Migrating to Epic?

Data Elements Selection

Deciding which data elements to move from your existing EHR is at the heart of every conversion project. Here are some factors to consider when determining which data elements to migrate to Epic.

Key Patient Identifiers

Demographics such as name, address, date of birth, are typically a core part of any conversion.

Structured, Discrete Clinical Data

Demographics such as name, address, date of birth, are typically a core part of any conversion.

Continuity of Care Documents (CCD)

CCD’s are useful for both summary data and discrete elements. This is because the underlying structure is based on the CCDA (Consolidated Clinical Document Architecture) standard. CCDAs can be used to generate historical PDFs for longitudinal view of the patient’s chart. It also contains all the discrete data needed for most clinical conversions.

Progress Notes and Other Relevant Clinical Documents

This data has important historical reference value. When considering notes and clinical documents look to balance providers needs vs wants to avoid cluttering your new EHR.

Data Quality

Older systems typically have a higher dependence on unstructured data variability and therefore increased data quality issues. Migrating to a new EHR provides you with an opportunity to start fresh—which means being selective about which data is converted to avoid the bad data in/bad data out paradigm.

Data Mapping

The data mapping effort is almost always underestimated by an organization but is critical for a discrete data conversion and crucial to keeping to your planned project timeline. For example: some items might not be codified, or they may not be in the required coding system. These situations require a lot of communication, vetting, and signoffs.

A Few Suggestions for a Successful Data Mapping Project

• Identify coding set mapping requirements upfront
• Determine the volume of data you have that is not codified
• Prioritize by instance count. Example: For medications: determine how many are prescribed and then prioritize accordingly
• Give extra time for basic data formatting of key elements. Example: time, language, gender, and demographics
• Make sure you have the Epic Dictionaries map from source codes to Epic Codes

Data Grouping / Sets

It’s important to define and build meaningful practice identifiers to ensure patients and their data can follow the provider. Consider what needs you may have for identifying patients/groups from a legacy perspective up front in your planning process. If you want to know which patients are affiliated with specific practices in your network, you’ll need to define and build meaningful Practice Identifiers

These identifiers can then be used during the conversion from the legacy system(s) for various conversion data set(s). If you’re planning to use the legacy practice level OID – having complex, or inconsistent rules can reduce or eliminate your ability for some practice level reporting, export utilities, or straight-forward conversion tasks.

Archiving vs. Conversion

It may not be practical or possible to convert all the relevant clinical and financial data from your old systems to your new one. Yet it’s crucial for patient care, collections, and legal compliance that you “leave no data behind”. Consider having a comprehensive legacy system data archival plan to provide easy access to a full view of all archived clinical and financial data from older platforms.

There’s no need to keep your legacy EHR or PM systems running along with the maintenance and licensing expenses that go along with that alignment. A user-friendly, flexible archive solution can be configured to operate as a module inside most leading EHR and PM systems. Thus, avoiding the need for clinicians and back-office staff to log into multiple systems to access historic patient information.

There are several ways to make historical charts readily available for providers without integrating the data into the new platform. For problematic data, this is a compelling alternative. Balancing what providers want and need with what is possible, is critical to achieving success at a technical and user level.

How Much is Too Much?

The benefits of archiving data are huge and often pushed aside in the initial stages of planning. Consider planning ahead for release of records and legal data storage requirements. Avoid filling your new Epic system with poor quality data or data with minimal access requirements. The financial and operational benefits of planning your data archival strategy up front are significant.

How Much is Too Little?

It is also possible to err on bringing in too little data during a conversion. Patient safety can be threatened from limiting access to legacy records. When deciding how many years of patient data to bring into Epic consider that if a patient does not exist within Epic you will not be able to use single sign-on from within EPIC to the Archive for that patient. The user would have to manually login to the Archive and search for the patient which can dramatically reduce the value of the Archive, and in user adoption.

Take Advantage of Data Tools

One of advantages of working with experienced conversion vendors is that they have often developed efficient data cleansing and workflow tools that can help mitigate challenges that inevitably arise with complex conversion and archival projects. Be sure to include data automation tools in your conversation when evaluating vendors.

Recommended Data Tools

• CCDA
  • Parsing – ability to parse human readable and machine code elements
  • Transforming – leverage all translation & mapping
  • Generating – ability to create HITSP C32 compliant CCDA
• Standard HL7 Interfaces (Parsing, Transforming and Generating capabilities)
• Translation and Mapping Tools
• Conversion Database
• EHR API Libraries
• EMPI Integration
• Document Conversion Tools
• Legacy EHR Specific Extract Scripts

When Making Data Management Decisions Don’t Forget About Workflow

In the end, the goal of a conversion project is to support administrative and clinical workflows that guarantee continuity of care for the patients served. Since medicine is a high transaction activity, even minor workflow inefficiencies get magnified.

Getting a practical perspective on how a conversion project can impact daily activities–from scheduling, to check-in, to visits, to ordering tests, and finally through the billing process, is essential for a successful project. This means understanding the workflow of all the staff that fulfill these functions—not just the physicians. This can also be an area where your conversion specialists can help, particularly if they have experience building and utilizing tools to support workflow issues that occur within conversion projects.

Consider Post-Migration Needs

Data Considerations

When establishing data feeds that will persist beyond the end of the migration project, determine whether Epic’s change tracking will meet your needs for reporting and investigating historical values. Consider building supplemental logging, change tracking, and data history into your ETL process as needed.

Epic Provider Data Management (Triplets) information for Providers (SER), Vendors (VEN), and Places of Service (EAF), often needs to continue to flow into the system from an external source after go-live. By establishing strong translation tables and a reliable feedback loop between your Triplets file generator and your Epic data early in your migration, you will save time and effort throughout testing of the new system and into the years that follow go-live.

Provisioning Considerations

Start determining how you will grant access to your new system. An Auto Provisioning Solution can decrease time to full system access for users, increase productivity versus manual methodology, provide built-in reporting capabilities that enable easy and accurate provisioning compliance tracking to enhance security and regulatory requirements.