data out of the old and into the new. What’s possible? What’s affordable?
Why do you want to convert your old patient records?
- Record retention – Depending upon your state and provider type you may need to retain your patient records for up to 10 years. Visit www.healthinfolaw.com to see the requirements for your state.
- Ongoing patient care – if you’re likely to see a patient again you’ll need access to your old records for their allergies, past medical history, etc.
- Smoother transition to your new EHR – if you can import and/or have access to prior patient information it will make it easier and faster for you to see patients in your new EHR.
Why is this so difficult?
- Unlike Billing, where most data is highly standardized due to HIPAA standard claim formats, most of the data in EHR records are not standardized. You have standard ICD-10 and CPT codes but beyond that most EHR data is highly variable.
- There is no standard for the way History, Chief Complaints, HPI, Exam, Plan, etc. are captured. Furthermore, most EHRs allow providers to dictate all or a portion of their notes. As a result, it is impossible to export all patient records as data and import them into another system as data.
What are the options?
The options start with how you want to access the data. If you’re a surgeon that rarely sees the same patient again, you may want your old vendor to simply archive your data in a readable format for you on CDs, and you safely store them away without even attempting an import into your new EHR.
If you want the data in your new EHR, a great starting point is finding out what the export options are from your old EHR. This often requires a call to your vendor (and they will hear “my client is thinking of leaving”) but that is the only way to know what it possible. Your new vendor can only work with what they can get.
What are likely output options from your existing vendor?
- C-CDA – This is a standard used by certified EHR to share patient data with other providers for ongoing patient care. See attached for more information on the CDA structure. Because most EHRs must be able to produce the CDA, most EHRs can also mass export the CDAs for use in another EHR.
- Keep in mind the CDA only includes the current medical data per the CDA structure. As such, it will not contain all past records and will not satisfy legal retention requirements. As a result, if you elect to import CDAs from your prior EHR, you will need to make arrangements to have access and retention of the detailed records of previous visits.
- .csv file with standard demographics and possibly additional fields. Similar to the CDA this structure cannot contain all past records so will not satisfy legal record retention requirements. In addition, since there is no standard for many demographic and other fields, it is very possible that a new EHR will not be able to import all information on a .csv as data.
- If you are migrating your billing, your old EHR (and new EHR) may have options available for billing related fields. These options are typical:
- Demographics only without insurance
- Full Demographics including the patient’s full insurance information
- Full Demographics plus patient’s balance
- Full detail conversion – Full Demographics plus the detail records for all outstanding claims
- PDF(s) – Some EHRs will be able to provide one or multiple PDF files for each patient that include all prior information – office visits, lab results, etc. If provided as one big PDF per patient the pages are typically in data order. If provided as multiple PDFs, some vendors will group the PDFs into folders such as Office Visits, Labs, etc.
- .bak database back-up file – this is a copy of the practice’s entire database. While this may sound appealing, a .bak file is designed to be read by the software that created it. Since your new EHR vendor will not have access to your old EHR system it may extremely difficult if not impossible for the new EHR to decode the data in order to import it.
- Combination – your existing EHR vendor may offer a combination of the above.
- None – Unfortunately some vendors do not offer any way to mass export patient data.
What about Cost?
Your existing vendor will likely charge to export data for you. The EHR may allow you to export the data yourself at no additional charge so you should also explore that option. If you don’t really need all of the old data in your new EHR some vendors will offer archiving and/or view only for a reduced price.
The new EHR vendor will also likely charge to import the data. Alternatively, they may recommend or use a third party such as Ellkay or Chart Capture. These services are typically at least $1,000 per provider and depending upon the technology there may be ongoing costs. If you are transferring billing data per above there will often be several options to consider.
Since this is going to cost me, should I proceed?
Only you can answer that question. You may want to take the following steps minimize the cost:
- Include some new vendors in your EHR search that provide free or reduced cost imports.
- Some EHRs with a PM/Billing system will have different options for importing billing related data. Consider the cost (is it worth it?) as well as the accuracy (garbage out = garbage in). It may be less expensive and more accurate to simply obtain information from patients the next time they come in after you implement the new system.
- Maintain access to your old EHR for several months and gradually export patient notes and import into your new EHR. Even if your old EHR doesn’t have a formal export process you should be able to print old notes to PDF and then import them into your new EHR gradually as you see the patients again.
- If the old EHR provides multiple options for the export consider the lower cost options, particularly if you don’t need all of the old detailed information readily available in your new EHR.
While migrating patient data can be expensive and difficult, consider the long-term costs and benefits:
- Create a simple Excel spreadsheet to compare the costs of your current EHR over the next 3-5 years to the costs for your new EHR over the same period. Include all Start-up costs for the new system including data migration costs.
- Factor in your current pain/issues – if you’re looking for a new EHR you are probably having significant issues with your current EHR. What are they costing you and your staff in time (= $) and agony.
Sometimes you don’t have a choice – your current EHR is going out business! Before you leap to another EHR make sure you don’t make the same mistake again – check out our 5 Pitfalls to Avoid in Your EHR Search.