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Appl Clin Inform 2020; 11(05): 742-754
DOI: 10.1055/s-0040-1718535
Research Article

Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

Chunya Huang
1   Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States
2   Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine—Louisville, Kentucky, United States
,
Ross Koppel
3   Deparments of Biomedical Informatics and of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
4   Department of Biomedical Informatics, University at Buffalo (SUNY), Buffalo, New York, United States
,
John D. McGreevey III
5   Division of General Internal Medicine, Section of Hospital Medicine, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Catherine K. Craven
6   Department of Population Health Science and Policy, Clinical Informatics Group, IT Department, Mount Sinai Health System, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Richard Schreiber
7   Physician Informatics and Department of Medicine, Geisinger Holy Spirit, Geisinger Commonwealth School of Medicine, Camp Hill, Pennsylvania, United States
› Author Affiliations Funding None.
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Abstract

Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery.

Methods We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions.

Results Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation.

Discussion There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support—all factors affecting potential clinician burnout.

Conclusion EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.

Keywords

electronic Health records - clinical governance - EHR migration - EHR transition - data management - cybersecurity

Authors' Contributions

R.S. conceptualized and organized the AMIA 2015 panel discussion, conceived of this manuscript, and wrote the first outline. C.H. wrote the first draft of the manuscript. All authors contributed significantly to the intellectual content of the manuscript and approved the final version for submission.


Protection of Human and Animal Subject

This paper includes neither experimental data nor personal health information. It is research that does not involve human subjects as defined in 45 CFR 46.102(f). The authors found no requirement for institutional review board review.


Supplementary Material



Publication History

Received: 31 May 2020

Accepted: 07 September 2020

Article published online:
11 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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