Transcript Implementing EHRs: An Exploratory Study to Examine Current

Jackie Moczygemba, MBA, RHIA, CCS, FAHIMA
Diane Dolezel, MSCS, RHIA

HITECH Act in 2009
◦ Medicare and Medicaid incentive money for
physicians implementing Physician practice EHRs
for meaningful use

EHR benefits
◦ Capture structured data for trend analysis
◦ Facilitate clinical quality reporting
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Lack of guidelines for what data elements to
transfer to EHR
Incomplete descriptions of methodologies
that are in use for data transfer
Lack of information about how much data
should be migrated
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Preliminary results for the Texas State
Research Enhancement Grant
Document data elements of longitudinal
clinical data essential for inclusion in a
primary care practice (PCP) EHR
◦ which data elements are being migrated into the
clinical physician’s EHR?
◦ what methodologies are utilized to migrate data
from the legacy systems into the EHR?
◦ how many months of data were migrated for each
patient?
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Data Source: Center for Medicare and
Medicaid Services website
◦ Physicians’ practices in Texas who have received
government incentive money as of March 2012
◦ Approximately 2,871 practices in population
◦ Sample size 1000
◦ Anticipated response rate of 30%
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Data collection: Web based questionnaire
◦ Faculty researchers collaborated with the Texas
State University’s Testing, Research-Support, and
Evaluation Center (TREC)
◦ SNAP Survey web-based questionnaire designed
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Postcards sent to 1000 physician practices
with QR code for URL
Physicians
Office Manager
Other:
◦ IT
◦ Medical Records Director
◦ Account Manager
20
13
1
1
1
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What is your medical specialty? Approximately
how many patients do you see in a year?
Did you migrate data for all patients? If no,
please specify:
◦ Patients
Patients
◦ Patients
◦ Patients
◦ Other:

seen
seen
seen
seen
in
in
in
in
last
last
last
last
12 months
18 months
24 months
5 years
Did you migrate the ENTIRE patient record from
the legacy paper system into the EHR?
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Seen in last 36 months
Greater than 36 months
Point of care conversion
7
1
8
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Migrate entire patient record
16
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Reason for visit/chief
complaint
History of present
illness
Past medical history
Medications
Allergies
Social history
Family history
Review of systems

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Physical exam
Clinic notes/progress
notes
Lab results
Imaging reports
EKGs
Other diagnostics:
please specify
Consultations reports
Data Elements Migrated
Number of Responses
12
10
8
6
4
2
0
Response Categories
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Methodologies used for EHR data migration
How was longitudinal health data migrated
into EHR
◦ Data entry (e.g. typed in selected data elements)
◦ Scanned
◦ Both scanned and typed in
Migration Methods
Number of Responses
25
20
15
10
5
0
Data Entry
Scanned
Response Categories
Scanned and Typed
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How much data did you migrate?
◦
◦
◦
◦
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Less than 3 months
3-6 months
six months-1 year
over 1 year (please specify)
Did you validate the legacy data migrated to
new system?
◦ Yes, no
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How did you validate that legacy data was
migrated correctly to the new system?
◦
◦
◦
◦
Visually examined sample of records
EHR vendor validated data
Software editing program utilized
Other (specify)
Validation Methods
Number of Responses
25
20
15
10
5
0
Visually Examined
EHR Vendor
Software Editing
Validated at Pt
Sample of Records
Validated
Program
Appt
Response Categories
Every 15th Record
Done By Myself
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Discuss data elements migrated (top 3)
 Allergies
 Medications
 Family and Past Medical History, Lab Results (tied)
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Quantitative review of data elements
migrated
◦ 91 frequency responses for data elements
◦ Allergies and Medications – 10 responses each
◦ Family & Past Medical History & Lab – 9 responses
each
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What was the biggest challenge with data
migration?
◦ “Sheer volume, had to purchase separate scanner,
hire part-time help and train them until all charts
were scanned into system.”
◦ “Organization and time. We don’t have time to
close the office to switch data, so we have to fit it in
when we can, which is why we do it as patients
come into the office. “
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Is there anything you would do differently
with data migration to EHR if you had to do it
over?
◦ “Create a process to systematically switch data to
the new system-- so that each chart was switched
over the exact same way.”
◦ “I would migrate only selected information from
records that were over 5 years old. We scanned 20
year old records of current patients. Although
maybe historical value, these records have very little
medical value.”
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Reduction in initial grant amount
◦ Rework and re-approval of budget delayed project
start
◦ Limited funds for postcard mail out
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Data collection
◦ Postcard mail out
 Public use file lacked email addresses
◦ Issues in preparing postcards
◦ Difficulty with data collection due to low response
rate
Thank you for your time!
Jackie Moczygemba, MBA, RHIA, CCS, FAHIMA
[email protected]
Diane Dolezel, MSCS, RHIA
[email protected]