EMR Educate - Integration Issues

Typical Situation

You have an existing Practice Management (PM) system (scheduling and billing), but you want to add EMR (electronic charting) functionality. Your first decision is whether to buy an integrated EMR/PM system and start fresh with modern technology across the board, or buy just an EMR system and attempt to integrate it with your existing PM system.

Typical Decision

Most EMR buyers faced with this decision will find it prudent to scrap their old PM system and buy a fully integrated EMR/PM system. The main reason is that patient charting and patient billing are so intimately connected that you want full integration between your EMR and PM systems, and the best way to get full integration is to buy a single, integrated EMR/PM system. You should also be aware that not all EMR/PM systems are fully integrated, despite a vendor's claim of full integration. "Fully integrated" is defined as the integration of EMR and PM systems that were developed from the ground up on the same platform. Whenever that is not the case, the EMR/PM system vendor has attempted to meld two disparate systems, and the true state of integration after such an effort is quite variable. See "The Integration Challenge" below.

The Integration Challenge

You could attempt to integrate a new EMR system with your old PM system, but you should expect to spend several thousand dollars in the process. Further, achieving full integration between two disparate systems is always very difficult, and diminishing marginal returns sets in quickly. The first $10 thousand you spend may get you 80% of the way to total integration, but then you might have to spend another $6 thousand for 5% more completion, $8 thousand for the next 5%, and so on. It usually does not make economic sense to attempt to integrate disparate systems (unless you have no good alternative). Remember, too, that less than full integration will always mean that you are not taking full advantage of the efficiencies afforded by your EMR system. If your billing staff have to go into your EMR system and look at the electronic chart for each and every patient encounter in order to bill (the same as they did when you used paper charts), you would be underutilizing the capabilities of your new EMR system.

Data Conversion Issues

If you have an existing PM system that is loaded with years of patient demographic and billing information, how do you get all of that data into your new EMR/PM system? Well, you have two basic options. One, you can use an automated process to convert your existing PM data over to your new EMR/PM system. Or, two, you can use a manual process.

Scripted Data Conversion

Scripts can be used to query the database used by your existing PM system, pull out specified information, and reformat it as may be necessary. The restructured data can then be added to the PM portion of your new EMR/PM system. Many EMR/PM vendors have "script libraries" that make the data conversion process very simple and inexpensive. If you have a really old or non-mainstream PM system, conversion scripts might not be available. In that case, if you want an automated conversion of existing PM data, you'll have to hire an IT consultant to create custom scripts for you. Expect to spend $3-5 thousand for such an exercise.

Manual Data Conversion

Under any circumstances, you can always opt for a manual conversion of existing PM data. The typical manual conversion method is called "work ahead", in which your staff manually convert patient demographic and billing information from your old PM system to the PM portion of your new EMR/PM system in advance of patient visits. Staff typically work 2 weeks ahead, and over time, your entire (and relevant) PM data gets into the PM portion of your new EMR/PM system. One benefit of the manual conversion process is that you don't waste money converting data for patients who no longer exist (died, moved away, etc.). Another benefit is that staff have the opportunity to correct inaccurate patient information and add missing information.