Ensuring clinician satisfaction with data integrity during EHR conversion

Problem, allergy, medication and immunization records are key to ensuring efficient care, but this information is often difficult to transfer.

Moving patient data to a new EHR from an old one can cause critical gaps in records and burden already stressed clinicians.

Physicians often make or break the implementation success of an electronic health records system. Start them off fully equipped with key patient documents, and they’ll sing your praises. Disappoint them, and you’re facing a long, uphill battle for system adoption and clinical productivity.

Keystone Health, one of the largest federally qualified health centers in central Pennsylvania, learned this lesson early in its Epic implementation. The 14-location FQHC’s steady efforts to ensure physicians had complete patient information on day one of Epic proved to be a smart decision and wise investment.

Keystone Health’s successful data transfer project involved four essential patient information documents and has returned countless dividends since it converted from NextGen to Epic in October 2020. By ensuring providers have easy and timely access to patient problem, allergy, medication and immunization (PAMI) data, it has received consistently positive physician feedback and high user satisfaction scores.

This organization was able to convert more than 60,000 PAMI documents and successfully create a complete legal medical record for the FQHC’s 140 providers.

Legacy data integrity

Easy access to correct and complete legacy data is critical for ensuring continuity of care and system adoption during Epic migrations. Even a small amount of legacy data missing from the new EHR can result in data gaps, resulting in physician frustration, redundant treatment and disjointed care management.

Data integrity is another top priority. Data converted from legacy EHRs also must meet quality standards. As documented in a report from the U.S. Government Accountability Office regarding the Department of Veterans Affairs’ migration from its legacy system to a new Cerner EHR, data quality matters. The report found challenges with the “accessibility, accuracy and appropriateness” of the migrated data.

Many organizations rely on automatic document and information conversion when moving to Epic. But not all documents automatically convert. For Keystone Health, important patient information related to problems lists, allergies, medications and immunizations did not automatically convert. And its team lacked sufficient human resources to complete the manual data transfer.

To meet go-live deadlines and ensure physician satisfaction, the FQHC opted to outsource the initiative to Intellis, which had prior experience serving Keystone’s partner organization, WellSpan Health. Throughout the project, Intellis provided a second set of eyes, a fully staffed team and valuable data conversion expertise.

No magic wand

Problem lists, allergies, medications and immunizations did not automatically convert from Keystone’s legacy NextGen system to Epic. Because these documents are routinely updated during every patient visit, the FQHC’s leadership was confident in the timeliness and accuracy of PAMI data. The challenge was how to convert that data from NextGen to Epic for 60,000 medical records, representing 65,000 patients.

Human eyes and manual intervention were required to ensure provider access to this patient information the first day that Epic was in use. By outsourcing to Intellis the transfer of PAMI data from NextGen to Epic, Keystone Health achieved three important outcomes:

    Five tips for success

    The conversion process yielded five core elements to a conversion project of this scope. They include:

      Teamwork and communication were cornerstones for the successful transfer of PAMI data. The service vendor quickly established a Microsoft Teams channel to keep everyone connected throughout the project. The vendor’s lead nurse provided clinical oversight while also leading a fully staffed team of HIM and data experts.

      The vendor’s team was given access to Keystone’s legacy EHR data, including continuity of care documents (CCDs). Each team member retrieved a batch of CCDs to process, pulling PAMI data and then re-entering it into Epic. Over time, patients were prioritized according to the upcoming visit schedule and patients with the most medications.

      Initially, the obstetrics service expressed reservations about using an outside agency. But those concerns dissipated after department clinicians witnessed the speed, organization and accuracy of PAMI data transfer. Keystone’s original goal was to convert 80 percent of all PAMI data before the Epic go-live. With outsource support, the FQHC was able to transfer 85 percent to 90 percent of all PAMI data for physician access and engagement on day one of Epic use.

      Provider satisfaction is crucial

      2023 holds much potential for additional stressors on our nation’s healthcare providers. From CMS’s proposed provider pay cuts to severe burnout and alert fatigue, physician departures may exceed previous levels in the year ahead.

      For example, an August 2022 MGMA Stat poll found that 40 percent of medical groups witnessed a physician retire early or leave the practice because of burnout.

      Any strategy that can be implemented to relieve physician burdens and support a more efficient provider workflow is a step in the right direction. Successfully transferring a physician’s legacy data into new EHRs is certainly one of these strategies.

      David Grant, R.Ph., MBA, MAS, is chief operating officer for Keystone Health.

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