With EHRs finally reaching a widespread adoption tipping point in the past few years, a new set of challenges has been introduced. When adoption was first occurring, most offices were moving from a paper-based system, and kept the paper around while transitioning to the EHR. While some of the paper never fully made the transition, the charts were still locked in storage, available if needed.
Fast forward a few years and there is a new situation: the EHR-to-EHR transition. Some offices have transitioned, not only once, but many times to new EHRs as the industry evolves, products get bought and sold, while others simply shut down. Unlike the paper charts that are always there, now clinical data is spread across one or more previous systems. Maintaining these previous systems is one of the major unforeseen, and often neglected, trends on the rise as more EHR-hopping occurs.
There is a reason this problem is becoming more apparent. The industry went from paper-to-EHR, as the predominant transition, to EHR-to-EHR transitions in just a few years. The infrastructure to run the previous EHRs, new at the time of installation, is now at an age where failure is becoming more imminent. Most offices seem to think that past systems are unimportant. They only hold old data that's rarely referenced anymore. That is fine until there is chart audit request or subpoena for a chart on the previous system and suddenly the server that holds it fails to turn on. Most people don't want to spend money on a system they aren't actively using, but that lack of attention could lead to permanent loss of important data.
This growing problem is further obscured because offices that transition are rarely coached on what to do with their old system. The new vendor has no control over the old system and the old vendor has no desire to continue supporting their system for free, while the office doesn't really want to pay for something they aren't using. This puts the previous EHR into a limbo/gray area where it "just runs" and everyone assumes it will continue running because it always has in the past. This is not a reliable assumption and is risky for the long term - remember, as the hardware ages, operating system upgrades occur, and a myriad or other variables change, the chances of something going wrong increases significantly.
So, what options are available?
Continue Official Support
The easiest thing to do, but usually the least desirable, is to continue to pay the old EHR company to keep the system up and running. This may be a requirement if you've used a cloud-based system and have significant amounts of data in it since they can simply cut your access to it. Some cloud vendors will send you the data, but alone, the data is no good without a tech person to sift through it and make it accessible - which could cost more than just keeping the old system running.
If the system is on-premises, this may involve not only paying a monthly fee to the software company, but also having a hardware/IT person who understands the hardware should it fail. Some software companies require the same support as if you were using the system while others may agree to a simple hourly fee should you have any problems down the road. Make sure to ask what options are available, because a cheaper option might not be volunteered without asking.
Find a Contractor
Some EHR systems have third-party contractors who know how their systems work. These third-parties may have a more affordable rate and give you the emergency support needed without having to pay for usage/updates/etc. support. This may also be the only option if the previous vendor has gone out of business.
- Data Export or Data Conversion
With data export, the software company provides a former client with a human-readable copy of all the data in the system. This may in the form of a large number of PDFs. It could be print outs or any number of things that could then be manually loaded into a new system. This option is appealing because it requires no special software or hardware to keep the records accessible.
Data conversion is a bit more complex and varies wildly from situation to situation. There are very few times when 100 percent of the old data can be imported into a new system. The only time this can happen is when a vendor has purchased another company and has worked on a one-to-one conversion, but even then great care should be taken to understand exactly what data is getting converted. Most conversions are simply demographics and appointments. More expensive options might include some encounter information. Most will not include enough information for an office to completely disregard the previous EHR, leaving the office to choose one of the other alternatives to keep the old system maintained.
Regardless of the method, the goal should be to protect the old system's availability or move all of the data from it in a reasonable timeframe. Obviously, having all the data in one system would be ideal, but it is also not feasible if there are thousands of records that have to be moved by hand and the office staff is already stretched thin. Maintaining clinical records, even in an EHR not actively used, is an important responsibility for an office. Any data in a previous EHR needs to be backed up, secured, available, and treated just as importantly as data in the new EHR until a time that all the data has been moved or the legal retention requirements have ended. This is a case of prevention being key - once something prevents access to your old system it is likely too late, or extremely expensive, to correct.