• Jul 03

    Versio Staff

    Don’t attempt data migration without Business Rules to guide you

    by  Versio Staff

    One popular choice for data migration has been to hand-key legacy information into the new EHR as patients are being seen. While it may seem a good idea at first glance, the impact can be significant.

    Aside from the drain on internal resources, consider how the staff will interpret the legacy chart. Some data sets will have an obvious match in the target system, but others will have much more complex choices. These exceptions can cause the target data to become unclear and inconsistent. Guidance from a pre-determined set of business rules is the key to handling exceptions.

    MANAGING EXCEPTIONS

    How can exceptions be handled efficiently so the record is complete without disrupting the timeline and affecting the budget? Creating business rules for your data migration prior to start is vital. Versio’s Medical Data Translators follow agreed-upon business rules to ensure the data flows smoothly into the new system and the meaning of the clinician’s notes is accurately conveyed.

    ACTUAL EXAMPLES OF EXCEPTIONS IN PATIENT RECORDS

    (We have used Epic Reference Data in these examples, but they can apply to any EHR)

    VITAL SIGNS

    Legacy says: Height 5’ 11”. Since Epic does not record heights this way, the Data Translator would convert this to 71 inches, which would correctly populate the Epic encounter.

    Legacy says: BP 20/80. A Translator would catch this and send it to the Exception Queue. The client’s business rules would provide guidance as to whether this “bad data” should be left out or if the original record should be consulted to verify the entry.

    MEDICATIONS

    Legacy instructions for patient would not be understandable. These should be converted to familiar terms (per Meaningful Use). Using established business rules, they are translated as follows:

    Legacy says: BLEPH-10 10% SOLN | 1 gtt od quid x 5 d

    Translates to: BLEPH-10 10% SOLN | 1 drop in right eye four times a day

    Legacy gives inconsistent med routes. Example: Tylenol Suppositories, but sig says “take 1 by mouth daily.” Data Translators would adjust this according to your business rules or flag it for your QA team to review.

    Legacy med (or problem, allergy, etc.) has multiple correct matches in Epic.

    Legacy data said: Proventil inhaler.

    Automated conversion would give you this: KDC:ALBULTEROL

    If the data is being hand-keyed, the Translator is presented with 20 choices when searching the Epic database to select the correct answer. Which one should they choose? What do the business rules say?

    Legacy has a description that does not match anything in the database. A trained Data Translator knows that “ovaries removed” is same as “oophorectomy” and makes the match:

    Legacy says: ICD-V45.70 | 81 HYSTERECTOMY, S/P; OVARIES REMOVED

    Translates to: V88.01CG Hx of hysterectomy with oophorectomy

    BLOOPERS

    Meds Example:

    DIGNITY PLUS DISPOSABLE XXL MISC Take one by mouth daily. (seriously?)

    Problems Example: (actually found in the database – not sure which planet this came from)

    346.71D Chm gr wo ara w nt wo st

    Clearly, the human element provides accuracy levels far above and beyond electronic migration alone.

    Auto migration (Legacy EHR to Epic) examples: How would your system handle the following?

    Legacy Medication:

    Cephalexin 500 mg caps 1 by mouth three times a day x10d lot # 30301451a exp 5/11

    Translator would migrate the name and dosage into Med name field, and then “translate” the sig into a free text field, so that all legacy data would pass to Epic.

    Legacy Immunization:

    Name = Pneumovax. Value = Refused.

    Translator would see the value of “refused” (as opposed to “done”) and (according to the client’s rules) deactivate this immunization so it would not pass over to Epic.

    Legacy Medication:

    LANTUS SOLOSTAR 100 UNIT/ML SOLN 25 units SQ nightly

    Since Epic will not receive “25 units” in its dosage field, this is carried into Epic in the free text field.

    CONCLUSION

    You hire experts for the majority of the functions related to getting your EHR online. Make sure you are engaging experts for your data migration. Versio has moved more than a million patient records with complete data capture and near-perfect quality.

    Please consider a short conversation and a demonstration of our unique process. This will be time well spent and ultimately a huge benefit to your staff, your physicians, and the patients you serve. Contact us: sales@myversio.com or 253-277-0505

    For additional information regarding our service lines, visit www.myVersio.com

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