Two weeks ago, I participated in the POSP education session "From Choosing to Using Your Complete EMR Solution 2". A good part of the day dealt with the issue of data migration and the maintenance of the quality of information as a practice transitioned from one EMR to another. What is quite clear from the presentations and discussion is that data migration is no simple task and requires data cleaning, the mapping of data from fields in one system to another to ensure that the information is transferred to the right place in the new EMR and also a process to validate the data in the new system and make sure that it is correctly transferred. This process can take months of work and is very time consuming and costly.
My personal experience with data captured in an EMR highlights the importance of having a robust data transition process and using an EMR that is well supported in Canada. In 2001, I selected and implemented an electronic medical record system that had been developed for the US market called CliniFlow. At that time, the functionality offered by CliniFlow was extremely sophisticated and I was impressed by the capabilities it would offer from a patient care perspective. Based upon a commitment by the company to bring CliniFlow into Canada and develop a full Canadian version of the product, I agreed to be the first implementation site in Canada.
A laboratory interface was developed to deliver private lab results into the EMR and in conjunction with the BC College of Pharmacists, permission was obtained to fax prescriptions directly to pharmacies with a unique identifier for each prescription. I began the process of implementing CliniFlow soon thereafter.
Between 2001 and 2003, existing patient data was migrated to the EMR and I was well on my way to implementing the EMR. However, there were still two unanswered questions from the EMR vendor. When would they make the official commitment to fully supporting the EMR in Canada and when would they commit to development of a Canadian billing module integrated with the EMR?
Despite the initial work and use of the system in my practice, the vendor decided not to officially enter the Canadian EMR market. Not having an officially supported EMR left me in a difficult position. Should I shut down CliniFlow or should I develop an alternative strategy that would allow me to continue using the system while at the same time reducing the risk of my data being held hostage in the EMR or incurring significant cost when and if I was able to transfer the data to a new EMR system? My solution from late 2004 was to run a hybrid practice. To use the most useful features in CliniFlow, while at the same time maintaining a complete paper chart for each patient in which I recorded encounter notes, the information that I was most fearful could not be transitioned to a new EMR particularly as much was stored as discrete data elements. Copies of reports and non-laboratory information were scanned into CliniFlow and the original copies were kept in the paper record.
Was this an ideal solution? Not by any means. After fully implementing CliniFlow, I made a conscious decision to step back to a hybrid practice in order to ensure I did not become a hostage of an unsupported EMR system.
I hope this serves as a useful lesson for others who may be considering the implementation of an EMR system not supported in Canada. In 2004, this was a problem, but is much less of an issue in 2010 as there are many highly functional EMRs available in most provinces.
What features did I continue to use in CliniFlow up until the time that I closed my medical practice in 2007? The list is extensive and includes:
- Medication profiles;
- Lab results and graphing for chronic disease management;
- Allergy lists;
- Drug interaction checking;
- Transmission of prescriptions direct to pharmacy;
- Management of incoming documents;
- Remote access to clinical information from home;
- Notifications and reminders;
- Problem lists.
Although not an ideal solution and one that required more work than either electronic or paper alone, what this approach allowed me to do was maintain the integrity and completeness of each patient record without fear of being unable to transition the data from CliniFlow to a new EMR.
What has been your experience with data transition from one EMR to another? I am interested in your comments and feedback regarding challenges and lessons learned.
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