One of my readers sent me the following story about an EMR data conversion experience they had just had. I’ve removed the name of the EMR vendor and PMS vendor, because I think this could apply to a lot of the “jabba the hut” EMR vendors out there. Enjoy!

I had an interesting conversation today with one of my clients who is now in the process of migrating to [EMR vendor]. My involvement is to assist in moving the patient demographics into a file that can be imported by [EMR vendor].

So it starts out a week ago with my receiving a spreadsheet naming the fields used by [EMR vendor]. Then the client sends me an augmented version of the spreadsheet saying which fields from their current system are to map to the new fields in [EMR vendor]. I’m fine with this, it just makes my job a little easier since I don’t have to do any guessing. I spend a half hour writing and testing the program, and send a sample test file of 200 patients to the client. I exchange an e-mail with the client and it is agreed we will have a conference call on 11/24.

This brings us to today. First call starts out, not all the people are available on the [EMR vendor] side. (There were scheduling conflicts.) So ten minutes pass while people discuss what time works best for everyone. Instant messages are sent in hopes of snagging other people. New time set for afternoon.

Afternoon comes. All parties are present. Interestingly, the programmer on the [EMR vendor] side seems a little unfamiliar with the field layouts as defined in the spreadsheet sent a week earlier (who knows who sent it). After some discussion on their part, it is not clear whether they are talking version x.4 or x.5. He’ll send an IM to another programmer for clarification. Seems to be some concern about our sending blank/null data for fields that are not being used. Decided it is not the big of a problem. Discussion between client and [EMR vendor] revolves around whether they are talking about [either of the 2 methods this EMR vendor uses]. It is finally decided that more fields are needed in the original spreadsheet. Which field should be used for “race”? Are patient names going to be converted in all upper case or upper/lower? They’ll check with another programmer – that might be a conversion parameter. More background discussion about the “autoflow” phone call scheduled for later that day. Call concludes that a new spreadsheet defining the fields will be sent out.

Observations: This is just the tip of the iceberg in terms of time and space that will be required as sites migrate to EMR. It will take lots of TIME – you’ve made this point repeatedly. The bigger the organization, the more features they have in their product, the more people become involved and the more complex the conversion process can become.

There was a lot of interesting response to my article on replacing an EMR. I actually got an email response that I believe is a really interesting read about one EMR vendors take on the challenges of converting the data from an old EMR to a new EMR. Here’s the email response (with old EMR vendor name removed since it could have been any EMR):

Interesting article. This is where I live each and every day.

Most recently, I’ve switched a client from [current EMR Vendor] to our product Red Planet. The price tag on upgrading [current EMR Vendor] was too prohibitive and they were already familiar with us since we were doing the PMS. So, we already had a foot in the door.

There were two challenges: 1) Converting the data. 2) Converting the culture.

The data was not easily accessible, even through it was SQL based. It was just hand-to-hand combat learning where/how the data was stored and then extracting. The real issue is that you don’t know that you got all of it. You bring up a visit on the new system, and it looks complete until you read some of the fine detail and discover it dropped the last 1/5 of a sentence. I’d scratch my head, go back and do extensive research, find the culprit, run another conversion and we would inch forward. This was extended over a 6 month period. It isn’t like converting a PMS where you know the receivables is X dollars and you can balance to the penny. There is no equivalent “penny” in the EMR and no one has the time to look at every nook and cranny of every note, shot record, lab result, image, or order. So when it looks close, you go for it.

An EMR imposes a culture on an organization. The staff, for instance, would continually ask me how they “suspend” a note so someone else could work on it. “Well, in Red Planet, we don’t do a suspend. There is no need,” would be my response. They would shake their heads, and try to wrap their minds around this new concept. I would watch them do things on their old system that I thought were tedious, non-intuitive, and very prone to error. I would then show them things in Red Planet and they would say to me it was tedious, non-intuitive, and very prone to error.

Now, when they were right about something being cumbersome, I at least have the ability to re-tool a process or function. In the end I’ve been able to capitalize on the things that were good from [their old EMR Vendor] and enhanced our product. I’m a fanatic for speed and accuracy, so being superior to what they had is an obsession.