Acute vs. Ambulatory Patient Care During a Migration Cutover

kristiemitchell-200By Kristie MitchellGalen Healthcare Solutions
Twitter: @GalenHealthcare

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.

Do you want to minimize disruption in your data migration cutover? Thorough planning is key. Considerations? Since not every cutover is identical, it is important to personalize each one to the unique characteristics of the organization. Moreover, when planning for an implementation that involves admitted patients, we need to plan accordingly without disrupting patient care. Admitted patients belong to the categorization of Acute care, or of medical facilities in which patients remain under constant care. Ambulatory care, however, refers to outpatient medical clinics that treat patients with non-emergency issues and commonly see patients in an office type setting.

Due to the differences above, special considerations must be made for our Acute patients, and more so, for the patients being admitted throughout the cutover process.

Our Recommendation:

  • Make sure the admitted patients’ data is entered into the new, target EHR seamlessly throughout the cutover process
  • Have users utilize workflow and tools that they will be using after the cutover period to manually abstract the patient data
  • Enter active orders; such as inpatient medications, procedures, code status, allergies and current problems
  • Ensure data is available to the providers in real time by rolling out workflow tools such as admission order sets and treatment plans for admitted patients during abstraction

Vitals can also be entered during cutover, but close consideration must be made with turning on the device integration. Galen recommends turning on the devices two months prior to the go live. Turning on devices early allows you to test the integration, and allows for vital signs to populate patient charts during the cutover. With the devices on and functioning, the data is available in real-time, which compares to a possible two-hour delay cause by the time it takes to extract, transform and load the data from your legacy system.

Staff Allocation & Training
Staff allocation and training for the cutover process must also be a major piece of your go live plan. Incorporating the right resources is important as we need to consider how quickly we must move to get the data into these charts. Communication between the providers and your cutover staff is a must. How will you plan on getting the orders that the providers want to add, into the hands of the cutover staff? Determining what order of events must take place to ensure proper care to admitted patients, can be quite tricky! Not only must you have staff that has been thoroughly trained on the target system, but you should have staff that is familiar with the patients, the providers, and the inpatient locations that we are targeting for manual abstraction.

We recommend that you staff resources that are knowledgeable about:

  • The target system future state workflows
  • The new target system tools
  • Current inpatient count
  • Potential discharged patients on the evening of cutover

When staff has a gauge on the expected effort to be made during the short time period, you are mentally prepared for the onset of chaos that is cutover. Users should be focused only on their assigned roles to keep the effort streamlined and communication open. I mention communication as it should be a training point to these end users. They must be aware of the other steps involved with the cutover process. For example, a user who is obtaining the paper orders from the provider, should also be aware of the status of the registration staff who are admitting or discharging patients manually. Only once a patient is admitted, can the nursing staff then enter in the orders received. A clear step-by-step cutover plan should be accessible and visible, to indicate when one step is complete, and when the next can proceed.

All of this is in sharp contrast to a cutover that affects Ambulatory patients. When we are working with a client in an Ambulatory setting, we do not need to account for any of the situations mentioned above. The focuses of an Ambulatory cutover are:

  • All data migration and interoperability items are completed during closed office hours
  • Patient data from your source system has successfully made it into your target system
  • Your interfaces are all pointed towards your new system, you’re on point to now see your patients the following day, and enter your data freely and electronically into your new application

There are considerations for every type of cutover plan that streamline together items such as: adjusting schedules, incorporating trainers on the floor to help end users, extra staffing for your help desk and patient notification to encourage patience while you navigate through the cutover process. Whatever type of setting you are in, proper planning will be instrumental to your success. Please look ahead for an upcoming data migration series blog for more information on the intricacies between Acute and Ambulatory Conversions.

This article was originally published on The Galen Healthcare Solutions Blog and is republished here with permission.