Switching To The Best EHR Solution – Part Two
Preparing for a data migration as part of our transition to our new athenahealth EHR system involved every member of our staff. Our Ob/Gyn practice consists of 7 providers and 30 staff members who worked hard to prepare for this conversion with the help of experts from MDS Medical and athenahealth. This article – part two of a series – highlights the steps we took to prepare for the migration and how we planned for our go live to athenahealth.
If you haven’t read Migrating to athenahealth – Part one, start there first.
Initial EHR Data Migration To athenahealth
With one call to MDS’ Vice President of Information Technology, Michael Schroeder, to confirm our timeline, our EHR data migration process was underway. Michael’s team prepared a comprehensive document, tailored to the specific needs of our practice. This migration plan outlined the type of data to be migrated, how it will be migrated and the timetable for the migration.
When the data is first migrated, athenahealth follows specific steps which allow for quality control, a crucial part of the entire process. They create a test version of your EHR, called a training version, which contains an initial run of all the data that has been migrated. Your team needs to check this data by way of random checks to confirm the data appears in the right place, i.e. medication is accurate, patient notes are current, etc. As the superuser, I oversaw the migration freeing up our staff to focus on our patients.
What Data Gets Migrated To athena?
Most of our discrete data was able to be migrated into athenahealth. However, there was some data such as including patient insurance information, past pregnancy details, prenatal flowsheets, pap recalls, documents, and future orders cannot be migrated to athena.
However, all of these documents and data is available indefinitely for viewing and pdf export using the mdsARCHIVE EHR archive program.
mdsARCHIVE is fully integrated into athenahealth, offering instant single-click patient lookup to our old system. This means our entire team has complete read-only access to discrete clinical data including allergies, vitals, problem list, medications, orders, immunizations, flowsheets (labs), and any other data that may have not been fully migrated to athena.
What About Patient Appointments?
Appointments already on the books were migrated by MDS, but that process could only be done once.
Other data transfers could be run more than once, an initial main transfer taking many hours, then “delta” transfers which migrates only records that have changed.
For instance, patient demographics were run 6 weeks before Go Live, which uploaded about 95% of our patients into the “training” program. From that point on, a lot can change regarding patient contact information and the addition of new patients. For this reason, another data migration took place 1 or 2 weeks before Go Live (a delta) which was a quick process that only ran changes that occurred from the previous migration.
The appointment data was pulled 3 weeks before Go Live, but it did not “arrive” in our live athena for 7-10 days. This was a strange time. New appointments could be made using athena, but the days were blank! So, during this in between time, any appointments that were made for dates on or after Go Live were double entered by our team. We booked the appointments in Prime Suite and also booked them in athena.
Why book in both systems? For those 7-10 days, all athena appointments were blank, except for what we added. But Prime Suite appointments were accurate. So we had to make sure we did not book patients in athena (which looked wide open) only to later on find out we triple-booked people after all the exported data arrived. This was (temporarily) extra work but was vitally important. Once the appointment data arrived in athena, we were able to stop booking appointments in Prime Suite (other than appointments for any date prior to Go Live).
Pap recalls were a challenge. Athena uses “ticklers” for recalls and none of the pre Go-Live Prime Suite “recalls” made it into athena. One idea is to print all your recalls one month at a time and enter them manually in athena. The beauty of doing this is that athena automatically sends out reminders for patients who need to book annual exams.
Our front office staff had to learn how to register new patients and book appointments using athena 3 weeks ahead of our Go Live date.
With the help of MDS, they did it!
What About Patient Insurance Data?
It’s important to note that none of the patient insurance information will migrate, due to formatting differences between the two EHR systems.
To help get this data entered, we decided to work with Epion. Their Mobile Patient Check-in solution allows the patient to enter their own insurance information and takes a photo of their insurance card a week prior to their scheduled appointment.
This allowed for clean and accurate insurance data for every patient we saw.
Prenatal flowsheets do not migrate into athenahealth’s OB module, but they can be exported as documents.
As an Ob/Gyn practice, our average pregnant patient has an appointment every 4 weeks. For every OB patient, we created a new prenatal flowsheet in athenahealth after the migration. We manually exported the Greenway prenatal flowsheets and also the first prenatal blood/urine results as documents. Then in our new athena OB episodes (as they are called), we started them with the first visit entry referring to the prior document (and we had a macro to make this quick). After the export, the flowsheets in Prime Suite can be signed and closed.
BUT – do not delete the Prime Suite F9 data.
This was a mistake we made. The F9 delivery due date report (undelivered) was very useful and we lost that. It is the only way to track that all your OB patients in Prime Suite were entered into athena. After every obstetric patient had been entered into athena we then were able to again create a list of every patient that was due and when. This list helped make sure that every OB record from PrimeSUITE made it into athena. One weird situation was that some patients had their last prenatal visit charted before Go Live and then delivered before they ever had a prenatal appointment booked in athena.
Other information had to be entered in the patient’s athena Ob episode such as OB problem list items prior to the first prenatal appointment. We had staff come in each Saturday for 4 weeks to get all of the OB data added to athena, one week’s worth at a time. Two employees sat next to each other, with one reading the Prime Suite data and the other person entering it into the athenahealth OB Episode. We asked them to switch back and forth, a great way for them both to learn the new system and increase their speed of data entry.
Sending a Prenatal record to the hospital was more work. We used athena, and exported the Greenway Prenatal flowsheet, Greenway OB labs, and athena created OB episode.
We also went live (at the same time!) with a 3rd party ACOG Prenatal charting program called Dorsata. This will be addressed in a future article.
Unexpected Perks In Our EHR Data Migration
One example is that MDS created a new line item in the athenahealth menu named mdsARCHIVE. This option provides access to the patient’s chart in Prime Suite. MDS designed a viewer to review existing information in Prime Suite that can also be downloaded. This feature is extremely helpful for our practice because it allows us to generate documents that can be sent on behalf of our patient to the hospital. Additional documents including original lab reports can be submitted and are also accessible through mdsARCHIVE.
Athenahealth provided quality control after every data migration, allowing us to review the data before it landed in the production area of our program. They also migrated every prenatal first lab panel (over 500 of them), and every open OB flowsheet from Prime Suite. They updated the Grav/Para count for us, but beware one issue: Each NEW athena OB Episode adds 1 to the Grav count, so make sure this is looked at carefully. They also are working on migrating delivery outcomes (birth histories) from Prime Suite to athena, a complicated process due to data mapping technicalities.
Ready For athena Go Live!
It was a long process to get us ready for this transition, but with MDS and athenahealth as our partners we were confident this move would benefit both our practice and patients. Knowing ahead of time how and when our data was going to migrate helped us to modify our staff training program. We still had a lot do do during Go Live but that story is also for a future article.
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