Transitioning from one Electronic Health Record (EHR) to Another: A Narrative Literature Review

Saleem, Jason J.; Herout, Jennifer

doi:10.1177/1541931218621112

Cited by 16 publications

(20 citation statements)

References 16 publications

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“…18 Although automated conversion can migrate structured data reliably, underlying discrepant structures and embedded content can cause data inconsistencies and compromise patient safety. 1,28 One incident highlighted a technology error in which data conversion caused a patient's medication dosage to be double the intended dose. 25 A formal risk assessment with near-real time supervisory review processes should be effected prior to automated data migration.…”

Section: Data Migrationmentioning

confidence: 99%

“…Clinicians report they appreciate additional staff for training and support. 28 One challenge is the "retreat of the army of a dedicated team after the initial go-live phase." 8 Practitioners believed the availability of ongoing training for more than 6 months can greatly reduce user frustration.…”

Section: Training and Supportmentioning

confidence: 99%

“…8 Practitioners believed the availability of ongoing training for more than 6 months can greatly reduce user frustration. 28 A case study 50 involving an EHR-to-EHR transition concluded that training is a crucial component to solving clinicians' problems with system usage, especially with specialized staff and classes dedicated to EHR transition. 42 Training coursework should group providers by common workflow to maximize the efforts.…”

Section: Training and Supportmentioning

confidence: 99%

“…42 Training coursework should group providers by common workflow to maximize the efforts. 28 Hospitals should conduct ongoing monitoring and support at a system level to best assess the health of the EHR itself and the end users. 14 Is the system functioning as designed?…”

Section: Training and Supportmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Data Migrationmentioning

confidence: 99%

Section: Training and Supportmentioning

confidence: 99%

Section: Training and Supportmentioning

confidence: 99%

Section: Training and Supportmentioning

confidence: 99%

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

et al. 2020

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“…For example, workflow disruptions or distractions such as provider training may negatively impact quality of care in the phase immediately before or after such a transition. Along these lines, there are conflicting single site reports of patient safety issues following EHR implementations and transitions [10][11][12][13][14] . While a recent study found no increase in patient safety events following EHR transitions in a cohort of adult hospitals 15 , there is limited evidence beyond dated, single site studies in pediatric hospitals, which carry their own set of unique operational health technology challenges.…”

Section: Introductionmentioning

confidence: 99%

Association between Electronic Health Record Implementations and Hospital-Acquired Conditions in Pediatric Hospitals

et al. 2023

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Background: Implementing an electronic health record (EHR) is one of the most disruptive operational tasks a health system can undergo. Despite anecdotal reports of adverse events around the time of EHR implementations, there is limited corroborating research, particularly in pediatrics. We utilized data from Solutions for Patient Safety (SPS), a network of 145+ children’s hospitals that share data and protocols to reduce harm in pediatric care delivery, to study the impact of EHR implementations on patient safety. Objective: Determine if there is an association between the time immediately surrounding an EHR implementation and hospital-acquired conditions (HAC) rates in pediatrics. Methods: A survey of IT leaders at pediatric institutions identified EHR implementations occurring between 2012 and 2022. This list was cross-referenced with the SPS database to create an anonymized dataset of 27 sites comprising monthly HAC and care bundle compliance rates in the 7 months preceding and succeeding the transition. Six HACs were analyzed: central-line associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), adverse drug events (ADE), surgical site infections (SSI), pressure injuries (PI), and falls, in addition to four associated care bundle compliance rates: CLABSI and CAUTI maintenance bundles, SSI bundle and PI bundle. To determine if there was a statistically significant association with EHR implementation, the observation period was divided into three eras: “before” (months -7 to -3), “during” (months -2 to +2), and “after” go-live (months +3 to +7). Average monthly HAC and bundle compliance rates were calculated across eras. Paired t-tests were performed to compare rates between the eras. Results: No statistically significant increase in HAC rates or decrease in bundle compliance rates were observed across the EHR implementation eras. Conclusions: This multi-site study detected no significant increase in hospital-acquired conditions and no decrease in preventive care bundle compliance in the months surrounding an EHR implementation.

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Transitioning from One Electronic Health Record to Another: A Systematic Review

Miake-Lye,

Cogan,

Mak

et al. 2023

J GEN INTERN MED

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Background Transitioning to a new electronic health record (EHR) presents different challenges than transitions from paper to electronic records. We synthesized the body of peer-reviewed literature on EHR-to-EHR transitions to evaluate the generalizability of published work and identify knowledge gaps where more evidence is needed. Methods We conducted a broad search in PubMed through July 2022 and collected all publications from two prior reviews. Peer-reviewed publications reporting on data from an EHR-to-EHR transition were included. We extracted data on study design, setting, sample size, EHR systems involved, dates of transition and data collection, outcomes reported, and key findings. Results The 40 included publications were grouped into thematic categories for narrative synthesis: clinical care outcomes (n = 15), provider perspectives (n = 11), data migration (n = 8), patient experience (n = 4), and other topics (n = 5). Many studies described single sites that are early adopters of technology with robust research resources, switching from a homegrown system to a commercial system, and emphasized the dynamic effect of transitioning on important clinical care and other outcomes over time. Discussion The published literature represents a heterogeneous mix of study designs and outcome measures, and while some of the stronger studies in this review used longitudinal approaches to compare outcomes across more sites, the current literature is primarily descriptive and is not designed to offer recommendations that can guide future EHR transitions. Transitioning from one EHR to another constitutes a major organizational change that requires nearly every person in the organization to change how they do their work. Future research should include human factors as well as diverse methodological approaches such as mixed methods and implementation science.

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Transitioning from one Electronic Health Record (EHR) to Another: A Narrative Literature Review

Cited by 16 publications

References 16 publications

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

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

Association between Electronic Health Record Implementations and Hospital-Acquired Conditions in Pediatric Hospitals

Transitioning from One Electronic Health Record to Another: A Systematic Review

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