Most of us have years of stored digital phone data, like contacts, apps, texts, and maybe a few selfies, that we’re pretty dependent on.
So, when we upgrade or switch phones, we’ve come to expect that our data will easily transfer and be accessible on our new device.
The same is true with medical records.
When hospitals switch EHRs (the equivalent of moving from Android to iPhone), clinicians, staff, and patients, expect that most, if not all, of the historical chart data captured in the old system will be transferred into the new system.
Because this is a common requirement for EHR changeovers, implementation teams have a lot of technical tools at their disposal to streamline the process and ensure that patient records in the new system are populated with some legacy data at Go-Live.
But unlike the ease with which you can move your vacation photos from one phone to the next, a comprehensive transfer of patient information also usually involves a degree of manual data entry and human decision making through a process called chart abstraction.
What is Chart Abstraction?
Chart abstraction collects information from a patient’s legacy medical record and populates that information into the correlating data fields or locations within the new EHR application. Practically speaking, it often requires transcribing or retyping notes from an old chart into the new one.
Moving critical patient chart data as soon as possible into a single source of truth makes providers more efficient and improves decision making at the point of care. It also improves user adoption of the new system and allows organizations to more quickly retire the legacy EHR.
We recently managed a large chart abstraction project for a health system that had made a series of acquisitions. The new sites were brought live on the organization’s preferred EHR, but its providers and staff were still managing between records in their legacy system and the new system.
To wean providers off of their legacy system, we needed to accelerate the transfer of data from the old charts into the new charts. Using experienced abstractors and a skilled project manager, we updated close to 48,000 patient charts over a period of 12 weeks with a high degree of quality and accuracy.
Preparation and attention to detail are critical for any large-scale chart abstraction process. As I reflect on our recent project, I can highlight several areas of focus that helped us reach our goals and achieve the success metrics defined by our client.
Define Scope and Priority
Before the abstractors start their work, a discovery process is required to document the goals of the client. The healthcare organization should define the data set to be abstracted. It’s not always feasible to move the entire patients record, so key stakeholders should decide what data need to be readily accessible to staff and providers using the new system.
The client should also define the prioritization and timing for their charts to be abstracted. For example, the records of patients with upcoming appointments are usually a high priority to ensure that their charts are prepped for impending visits. Organizations may also choose to prioritize the patient records of certain clinics or specialty groups, so those preferences need to be captured up front.
Another key in pre-planning is to ensure abstractors are ready to hit the ground running on day one. They will need:
- Logins and passwords for each of the legacy and new EHRs prior to the start of engagement
- A walkthrough of each legacy EHR system and the specific data to be abstracted
- Detailed instructions on how to login and access each of the legacy and new EHRs
- Access to a centralized communication / collaboration tool to escalate issues and get answers to abstraction questions throughout the engagement
Ensure Rigorous and Regular QA
A successful chart abstraction project strikes a balance between volume goals and quality goals. Each abstractor should be aware of their daily volume targets and subject to a rigorous quality assurance process.
In our recent project, we audited a minimum of 10 charts per person per week with an expected quality score of 95% or higher. Typical areas of the EHR chart to audit include:
- Problems Lists
- Immunizations (especially COVID-19)
- Patient Histories (Medical, Surgery, Family, Social)
- Last Progress Notes per Discipline
QA results should be closely monitored by team leads with special attention to any issues that may be common to the entire group, or that require individual attention and counseling. More on that below.
Manage and Inspire the Chart Abstraction Team
Chart abstractors typically work remotely and in isolation. Frequent and clear communication can help them feel like part of a team, while also addressing their individual challenges and goals.
I like to set short (no more than 15 minutes) video huddles with my entire team at the beginning of each workday to:
- Review chart abstraction totals from the previous day
- Share any client updates
- Confirm assignments for the day
Outside of the group, my leads will set individual meetings, as needed, with any team members that are having difficulty meeting volume or quality goals. These meetings allow for direct feedback and counseling that often achieves the desired effect of improving performance.
Occasionally, individuals need to be replaced. As a best practice for resource planning, we anticipate some attrition and maintain a bench of qualified replacements to keep the project on track.
Fortunately, most abstractors are obsessive about quality and are motivated by positive reinforcement. I like to use contests and prizes to incentivize performance and keep the project fun. Announcing the winners and awarding top performers in a group meeting lets everyone cheer on their teammates and creates a little friendly competition that improves results.