The Lost Creek Consulting Blog

In With the Old: Cleaning up data eases migration

2012-01-12T16:42:00.000-08:00

If the new year holds a new EMR system for your clinic, congratulations. While your new system can streamline and improve your level of care, the biggest improvements to your medical data may actually occur before you even migrate your data.

We asked Justine Smith, a project manager with Lost Creek Consulting, to give us an overview of the vital first step of data migration – the cleanup.

When Justine walks through your clinic doors, put on your rubber gloves. She’s a big believer in data cleanup. As she puts it, if having high quality data at the end of the migration is important to you, then cleaning up the old data before you begin is just as important.

What do we mean by cleanup? All EMR systems have some volume of “bad” data – invalid or incomplete files – that will be easier to correct before it’s moved to the new system. But before you dive in and start hunting down missing birthdates and heart rates, first figure out how much time you have to spend.

Before your new system goes live, plan on two to six weeks for the data migration itself. Actual time will depend on the size of your clinic and how much data you have. This timeframe does not include cleanup time, so if your go-live date is two months from now, you may only have a couple of weeks to get your ducks in a row.

Whether you have a week or a year to clean up your data, it’s best to start early and have a plan of attack. Start by listing which data elements will be migrated in their entirety and hold the highest priority. Some data might not be necessary to move at all, but err on the side of safety where legally protected medical records are concerned. Our advice is to migrate everything possible, but to focus cleanup efforts on the most important and most often used records. Otherwise, Justine warns, “You can spend an infinite amount of time cleaning up old data.”

Once you’ve outlined the steps you’re going to take to prepare for your migration, it’s time to start looking into that old data and knocking off the cobwebs. Bring patients in on the process; ask them to confirm or update personal data such as birthdates, SSN, addresses and phone numbers when they come into your office.

Cleanup will also involve streamlining your files. Look for duplicate patients and merge those charts where and when possible. Identify providers who are no longer with your clinic. Flag deceased and inactive patients, as well as patients you have fired.

We don't recommend this method!

With the remaining charts, check that medications and allergies are coded wherever possible. This can be done as the provider sees the patient prior to the migration process and has the opportunity to review his or her medication and allergy history. Get a doctor’s signature on unsigned charts, and complete any other missing elements when possible.

From an organizational standpoint, data cleanup requires excellent teamwork to deal with issues as they arise, and strong leadership to set priorities and meet them in the given timeline. Communication within the team, as well as with consultants, the old EMR and the new is vital. It can make the difference between a smooth data migration and a drawn-out, complicated one.

Cleanup, like data migration in general, is a learning process. Justine says the biggest part of her job is training people to deal with various data problems and being thorough and consistent about correcting them. It always pays off in the long run, she says. With good cleanup and thorough testing, there is far less opportunity for data to be misinterpreted or misdirected during the migration process. Clean data makes for a clean data migration – and that’s the way to start the new year off right.

Happy Holidays from Lost Creek

2011-12-22T18:32:00.000-08:00

Wishing you all the light and joy of the season.
Hang on to your hats, it's nearly the new year!

Cleaning out the Refrigerator: Three tales of data migration

2011-12-21T10:50:00.000-08:00

Your clinic has 10,000 patients, or maybe even 100,000. You have a hundred providers, with patient data going back five to ten years. Your electronic medical record is like a refrigerator that hasn’t been cleaned out in a decade – you’re not sure what will happen when you reach all the way to the back.

Luckily, you can keep adding information to the refrigerator and things won’t start falling out the door, but eventually your providers will need an upgrade. Maybe your new microwave is silver, but the old fridge doesn’t match, and it would be really neat to have a TV screen in front. You decide it’s time to migrate to a new EMR, a thought that might make you a bit queasy. What about all that data you have stuffed way in the back? What if it’s been there so long it’s not even correct anymore? Can you move your x-rays and charts as well as the text files without losing anything?

Lost Creek Consulting has helped hundreds of healthcare providers migrate their data to new EMRs. Rather than tell you ourselves how to get it done, however, we asked some clients we worked with in the past for their advice on making the transition. None of these migrations were quite the same, and some went smoother than others, but all offered valuable insight into some of the pitfalls – and benefits – of moving into a new EMR.

Christine works at a multi-specialty clinic on Florida. With 89 providers and records for over 400,000 patients, cleaning out their refrigerator was a big job. All migrations begin with the export, the process by which the old electronic medical record provider, in this case AllScripts, extracts the data from the system. While Christine’s IT team busied itself with the hardware aspect of the migration, Lost Creek set to work putting the exported data into a format that could easily be imported into the new EMR, Centricity. From there, the import was relatively quick and easy, thanks to some software tools we’ve developed to make it that way.

“If we didn’t have Lost Creek’s import tool, it would have been crazy,” Christine says. Manually moving all the data would have been next to impossible, and simply turning the refrigerator on its side and dumping everything into the new one would have resulted in chaos. Instead, we cross-referenced all the data and used our tools to match every file and data point to the correct health record.

Lost Creek’s PMAD Preload Form is another aspect of data migration that has really made a difference to patients at Christine’s clinic. This tool allows providers to review all problems, medications, allergies and directives with each patient before they are imported into that patient’s record. This preload review allows the user to correct outdated information, code medications that haven’t been coded, and remove invalid diagnoses.

What would Christine do differently next time? She says that not all the data from the old EMR made it into the new one, a problem that arose during the initial export from AllScripts. Her advice to other large clinics planning a migration is to start the dialogue with both the old and new EMR vendors early on in the process, and be engaged the entire way through to be able to correct problems as they occur.

Melissa is the IT Project Manager for a clinic with 10,000 patients and 14 providers, with electronic health record data going back ten years. Their old EMR was actually built by one of the resident doctors, and Melissa admits to being a bit nervous at first about making the old and new software work together.

The process for Melissa’s clinic was the same as Christine’s. First, the data was exported from the old EMR, and Lost Creek went to work mapping everything to fit discreetly into Centricity. Meanwhile, however, Melissa says she discovered more data in the old system that needed to be migrated, and she found herself making repeated calls to us to change the plan.

In the end, all of the data Melissa’s clinic needed was transferred into Centricity, and she is very glad they made the switch. Not only is the new system more efficient, thanks to the PMAD Preload form, the accuracy of their information has improved.

If they ever have to migrate their data again, Melissa says she would be better prepared with a more concrete plan of what exactly she would migrate to the new system. She says everyone at Lost Creek was very flexible about this, but the process would have been smoother had she had a better idea of what her clinic needed. We would add that thorough and aggressive testing of the database can catch almost all missing data, and allows us to fix any problems before going live.

How much testing should you plan on doing? “As much as possible,” was the emphatic advice we got from Stephanie, another client. Her small-town inpatient clinic and senior health call service manages data from ten providers, and recently migrated that data to Centricity. She says unforeseen data problems bogged down what should have been a smooth process.

After the first export from Stephanie’s old EMR, the queries they ran showed that all the data elements were there. It wasn’t until Lost Creek had migrated all the data and the clinic went live with the new EMR that they realized the export had missed 300,000 files. The old EMR ran the export again, and finally all the information made it into the new EMR, but the period of missing data was frustrating for all involved.

Despite her clinic’s rocky transition, Stephanie says says the new EMR has made a huge difference.
“Now we have a more up to date, current EMR that is more efficient,” she says, and it’s earned high user satisfaction so far. Patients appreciate receiving a printout of their updated medication list, then having their prescription waiting at the town pharmacy when they get there. There’s also a huge reduction in paper shuffling when patients go in for lab work.

Providers in her clinic, too, like having all their patients’ information in one place. In the old EMR, they would have to look through different systems to find records of vitals, medications, immunizations, and other data. Stephanie says they also value the alerts and pop-ups the new system provides, keeping preventative care and routine visits on track. Documentation has greatly improved, because everything is now stored on the computer system.

We can now soundly say that Christine, Melissa, and Stephanie have all their snacks in a row in their new EMR systems. Although they may wish data migration had been as simple as buying a new refrigerator, all three said they learned a great deal in the process. They also agreed that without an outside consulting firm working quickly to put all their data into the new EMR, the migration would have taken much longer and experienced many more hangups.

Our goal is always to migrate your data hangup-free, and for most of our clients, it is a smooth transition. In this article, we chose to feature some of the more difficult migrations we’ve done in order to generate some time-saving tips for future clients. Here’s a recap:

Start early. Plan for time to test the databases.
Test early and aggressively. You’ll save time in the long run.
If you find missing data, contact both your old EMR and your migration specialists to find the source of the problem right away.
Keep communicating with old and new EMR vendors throughout the process.
Expect weird problems. (Some of those leftovers might have mutated.)
Always dry run a complete test before going live with the system.

Again, most of the data migrations we handle at Lost Creek do go smoothly, and missing files are the exception, not the rule. As Christine, Melissa and Stephanie all agree: Taking the leap to your new EMR will be worth the effort, and there’s always something to be learned in the process.

Lost Creek Makes an Impression at the CHUG Fall 2011 Conference

2011-11-02T21:49:00.000-07:00

David, Dan and Robin show off their popular shirts at Lost Creek’s booth.

People were talking about them in the elevator. Conversations at mealtimes gravitated to their flashy colors. Rumors circulated that in Oregon, everyone wears them. Finally, they came right to their booth and let them know: Your tie-dye shirts are awesome.

Or, at least that’s how our CHUG squad – David, Robin, Dan and Brendan – tells the tale. They returned last week from the Centricity Healthcare User Group (CHUG) conference in Austin, TX. The four were stuffed with good Texan food and brimming with ideas for making Centricity EMR more accessible and useful.

The conference, held twice a year, is an opportunity for medical care providers who use Centricity, those considering making the switch, and vendors who provide services to Centricity users (that’s us!) to get together and rub shoulders. It was Dan’s and Brendan’s first time attending a CHUG conference, and networking was definitely the most valuable aspect for them. Because what we do at Lost Creek is so specialized, we don’t often have a chance to swap information with other professionals who work with Centricity EMRs. Then again, what made the conference exciting for those who went was being in the same place as hundreds of others who share our “big picture” goal – improving patient care.

In fact, with more than 700 attendees, CHUG was bigger than usual this time around. We suspect that the extra folks were there because their medical groups are making the switch to Centricity, thanks to the new healthcare legislation that offers subsidies for implementing electronic medical records. The extra traffic kept Lost Creek’s booth extra busy. People kept stopping to ask about the t-shirts, the photo of the creek (yes, it’s real!) and, of course, our data migration and integration services.

Robin gives a live demonstration of Lost Creek's data migration tools.

Conferences like this one are incredibly valuable because of the opportunity to interact one-on-one with clients and potential clients. It’s not just about marketing, it’s about establishing trust. We handle sensitive patient data that providers will not hand to just anyone. Going to these conferences, meeting some of our clients in person, and getting a little face time in makes the entire data migration process a whole lot smoother.

CHUG isn’t just about putting names to faces and enjoying good meals, however. Everyone who went to Austin found value in the presentations and breakout sessions, where they learned about the Centricity user experience firsthand, including persistent challenges. David taught a two-day course on LinkLogic, Centricity’s interface tool. He said the session opened his eyes to the need for training and support in LinkLogic. To respond to this need, Lost Creek Consulting will be offering interface support services and our own in-house set of interface tools. Watch our website for more information.

Now that they’ve digested their food and gotten back to work, David and his team are off and running, developing their new LinkLogic tools, and counting down the days until CHUG comes around again. What’s in store for the next conference? David and Robin are scheming something involving vests and bow-ties. After all, here at Lost Creek Consulting, we have a reputation to uphold.

Migrating to the Future

2011-10-14T18:25:00.000-07:00

The year is 2050. William F. Patient is 65 years old. Every morning, his toothbrush takes his temperature, heart rate, blood sugar and cholesterol levels and transmits them to his healthcare provider’s Personal Health Record. In the kitchen, his toast is already toasting and his coffee is brewing, while his medication dispenser, also connected to his EMR, administers the correct dosage of William’s prescribed medication. William saunters in, grabs his breakfast, and settles down to the morning news on his video screen.

Later that day, William takes his rocket car to the doctor’s office for a checkup. His doctor pulls up his medical record on her wall screen and together they go over the information charted there. It covers his history dating back to the end of the paper era, around the year 2011, including information from other doctors he’s seen, hospital visits, and comparisons with data from other men of his age with similar histories.

Most of these predictions may be fantasy – why don’t we have rocket cars yet? – but here at Lost Creek Consulting, Inc. we know that there is much room to grow in the field of electronic health records. In a world where we can instantly access information through our cell phones, video chat with people on other continents, and do most of our banking, shopping and communication online, allowing our doctors to access and update our personal medical information should be just as easy.

So why isn’t it? Part of the problem is translatability. There are over a thousand different electronic medical record systems currently in use. If each EMR were a language, our medical system would be the Tower of Babel. While EMRs are certainly an improvement over paper records, migrating all medical care providers to the same “language” is just as important as having the technology in the first place. Say a patient’s primary care provider uses one EMR, but the hospital that patient visits in an emergency uses a different one. Sharing those records requires the extra step of consulting the IT department, costing the patient precious time.

In ten years' time, we see things changing quite a bit. Instead of a thousand, there will be a handful of electronic medical records in use by the majority of health care providers. Just as the computer age began with several competing technology firms racing to gain market share, EMRs are now developing swiftly to improve medical record keeping. It’s not surprising, then, that many healthcare providers are finding reason to migrate from one EMR to another. That’s where Lost Creek Consulting comes in.

Our focus is in the GE Centricity suite of EMRs, one of the more common electronic medical records in use today. Put simply, we translate medical data for clients migrating into or out of Centricity. As a business, we’ve been around for over six years, and our programmers and project managers have decades of experience in their fields. The tools we have developed make the data migration process smooth and efficient, and our combined expertise allow us to navigate the many hangups that make this kind of project a headache for most IT departments. But more important, here at Lost Creek we have a personal commitment to improving access to EMRs for doctors and patients. We have seen the power of this technology to create solutions for doctors and patients, making the way to better health care for all. To us, that’s the bottom line.

Just ask Robin Lomont. She’s our Senior Account Manager and the first person our clients generally interact with. In 1984, at the age of 54, her mother was diagnosed with non-Hodgkins Lymphoma, found in the lymph nodes of her spleen. Her spleen was removed, but the cancer returned to places without lymph nodes – her lower back, then her lungs, and finally, in 2003, her brain.

In late 2004, after her last round of chemotherapy, Robin’s mother visited an oncology specialist who not only used electronic medical records, but also had access to her EMR from her regular oncologist and her hospital. With a view of all three records, this doctor found that she was eligible for a clinical trial of a new anti-lymphoma drug. With nothing more to lose, Robin’s mother signed up for the trial. A few months later, she had a clean bone marrow test. She’s now 81, stronger than ever, and cancer-free.

Robin credits the “triangle” of EMRs – the two oncologists’ plus the hospital’s – with creating the necessary access to information that led to her mother’s recovery. Without the bird's-eye view of that medical information, her oncologist may never have identified her as a candidate for the trial that saved her life. Since joining the team here at Lost Creek Consulting in 2009, she has been dedicated to helping other healthcare providers do the same for all patients.

With a universal electronic health record for every patient, the opportunities to improve patient care are limitless. Already, the gears are moving toward creating a centralized health record system, where doctors can securely exchange information and gather data on groups of patients. With borderless communication across the country and the world, healthcare providers can use each other as a resource to answer difficult questions about specific patients, look at trends in the overall health of a population, and learn about new drugs and treatments more efficiently than through the traditional routes of research dissemination.

With an eye to that future, Lost Creek is always hard at work meeting the immediate need for easy, flawless data migrations for healthcare providers using the GE Centricity suite of EMRs. By helping our clients find the system that works best for them, we're improving patient care and making doctors' lives easier. We haven’t invented William’s high-tech toothbrush – and probably won’t – but as a skilled team of developers and programmers, we’ll handle anything on the data transfer end of things. Visit our website to learn more about the full range of EMR services we offer.