By Glenn Schweidler, RHIA, Partner and Chief Operations Officers, Intellis
Health system acquisition of physician practices and medical groups has steadily increased since 2012 with hospitals and other healthcare corporations now owning nearly half of all physicians. Most CIOs and IT teams within hospitals and health systems are well-aware of the ups and downs of physician practice acquisitions. Properly converting legacy data to ensure clinician access to information, satisfaction and quality care is paramount.
Based on the experiences of a large health system that has successfully acquired and merged hundreds of medical groups into their enterprise Epic system, several best practices have emerged. This article shares this health system’s insights, lessons learned and practical advice to address data challenges during physician practice mergers and acquisitions.
Legacy Data Doesn’t Always Convert
Much of the legacy data contained with physician practice systems will automatically convert. But some of it, often data most important to physician users, does not. For the data that does not automatically convert to Epic, a manual process is the only option.
Time consuming and labor intensive, getting the final pieces of patient information from legacy physician systems into Epic is an enormous task.
After hundreds of acquisitions, the health system became uniquely experienced in abstracting legacy physician practice data through both automatic and manual methods. Best practice processes and procedures to ensure physician and patient satisfaction before, during, and after the conversion to Epic were established and are used repeatedly to achieve positive IT outcomes.
Every Piece of Patient Data Is Important to Your Clinicians
Every piece of vital patient data is important and must be available to onboarded physicians and their care teams within Epic quickly, easily, and completely on day one. Data integrity was the organization’s top priority to ensure a complete and accurate legal medical record for their physicians and patients. Every step to ensure a complete and accurate legal medical record brings organizations closer to building long-term physician and patient satisfaction.
As mentioned above not every data element automatically converts from legacy physician EHRs and EMRs to Epic. Therefore, a process for manual data abstraction is necessary. The most important data elements that don’t automatically convert from physician records include medication records, allergies, diagnosis lists, text-based office notes, and immunization information.
Identify the Need
The organization identified the need for chart abstraction at the start of their Epic implementation. They wanted Epic to have the most up-to-date history for caregivers and to deliver the best care statewide. Physicians also needed to easily see their current patient information and clinical documentation from legacy systems in the health system’s Epic platform.
Access to the most recent data positively impacts provider productivity and supports quality care delivery. Chart abstraction also prevented providers from logging into multiple systems to review previous documentation resulting in another boost for provider satisfaction and productivity.
To determine which data required manual abstraction, the conversion team met with onboarding managers, practice managers, and strategic care stakeholders from each practice. Through these meetings, the conversion team gained a deep understanding of the project scope for each acquired practice and determined exact data elements to be automatically converted versus manually abstracted into Epic. Practices were then offered the necessary services. A scope of work was built and the required project resources were identified.
Align Resources, Prioritize Accounts
Manual data abstraction requires a specialized set of resources and prioritization of accounts. Teams benefit from health information management (HIM) expertise, project management, quality control, and end user expertise. These types of resources recognize the importance of a legal medical record and problems with faulty data.
The organization prioritized abstraction by provider locations and service lines. And since chart abstraction services can be up and running in a single day, prioritization based on a patient’s schedule was also an option for each practice.
Another best practice is to prioritize frequently seen patients. In this way, their most recent clinical information is immediately available to the physicians and care team within Epic in the event of urgent appointment.
Move Data Forward
The organization also realized that there are two components to moving data forward from an acquired physician practice’s legacy system to Epic. The first is to electronically convert data into Epic. The second is to manually abstract all remaining critical information including:
- Most recent master patient index (MPI) data
- Text-based notes
- Patient histories
This information is most visible to providers and necessary for clinical documentation integrity. Providers are under tremendous pressure to quickly learn the new Epic system, clinical workflows, and documentation processes. Immediate access to the most recent patient data from their legacy system is beneficial, reduces administrative time for practice teams, and improves patient care.
Other Lesson Learned
The need for solid training and quality programs is another best practice established by this large health system. Investments made on the front end of the process to fully understand the legacy system and practice workflows delivered better long-term results in each clinician’s Epic training, account set up, and documentation shortcuts.
Data quality is also paramount. Patient histories must be accurate for quality care and to ensure the legal medical record remains clean going forward. Dirty data creates trust issues and barriers that may never be overcome. This includes loss of patient trust in an organization’s EHR and patient data over time.
Documentation errors made in one encounter carry forward into future encounters. Therefore, it is essential to establish a process to quickly identify and correct inaccuracies in the patient record. Establish support for end users to report errors and notify data conversion teams if any patient data elements are missing.
Multiple avenues to elevate inaccuracies are helpful. If clinicians have any doubt about converted patient information, they should omit it from future notes and discuss with a practice manager on a case-by-case basis.
Finally, being acquired by a health system involves a steep learning curve for physician practices. Substantial change occurs during mergers and acquisitions. Moving to a new IT system is only one part of the journey. There are new payroll, email, time keeping, and other systems to manage. Throughout the process, it is important to be respectful of the pressure on providers, care teams, and the entire practice staff.