Combining health systems and hospitals means combining their health information, making the health information management (HIM) strategy a critical facet of any merger, which can be tripped up by poor planning or having an unhelpful electronic health record (EHR) vendor.

Presenting at the 2017 American Health Information Management Association (AHIMA) conference in Los Angeles, Melissa Landry, assistant vice president of HIM at Louisiana’s Ochsner Health System, offered her own blueprint for making this transition as smooth as possible. Ochsner now manages 29 hospitals, more than 80 clinics and urgent care centers and employs more than 18,000 people.

When a new practice or facility is acquired by or to be managed by Ochsner, Landry said the HIM division’s plan can begin with the partnership agreement itself. The legal documents detail if or when Ochsner takes legal custody of the provider’s legacy medical records. The next step, Landry said, is understanding the provider’s current HIM state.

“Some of the small physician office practices don’t really have formal, documented procedures,” she said. “When we go in there and we ask questions about their EMPI (enterprise master patient index), they sometimes don’t have a clue as to what we’re talking about.”

The new partners are brought up to speed by sharing Ochsner’s “HIM Playbook,” which details the system’s HIM procedures and what they can expect during the transition period. This will cover many of the partner’s questions, Landry said, like what happens with paper records and who pays for the storage of those records.

One of the final steps in the planning stages at Ochsner is planning on decommissioning legacy EHR systems. The new partners will be transferred over to an Epic system and the existing vendors can be less than helpful with the transition, because in their eyes, Landry said, they’re losing a customer.

“Sometimes they won’t even talk to us because they don’t have a contracted relationship with Ochsner,” Landry said. “Many times, the practices has to get very involved in those discussions or else we have to get a formal, legal agreement that allows us to be the liaison for that partner.”

Landry repeatedly emphasized the need to involve and keep informed acquired practices during the transition. This would include spelling out how much data will be archived (Ochsner’s standard is to go back 10 years), when data will be migrated to Epic and explaining to clinicians that not all the information will be available in the new system as it was in their legacy EHR.

One of the biggest hurdles can be open encounters and unsigned notes, which won’t be transferred to the new system. Landry said they discovered during one integration that a provider hadn’t been closing her encounters in her legacy system for years.

“I have no idea how she managed for several years on an EMR and never closed an encounter,” Landry said. “We actually had to pay extra for our vendor to batch close all of her encounters so we can get her data in the extract.”

The EMPI can be one of the most important ingredients in a smooth transition. Landry concluded by saying many of the smaller providers haven’t paid much attention to eliminating duplicative records, but Ochsner’s processes have cut those rates to less than 2 percent.

Getting the EMPI sorted out during the transition process will be key to information governance once the practice is fully integrated, according to Rita Bowen, MA, a former president and board chair for AHIMA.

“That is so paramount for everything to connect. Those are the keys to the kingdom,” Bowen said.