Whether you are implementing a complete-package Electronic Health Record (EHR) system or just the scheduling component, a successful appointment migration program will take considerable effort and planning. Today’s EHR systems provide advanced levels of sophistication and capabilities for moving future, scheduled appointments from legacy systems into the new applications. In most cases, it is no longer necessary to consider manually converting every single appointment. Nor is it necessary to bring in outside, specialized technical firms to perform advanced levels of wizardry to convert legacy data into the required format of your new scheduling vendor. Today’s more popular vendor systems have tools that guide your inhouse project analysts through the process of converting or migrating future appointments into the format necessary for programmatic uploading into the new scheduling application with a very high degree of success. You should expect to be able to upload 90%-95% of your scheduled appointments, and manually enter the rest. Exceptions to regular uploads will include complex cases such as Oncology, Surgery, and Radiology.
The following are some tips on establishing a successful appointment program, broken into two parts – preparation and the actual migration process.
Preparation
Identify the different applications and methods used to schedule patient visits and procedures in the current state. This might include different vendors for ambulatory clinic appointments, planned inpatients, surgery cases, etc., and could consist of less sophisticated tools such as manual calendar booking and MS Outlook as well as major vendor tools.
Determine if you can obtain clean, consistent, and complete data from your legacy scheduling systems. The most important resource will be your analyst that can effectively do this. The reports analyst will need to be able to run this information several times throughout the conversion project to ascertain the expected volume of appointments to be converted, as well as at the time of actual migration. Also, determine if you will need to work through your legacy vendor to obtain custom reports or other data as early as possible as they may not be as accommodating as you need.
Some integrated delivery networks are set up to schedule appointments in the ambulatory clinics and points of care. Others have a centralized scheduling department that schedules patient appointments across the entire spectrum of care. It is not advisable to use the EHR implementation project as an opportunity to change from a decentralized to a centralized, enterprise-wide scheduling operation unless you have already done this from an administrative, organization standpoint and are simply using disparate systems and will move to one vendor scheduling system.
Work with your EHR vendor starting a year or more in advance of your planned implementation to identify the following appointment migration considerations:
What is the planned go-live date for the overall EHR, and when should you plan to conduct the appointment migration? Most healthcare systems start appointment migration two weeks in advance of the planned, major go-live event. This typically allows the organization two weekends to complete the process as well as complete pre-registration for the upcoming appointments.
How far out will you schedule appointments? Most organizations will schedule out using a rolling 13-months from the current date. Identify any issues with physician leadership if this will be a significant shift in practice management.
Who will be allowed to schedule appointments? Do nurses, physicians, others schedule in legacy, and should they be allowed in the future system? This will affect training.
Begin to think about logistical questions such as:
Who will perform the manual appointment conversion? Will you use existing staff, temporary personnel, etc.?
Will you bring them all together to conduct the conversion or handle remotely? The recommendation is to centralize the staff performing the manual data entry, support, etc., and much as possible.
Will you try to complete the conversion on one weekend (Sat/Sun)? Are there HR issues to be addressed?
How will the time used for the conversion weekend be handled from a budgetary perspective? Get guidance and documented direction from the CFO.
Another consideration to be worked out and investigated with your EHR vendor is orders and referrals. While it may be relatively simple to pull appointment data from legacy systems and import into the new EHR, that may not be true for orders and referrals. Will you be able to extract data from the legacy system that can be used in the new EHR? Is this consistent across ambulatory, surgery, radiology, etc.?
Recalls or ticklers are other significant areas of concern for appointment migration. Many organizations cannot schedule appointments out for more than six months. For a patient that comes in annually for a mammogram, for example, they will send a reminder notice via phone call or mail asking the patient to the clinic to schedule. While these are not in the legacy system as appointments, they are captured as “recalls” or “ticklers.” You will need to identify how these are captured and worked in the current state and understand if and how the new EHR vendor will address these.
Though not required, a white paper should be drafted by project leadership regarding the appointment migration process once all issues are addressed. This document, with the approval of senior leadership, will serve as the guiding principles and provide clear expectations on the appointment migration process for Information Technology, operations, and EHR vendor early on in the project and save a lot of re-decisions and confusion.
Also recommended is the formation of a small sub-group of individuals from IT, operations, and vendor to begin reviewing the appointment migration program at least nine months in advance of the actual migration. Most of the meetings early on can help separate from IT and operations representatives, but some will require joint meetings depending on the topics to be addressed. Meeting cadence should be every two to four weeks early on, and then weekly as appointment migration dates approach.
It is also recommended that you identify an appointment migration project leader from operations to be the point person for the organization – the “face of the project.” You should still have vendor and project management conducting the meetings and driving the groups, but having someone such as a clinic manager that is respected by their peers across the organization will help with smoothing out issues that arise across the ambulatory, ancillary, and hospital areas. This person should also be the one to facilitate the appointment migration planning meetings for operations and be included in the IT-focused meetings as well.
By following the tips above, you should be well on your way towards a successful, clearly defined appointment migration program. The next step is implementation.
Implementation
As the date for your appointment migration weekend draws near, you should consider the following:
Identify a name for the event, a fun name that is separate from the overall EHR implementation. Your appointment migration event will likely entail a full Saturday and Sunday two weeks in advance of EHR go-live, and staff will be working overtime in an area that is not their regular place of work. To the extent allowed by your organization, make this a fun event by holding drawings for door prizes, raffles, offer plenty of snacks. Food and drink are a given.
You will work closely with your EHR vendor to determine the actual number of staff needed for the appointment migration event. Staff will be required for manual conversion, quality assurance, orders and referral entry, etc. Enlist a team to help by having them sign up for specific shifts/times being offered two weeks or more in advance of the migration event. The most significant number of resources may be for pre-registration activities that will need to be completed before patient arrival. This may be affected by the amount of data elements being converted with the appointments (i.e., guarantor data, coverage).
The recommendation is 7a-7p Saturday and Sunday, with staff signing up for 6-hour shifts. Most of the work will be completed on Saturday, with Sunday being for carry-over and catch-up on issues. Plan for food accordingly and expect fewer people on Sunday afternoon. It is highly recommended that you assign rooms and workspace for everyone for each shift and communicate this a few days in advance so they can proceed directly to where they need to go upon arrival. Many groups will want to work together (i.e., Radiology), so consider these in your assignments.
Likely, your available space is limited for the appointment migration event, and you will use the same training rooms as being used for end-user training. Dual screens are a huge help in performing appointment entry while also looking in legacy systems for necessary data. Manual reports for legacy appointments should be printed the night before and should have a large enough font to be easily read but small enough to include the necessary data. Rulers and highlighters are a big help for the users entering manual appointments.
Security in the new EHR for the migration weekend will likely differ from the security that will be needed post-go-live. Have your IT security analysts on-hand to address issues and changes immediately throughout the migration event.
Staff helping with the migration event should have already attended vendor training in advance. No training, no access, no exceptions.
Support for end-users conducting the appointment migration should be provided by your EHR vendor, project team analysts, and Super Users from your operations areas. The same support structure that the organization will be using for the EHR go-live should be in place now for the migration event and over the next few weeks. The process for entering help tickets, requesting help, etc., should all be the same and already in place. If your organization is using At The Elbow support at EHR go-live, plan to have some of these resources on-hand for the migration event and subsequent weeks to support the end-users.
Consideration needs to be given in advance of the appointment migration event regarding appointment reminders. If you are moving to a new process/vendor for appointment reminders, consider the timing for turning on the new process and stopping the legacy process. There should be no overlap.
We cannot stress enough that once you start the migration of appointments into the new EHR scheduling system, you are LIVE. All appointments for the EHR go-live date and forward must be scheduled in the new system. Scheduling staff will continue to use the legacy system for appointments scheduled before the EHR go-live date, but all appointments beyond that date will be in the new system. If possible, turn off access in the legacy system to schedule appointments beyond the EHR go-live date. If not, then plan to run reports daily in legacy to identify appointments that were scheduled in the wrong system as staff will make this mistake despite all messaging, warnings, training, etc.
Appointment migration programs are a major part of EHR implementations that can be a difficult challenge of not done correctly or left to the sole guidance of a few or just the vendor. You only get one try, and failure is not an option. But making it fun, effective, and a complete success is.
If you are interested in learning how Optimum Healthcare IT can help your organization establish a successful appointment migration program, click here for our Revenue Cycle Advisory Services.
