How to Migrate Midmark EKGs to a New EHR

How to Migrate Midmark EKGs to a New EHR


The title of this article is the very question my current client and I have been trying to solve for many months now.  This health organization had previously done a data migration from their Misys EHR system to Allscripts TouchWorks™, but at that time were unable to migrate the EKGs and Holters from Midmark because of the difficulty of rendering those files in the target EHR.  Recently, we began working on completely archiving their Misys EHR data into the Galen VitalCenter Online Archival (VCO-A) solution and we hit the same snag with the EKGs/Holters.

Ultimately, the challenge was that Midmark has an integration with the legacy EHR (in this case Misys) where the actual result images are stored in the Informix database in a “.car (compressed archive report)” format.  This format is troublesome because most EHRs and archival applications require the file type to be in a more standard format – ie: Tiff, PDF, doc, etc.  Since the data migration had already been completed years ago, we were now solely focused on how to convert these files into our VCO-A environment as PDFs.

We searched far and wide for other folks who encountered and solved this same issue and didn’t find any great leads.  After some internal discussions and trials, we were able to come up with a solution to convert the .car files to PDF format and then treat them just like any other image file.

  1. First step was to extract the .car files from the Informix database to a file on disk.
    • In order to associate the patient to the converted PDF, It was important for us to also maintain the metadata.
  2. We were then able to leverage the IQManager application to view .car files.
    • This same program can open and save the file to PDF.
    • The system had over 200k .car files and doing this process manually one at a time was not feasible.
  3. The next step was to write a script that allowed us to automate the process of the IQManager application opening and saving the .car files as PDFs.
  4. We then needed to make sure that we kept a standard naming convention of the files so the PDF matched the name of the .car file and could be associated to the correct patient.
  5. Another key piece of the process was that we needed to have a dedicated server running this solution, as it was crucial for the conversion process to run uninterrupted. The entire process to convert all of the .car files to PDF took roughly one week, after which, we were able to proceed with the rest of the archival process.

As with all of our data migrations, we leveraged a plugin-based itinerary pipeline architecture within our GalenETL platform to ensure accuracy, repeatability, audit-ability and efficiency. Data migration best practice requires a robust audit trail to provide a reliable method to track data back to the source. Leveraging our platform with established libraries allowed for ease in automation, intelligent matching, and ultimately, file type conversion while maintaining fidelity.

This is just one example of many that we have encountered when migrating data from one EHR to another and archiving  data into VCO-A. It serves as a reminder that many systems store data in different ways, and it might not always be a straightforward process to back up the data.

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10 Comments

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  1. 1
    Asher Ekstein

    Hi,
    We are facing the same issue with the .car files from iqmanager, is it possible for you to share the script you used?
    Thanks.

  2. 2
    Barry Chamberland

    Hi Asher, I have forwarded your information on to the appropriate Galen resources that can help answer your request. I do know that .car files are pretty frustrating and I hope we are able to get what you need for your project! Thanks, Barry

  3. 4
    Adam A Butchy

    Hello, great article and all too relatable. Could you share the script for handling .car files with me as well?

  4. 5
    Justin Huckaby

    We are also in the midst of a project and need a way to convert these files. How could we obtain this script?

  5. 6
    Tom Barnes

    Hello, I would also like to take a looksee at the script. possible?
    My files are not within iqmanager dbase, but stored on a file server. was thinking of somehow utilizing the midmark print to pdf printer.
    thanks,
    tom

  6. 7
    Teresa Edwards

    Barry,
    I’m guessing that instead of “share the script”, the Galen team will offer to sell the service. However, If you are able to share the script, that would be very helpful. Am I understanding correctly that, even with the script, we must have access to the MidMark IQManager tool? Any insight that you could offer would be greatly appreciated.
    Thank you.

  7. 8
    Christian Nicolas

    Hi Barry,
    We also need the same assistance with our Midmark files. We actually have a custom script similar to what you have but the issue we run into is the version of Midmark that supports command line is 6.x and we are on a much higher version, 10.x. Once a CAR file has been open in a higher version of Midmark, it automatically upgrade its version. The 6.x version of IQIC will now encounter a comprezssion issue.

    Is your script compatible with a higher version of IQIC? If so, we are very much interested with this service.
    My work email: nicolacr@rwjms.rutgers.edu

    Regards,
    Christian Nicolas

  8. 9
    Asher Ekstein

    Hi,
    To everyone commenting here, I was never sent the script, I was told that it was private company resources that couldn’t be shared, and that’s very understandable imo.
    However to anyone else facing this issue here’s how I resolved my issue, I used a bat script to open each file in the iqmanager software and then after a few seconds close it, this essentially added those ecgs to the iqmanager local database, the script also created new database files and renamed the old after a certain amount of car files because otherwise it would become unstable, I was then able to open the iqmanager program and print all records to pdf, rename database, open again, print all records rinse and repeat, I ran it on a dedicated VM and I monitored it, there was more to it but that was basically the idea.
    If any of you want my script let me know by email asher@nexivity.com, I might not respond very quickly though.

  9. 10
    Barry Chamberland

    Thanks Asher for you input and sorry all that I have not responded to yet. Yes its true that we can’t technically “share” the script, we are working internally on options that we may be able to provide if you or your organization was interested in contracting with us. Others at Galen are working on it as we speak and they will reach out to any of you in the future if you are still interested in hearing options that the Galen team can provide.

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