Conversion from one EMR to Another - What are the Options?

If you are currently using an EMR and wish to change, adopting a new EMR system will require significant thought and planning in terms of data conversion strategies.

There are a number of mechanisms to convert data from one EMR to another:

1. Simple conversion: Manually re-enter the data into the new EMR. This is a time and resource intensive process, but does have the advantage of being able to clean the new data at the time of entry. There will be no unmatched fields or data conflicts. At a minimum, it should be possible to export the old records in the form of a .pdf file and attach the individual .pdf files to the patient record in the new EMR for reference purposes;
2. Vendor direct conversion: The new vendor undertakes to convert data in the old EMR system to the new system. This is usually a one-off process and can incur significant cost if the data structure in the old EMR is significantly different to the new system requiring a great deal of custom mapping between different data fields;
3. Conversion according to accepted data standards from EMR to EMR. In an ideal world, if all systems store data in a standard format i.e. exactly the same format and field in both systems, it should be a much simpler and less costly exercise to convert from one EMR to another. In the UK, this has been done using the GP2GP system. (Note: Using GP2GP, not all data is converted from one EMR to another and a data limit is imposed in terms of the amount of information transferred between systems. However sufficient data is transferred to have a fully functioning EMR patient record in the new system);
4. Third party conversion: Companies or organizations that have expertise in data conversion provide a service to convert EMR from one system to another. The challenge that these companies face is related to the way that data is collected and stored in the original system by the users;
5. Hybrid conversion: Certain discrete data is transferred from one EMR to another e.g. lab and demographic data and this is combined with a .pdf file for each patient record which is then attached to a patient record in the new EMR system.

(The prior is a summary of a presentation given in Vancouver on December 27th by David Ulis, Program Director for the Physician Office System Program in Alberta).

Does this cover the spectrum of data conversion? To add your thoughts and comments, click on the 'Comments' link below

Comments

[Raymond Simkus]

The issue of switching from one EMR to a different one gets to be a bigger and bigger problem the longer the time that the initial EMR has been used. Going back to the very old BC Medical Software Vendors Association specs and the more recent BC, Alberta and Ontario specs it is clear that they are all incomplete. The PITO funding has a very small allotment for data transfer. The reason for that is that it was only the demographic data that was planned for. Over a 10 year period of using EMRs my office accumulated over 800,000 lab results and a 100,000 prescriptions. This was transferred using the Alberta specification. Some time after the transfer we found out that the transferred data was missing significant components. My feeling is that the transfer specs are not detailed enough to do a good enough job. To make things more difficult most physicians do not seem to express much interest in old data and as a result the vendors do not see a demand to do a better job. Each vendor seems to use a different information model and when you transfer data from one system to a different one there are clashes. Data either gets lost or functionality of the data is crippled.

Another area of concern is how to manage data retention requirements. What will be legally acceptable? Do you have to keep the old system running for 25 years because what is in the new EMR is transformed data and not the original?