WASHINGTON – As practices merge, how hard is it to merge EHRs?
Even in what might seem to be the best circumstances, it can be a huge challenge, according to Jacqueline Fincher, MD, of McDuffie Medical Associates, Thompson, Ga.
One appealing aspect of the merger of Dr. Fincher’s practice with another was that each practice used an EHR from the same vendor and each was operating with the same updates.
Gregory Twachtman/Frontline Medical News
Dr. Jacqueline Fincher
“This is the perfect setup,” she said at the annual meeting of the American College of Physicians. “We don’t have to go to Epic. We can stay on the same EHR. In fact, this group had gone on the same EHR back in 2006 within a month of the time that we went on; we were on the exact same version and the same everything. We were totally even. The thought among the corporate and IT staff of the new entity was that this is going to be seamless. We’re just going to renumber the accounts and everything will be just fine.”
A call to the EHR vendor, whom she did not name, revealed that the process would be anything but seamless.
“Our IT staff contacted our common EHR vendor and said we want to merge this practice with our bigger practice and the EHR company said, ‘Wow, we’ve never done that before.’ What? In this day of consolidation and integration, they had never done it before? Nor did they have a business model to do so, much less a digital plan to do so. That was pretty shocking,” she said.
Dr. Fincher noted that the EHR vendor recommended a third party vendor to handle creating an interface between the two EHRs. “Most EHR companies do not, I say, do not have a dedicated service to migrate data. It’s almost always going out to a third-party conversion service that doesn’t know you, doesn’t know your work flow, and makes everything even more difficult.”
Two and a half months – and 10 interfaces – later, the launch of the combined EHR was a disaster, Dr. Fincher said.
Even though both practices were using the exact same version of the EHR, each had very different work flows, defaults, and other nuances that meant data didn’t transfer smoothly – cheaply.
Among the surprise expenses: about $55,000 for additional hardware, network cabling and interfaces; $35,000 for additional servers; and at least $100,000 for personnel expenses related to the data migration.
Given her experience, Dr. Fincher advised her peers “to start at least 6 months in advance to map and convert the data.”
And it is vital to get input and participation from all office stakeholders – both clinical and administrative staff – regarding how the data is migrated, she said. Be sure to completely understand all work flows from both practices so that you know how the data is going to migrate.
“Understanding work flow, that is absolutely critical. Every single office has a different work flow for every type of encounter by any method. How these work flows are the same or different between your office and the new practice or your EHR and the new EHR that you’re going to, they are different. You have to understand the differences,” she added.
“We didn’t perceive that there was that much difference but when everything crashed, we discovered there were because they had different work flows, they had different defaults in place, those types of things.”
Other key questions: Which data needs to be migrated? How long should the old system remain in place? Should the data be migrated manually or digitally? How much time will the EHR merger take?
“You want to establish that structured planning time,” Dr. Fincher said. “You’ve got to carve out scheduled time with the group in order to do this. Establish the tasks that need to be accomplished, so just making a to-do list every week and who’s going to be accountable to accomplish those parts of the list” is important.