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Migration of data from an existing EMR - Is this an unforseen Achille's Heel?

Posted Oct 30 2008 3:21pm

One of the big issues that has recently come to my attention and something that I have discussed with colleagues in BC and around the country is that of the migration of patient information (clinical and other data) that is stored in one EMR when migrating to a new EMR system.

One of the benefits of being an early adopter of EMR has been the ability for practices to reduce dependency on paper processes and improve recall and manage patients better by having access to data in an electronic record format. As a result, some practices have been using EMR systems for more than 20 years in Canada (the unsung hero's of this process). However, as early adopters, standards were not defined for their system developers to ensure that the data was transportable between systems. Not just a core data set of clinical information such as office notes, lab or DI information, but 'all' the patient information that exists in the record. The largest investment in any EMR system is the time it takes to enter all of the data into the system.

Work is currently underway to establish pan-Canadian standards for EMR vendors that would create a requirement for vendors to modify or build their products to meet the specific standards for data transfer in the event that a physician would migrate to another product or would need to transfer a patient record. However there is a significant 'wrinkle' in this process that needs much more debate and which to date has not received much air time.

It is not just the clinical data that needs to be transferrable between systems, but the meta-data as well. And herein lies the challenge. As a clinical example, let's say that I receive a lab result on a patient for a CEA level (used to screen for Colon Cancer) and the level is just above the upper limit of normal. I send an internal message to my receptionist asking her to contact the patient and arrange for a repeat test in 6 months time. This is recorded in the EMR in addition to the contact that is made with the patient by the receptionist. However the patient does not return for follow up and when see 18 months later for an unrelated problem mentions some rectal bleeding - probably due to hemorrhoids. Investigation reveals an advanced adenocarcinoma of the rectum and the patient denies any effort by my office to contact him for follow up on the initially slightly abnormal CEA resut. In the interim, I have migrated to a new EMR system with all the bells and whistles, however the 'meta data' did not transfer with the migration. I have all my clinical notes and reports, but not the audit trail of what was said and done to try and contact the patient. The audit trail no longer exists as I do not have my old EMR system anymore. How would I defend myself in this situation?

The point I am trying to make is that if an existing user of an EMR decides to migrate to a new system, there may be a medico-legal imperitive for that physician to maintain a copy of the 'old' EMR system INDEFINITELY on an additional computer in the office in the event that an audit trail would need to be produced in the future. This is a very real problem.

Do you feel it is overstated as I have described the issue? Do you have any solutions or suggestions on how to deal with this problem? Who assumes the cost of supporting the old EMR? For how many years would it be necessary to maintain a copy of the original EMR? I am sure there are many more questions.

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