New EHR? A Checklist to Protect Data Integrity
By Jason Caturano, Vice President of Research & Development, Harris Data Integrity Solutions
When migrating to a new EHR system, protecting the integrity of your patient data is paramount – and should be a consideration from the outset as pre-migration actions will dictate the level of post-migration problems.
Avoiding those problems and preserving data integrity is the goal of the following project management checklist of considerations and actions to take during each of the five primary stages of system migration: pre-selection, technical implementation, clean-up and migration, training and testing, and post go-live. While not exhaustive, this checklist is a helpful reference guide to avoid a sudden influx of duplicate records and overlays that can clog up patient identity queues, overwhelm HIM teams, and impact patient safety and care outcomes.
Software Selection
Once the decision is made to bring in a new EHR system, a project team should be assembled that represents the needs of impacted departments and the core resources required to make the implementation and data migration happen. This group will be tasked with system selection.
Utilizing MoSCoW prioritization – Must have, Should have, Could have, and Won’t need – create a list of the features desired in the new software.
Research solutions that meet those criteria, winnow the list down to the top five options, and further narrow it to the top three.
Request additional information from the three finalists, such as system demonstrations, trial software, documentation, etc.
Secure and evaluate price estimates from the finalists, which should represent the total cost of ownership (i.e., licensing, training, implementation, hosting, etc.)
Based on those estimates, develop the budget request and justification, secure budget approval, and proceed with acquisition.
Technical Implementation
Once an EHR system has been selected, the next stage is the technical implementation. This encompasses all the technical aspects of implementing the software, including installation, integration with other systems, establishing contingency plans, data migration, and training the trainers. During this stage, the implementation team – which is typically an expansion of the selection team to include additional SMEs – should:
Identify how the new EHR will integrate with the current solution.
Determine what data should be migrated to the new EHR.
Create a data mapping plan to ensure data is properly migrated.
Determine if, how, and where to archive data that is not being migrated to the new system.
Identify how data will be shared between the new and existing systems.
Identify what data will be received into the new system and from where.
Clean-Up and Migration
The clean-up and migration stage is one that should ideally start before technical implementation in preparation for the eventual transfer of data from old to new EHR. This stage is ideally guided by HIM, which has the most in-depth understanding of the patient record and the havoc mis- or un-matched data fields can wreak on the new system.
This stage is the most crucial for maintaining data integrity throughout the transition. As such, it may be appropriate to engage a partner like Harris Data Integrity Solutions to manage the clean-up and migration stage, freeing internal HIM personnel to focus on core responsibilities and support the transition team in other critical areas.
While in the testing environment:
Analyze patient records for missing data.
Identify duplicate or overlaid records in the system.
Identify any crossover records.
Identify any disparate data fields between the old and new systems.
Undertake a pre-migration clean-up of the MPI/EMPI to eliminate crossovers and duplicates.
Training and Testing
With the implementation complete and data migrated, the project moves into the testing and training stage. This is when the focus shifts to moving the new system out of the training environment and into the production environment where users begin to work in the new EHR. This is the stage where issues are most likely to arise, meaning contingency plans are critical.
Identify and train internal superusers to support end users during testing and beyond.
Confirm that the HIM team has a clear understanding of the tools that will be used to remediate duplicates and overlays within the new system (e.g. Epic’s error queues).
Confirm that duplicates are being properly identified.
Conduct comprehensive user training.
Put the new software through its paces in the testing environment to validate performance and functionality.
Schedule additional testing with end users to confirm and/or adjust workflows.
Create a transition plan from the testing to production environments.
Establish a go-live “war room” with dedicated resources to handle day-of calls and troubleshoot issues.
Create contingency plans to handle any issues that arise during final go live.
Create a process to report any issues that arise after implementation.
Conduct limited release – or go live – where applicable to ensure the transition to the production environment can happen seamlessly.
Complete end user onboarding.
Finalize go live and transition to the new daily operating environment.
Post Go-Live
Once all end users are on the system, it’s time to troubleshoot issues and resolve any problems that arose during go-live to ensure the new EHR is up and running and users are adjusting to new workflows and features.
Sort and address reported issues based on severity.
Request feedback on functionality from end-users.
Transition the EHR implementation from the project management team to regular IT support.
Update all stakeholders on the project and any next steps.
Conduct daily monitoring of queues to identify and resolve duplicates, overlays, or other data discrepancies.
Create new procedure documentation where needed to reference the workflow of the new EHR.
Transitioning to a new EHR or, in the case of a facility merger or acquisition, consolidating disparate systems is a daunting process that can significantly impact the integrity of a hospital’s or health system’s patient data. Following this checklist and ensuring data is protected at all stages can go a long way to ensuring a successful migration.