Switching EHR systems without losing a week of clinic

Replacing an electronic health record is a project with a hard edge. On one morning the clinic stops using one system and starts using another. Most of the pain comes from decisions that were put off until that morning. This guide goes through the work in the order it tends to need doing. It is general information, and the contract, the data move and your privacy obligations are worth reviewing with your counsel and compliance officer. More on the choice itself is in the EHR and records articles.

Decide whether to switch

Switching costs a lot of staff time even when the new system is cheaper to run. Write down what is actually wrong with the current one. Slow charting, missing connections, poor support and a vendor winding down the product are different problems, and some of them can be fixed without replacing anything. Ask the current vendor what it would take to fix each item, in writing, and set the answers beside what the replacement promises.

If you decide to switch, name one person who owns the project and one clinician who speaks for the providers. Projects without both tend to drift.

Get your data out first

Before you sign with a new vendor, find out what your current one will give you and in what shape. Request a full export, or a test export of a sample, and look at what comes back.

• Is the structured data there: demographics, problem lists, medications, allergies, immunizations and lab results?
• Are the notes there as readable text, or only as a pile of PDFs?
• Are attached documents and images included, and do they link to the right patient?
• Does the export carry appointment history and open balances?

Check your current contract for termination terms and export fees now. The time to learn that exports cost extra, or take weeks, is before you announce a go-live date.

Decide what moves and what stays behind

Not everything migrates as structured data, and not everything needs to. Sort the records into three groups:

• Data the new system must hold as structured fields from day one, such as demographics, active problems, medications and allergies.
• Records that can arrive as documents attached to the chart, such as older notes.
• Records that stay in an archive you can still search.

Retention periods for medical records are set mostly by state law and by payer and licensing rules, and they vary by record type and by the patient’s age. Ask your counsel how long you must keep what, and make sure whatever archive you choose stays readable for that long.

Ask the new vendor to run a trial migration on a copy of your data before the real one. Then have a clinician and a front-desk person each check a handful of charts against the old system. Problems show up fast: merged names, wrong date formats, medications that lost their dosing.

Build the timeline backward

Pick the go-live date last. Start from the date the old contract ends and work backward, leaving room for the trial migration, the fixes that follow it, training and a buffer. Avoid weeks when the clinic is at its busiest or short-staffed. Ask each vendor for a schedule for a practice like yours rather than a generic one.

Plan a lighter schedule for the first days on the new system. Booking fewer visits per provider and leaving the gaps open costs less than running hours behind on a system nobody knows yet.

Rebuild the connections

List every system your current EHR talks to and note who owns each connection: labs, imaging, e-prescribing, the clearinghouse, the patient portal, payment processing, the phone system and any reporting tool. Each one has to be set up again for the new system, some by the new vendor and some by the other party, and some have lead times you do not control. Start those requests early. A connection that is not live on go-live day becomes manual work for your staff, so decide which ones you can do without for a week and which you cannot.

Tell patients what changes, too. A new portal means a new login. Reminders may come from a different number. A short notice before go-live saves the front desk a lot of calls.

Train people for their own jobs

Train each role on the tasks it does. A medical assistant and a biller use the system differently, and one session for everyone serves neither. Give a few staff members extra time so they become the people others ask first. Run practice sessions with realistic scenarios from your own clinic, such as a new patient, a refill request and a claim correction, and write down every place people hesitate. Those are the points to fix before go-live, in templates or in written steps.

Go-live and the first month

Hold a short huddle each morning and again at midday: what is slowing us down, what is broken, what needs the vendor. Keep one shared list of issues with an owner beside each, and send the vendor the list rather than a stream of separate calls.

Watch the money early. Check that claims are going out, that the clearinghouse accepts them, and that payments and denials are coming back and posting to the right accounts. Billing problems hide in the first month and surface in the second, when balances do not match. Compare the first batches of claims with what you would expect from the same weeks in the old system.

Claims for visits before the switch usually still need to be worked, so ask your billing staff how the old system will be used for that, and for how long. Keep read access to it until you have confirmed that both the records and the open accounts are accounted for.

Close out the old system properly

The old system still holds protected health information until the data is returned or destroyed. Check what your agreement with that vendor says about the end of the relationship, and keep it in force until the data is dealt with. Then get written confirmation of what was returned and what was deleted, and file it with your HIPAA documentation. The HIPAA software checklist covers the paperwork side, and the vendor question list is worth rereading with your current contract beside it.