A growing number of hospitals are now beginning their second cycle of EMR implementations. But migrating from one vendor to another can be daunting. Healthcare Informatics editor Daphne Lawrence recently talked with Jonathan Thompson, a vice president at Minneapolis-based Healthia Consulting, about his experience with migrations, and his recommendations for an easier transition.
DL: What’s the other pitfall?
JT: The other pitfall? It seems contradictory to say this but printing is an issue as well. Even though you’re migrating from EMR to EMR there are documents that are going to be printed, like prescriptions. Today prescriptions are printed out of the EMR, hand signed and then handed to the patient. Getting them to the right printer, getting discharge instructions during go live, you want to continue your best practice of educating the patient around what they should be doing when they’re discharged, the reconciled medadmin list, and any follow up exams or procedures that are coming. The info is typically printed. Those discharge instructions during go live often get rerouted or go to a wrong printer--or don’t print at all. Because of the volume of printers and discharge activities, the wires get crossed. The first few days of a go live are spent tracking down ‘where did it go?’ Then you’ve got the privacy factor, for example if the patient was seen for HIV and I hit print but it didn’t print to my printer. OK, we’ve got a problem. Did it go to the front desk, or get thrown out without shredding?
We’re doing a strategy for an ambulatory group that just bought a community hospital. They’re going to tear down the community hospital and build it from the ground up. And part of the expectation is that paperless doesn’t always mean completely paperless. Providing that service to the patient/consumer means providing takeaway things. It’s kind of a key topic in the migration and certainly from a go-live standpoint that’s always an issue. Every implementation I’ve ever been a part of security and printing are the top two issues.
DL: What about the actual data migration? How do CIOs structure their staff for accountability?
JT: CIOs may not have their finger on managing that implementation and the conversion and they may not have their finger on all the data elements that are being migrated. But there has to be accountability to that level. And the way you get accountability is through objective reporting and metrics. I call it the dashboard from the executive management standpoint that has the details coming up from the owners and stakeholders in the key areas. So for example, data migration is a key area in moving from one EMR or the next. There are metrics that are measurable and objective that the CIO should be aware of. Some of the measures might be number of patients and encounters that were in the old system and number in process of converting to the new system. There should be metrics that the CIO is keeping the pulse and should at least be aware of, because there are going to be unknowns. I think the challenge for a CIO is identifying those unknowns more quickly than not, and capture them in a way that you can measure progress to the timeline. The CIO's mechanism for keeping a tab on that is key tools such as a dashboard, or two through a governance and structure that the CIO set and making sure there’s accountability in the groups, the clinical and financial realm from a decision making standpoint.
DL: Do you need to restructure your IT team?
JT: Absolutely! I think the IT team HAS to be restructured from EMR to EMR. Because you’ve got two camps, you’ve got the legacy system to keep the doors open and then the new structure with project managers and implementation specialists who are going to need to be trained. It depends on the vendor, of course, but if they’re going to have accountability for building out and meeting with these operational areas to define new workflow and to define build, that’s one of the questions a CIO should ask right up front: how do I restructure the organization to become successful.