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Miake-Lye IM, Cogan AM, Mak S, Brunner J, Rinne S, Brayton CE, Krones A, Ross TE, Burton JT, Weiner M. Transitioning from One Electronic Health Record to Another: A Systematic Review. J Gen Intern Med 2023; 38:956-964. [PMID: 37798580 PMCID: PMC10593710 DOI: 10.1007/s11606-023-08276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
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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Affiliation(s)
- Isomi M Miake-Lye
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Alison M Cogan
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Selene Mak
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Seppo Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Catherine E Brayton
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ariella Krones
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Pulmonary and Critical Care Medicine, VA West Roxbury Medical Center, West Roxbury, MA, USA
| | - Travis E Ross
- Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, VA West Haven Medical Center, West Haven, CT, USA
- Yale Center for Medical Informatics, New Haven, CT, USA
| | - Jason T Burton
- Louise M. Darling Biomedical Library, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Weiner
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, IN, Indianapolis, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Huang C, Koppel R, McGreevey JD, Craven CK, Schreiber R. Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations. Appl Clin Inform 2020; 11:742-754. [PMID: 33176389 DOI: 10.1055/s-0040-1718535] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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.
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Affiliation(s)
- Chunya Huang
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, United States.,Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine-Louisville, Kentucky, United States
| | - Ross Koppel
- Deparments of Biomedical Informatics and of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Biomedical Informatics, University at Buffalo (SUNY), Buffalo, New York, United States
| | - John D McGreevey
- 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
- 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
- Physician Informatics and Department of Medicine, Geisinger Holy Spirit, Geisinger Commonwealth School of Medicine, Camp Hill, Pennsylvania, United States
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