This is part of our data migration blog series – a range of topics intended to help organizations who are migrating from one EHR to another.
Over the past four years, I have focused primarily on helping healthcare organizations migrate data from one EHR to another due to acquisitions or EHR consolidation. Many times, the first piece of advice that I give an organization is to standardize scope and migration strategy so each is consistent across the organization. This is especially important when multiple legacy systems are being sunset, as many times, the users of these various systems have different wants and needs. Due to the need for tracking adolescent growth and health over time, pediatricians usually require more data to be migrated. Therefore, I recommend that pediatric needs drive the scope and migration strategy to fulfill their data requirements while simultaneously maintaining a uniform scope and strategy across the organization.
The three most important data elements that drive my recommendations are:
1. Vital Signs & Growth Charts
3. Well Child Visits
In regards to vital signs, most organizations just want to migrate the last height, weight, and blood pressure reading for their patients. They will then rely on the new EHR to calculate BMI and BSA. For pediatric patients, it is important to see where the patient has trended on growth charts over the years. To accomplish this, I recommend a scope adjustment for the entire organization to include all height, weight, blood pressure, and head circumference readings at a minimum. This way, when the data is loaded into your new EHR, providers can pull up the appropriate growth charts and see the plotted historic data. By increasing all vital sign readings for the adult patients, providers will also get a better picture of their health over the years without adding much additional effort to the project.
Maybe you remember the frequency of your doctor’s visits as a child or maybe you have children of your own and feel like you are living at the pediatrician’s office getting a slew of immunizations. This is another area where there is a clear difference between adult and pediatric patients. Many organizations have already determined that a full immunization history should be migrated to the new EHR, so this recommendation is more about strategy than scope. Some states have implemented immunization registries that have integration within EHRs. Organizations will want to evaluate the different repositories for immunization data, establish which source contains the cleanest data, and then determine how easy (or difficult) it is to retrieve the data. Many times, if the state immunization registry has been integrated to share immunization data with your new EHR, this is the best solution as the cost is minimal and the data is reliable. However, if your state registry cannot share information at this time, there are other ways to migrate immunization data – the most popular methods being via CCDAs and HL7. Both have pros and cons which will be elaborated on in a future data migration series blog.
Well Child Visits:
It is important to note that data migrations are not able to meet all of the legal requirements to decommission or archive a legacy system. Because of this, I recommend migrating the minimum amount of data needed to support continuity of care while preventing a high volume of “junk” from populating charts. One of my recommendations is to evaluate which note types and how many years’ worth of notes need to be migrated to support continuity of care. I strongly recommend that nurse, telephone, and refill notes be excluded from a migration as the volume tends to be high and many times they are not referenced again. Sometimes organizations only migrate the last annual exam note to minimize note volume. However, for pediatricians this may not be enough to track growth and health over time, so it is critical that they are able to reference all Well Child Notes as well as any chronic disease management or sick notes. Pediatricians may be more likely to reference a historic note to see if a patient has a reoccurring problem that needs to be addressed differently.
Children possess anatomical, physiological, and psycho-social differences that distinguish them from adult patients. They aren’t “little adults,” so remember that the pediatricians caring for these patients may have different needs than the practitioners caring for adult patients. Chances are your organization has a pediatric population. It may be easier to let their needs drive the scope and strategy for the organization as a whole since other adult specialties can benefit from specific pediatric recommendations without adding cost or effort to the overall project. Make sure to catch our full data migration blog series.
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