Knowledge Expansion Take the glitch out of a switch: How to effectively oversee your practice management conversion Insight Article Electronic Health Records Business Operations Technology Sign in to save Anthony Watson These days software is written to empower doctors and help them manage the various aspects of a medical practice. However, you may not have anyone on staff who is particularly tech savvy. Without technical expertise, the conversion to a new system can seem daunting. Although you may not need technical expertise to operate a practice management system, managing a conversion is a different story. Without project management skills, you are left to work with the new system’s project manager, which can become a very one-sided relationship if you let it. Some conversion oversight techniques can help you manage your own conversion. In today’s world of extreme complexity, a relatively simple workflow is invaluable. It’s also essential to engage any staff who could be referred to as “experts” in your office’s workflows and current utilization of the old system. The following is a relatively simple workflow to get you through the data conversion. The money aspects This data conversion workflow primarily revolves around the money aspects of your system as they relate to patients, providers, insurers and responsible parties. These balances will be stored in an accounts receivable (A/R) and payable data structure, which is somewhat more convoluted in a medical practice. The insurance providers along with claims add complexity to the accounting systems in practice management. The money coming from multiple responsible parties can make it more difficult to manage. Before launching a conversion, it’s important to ensure the old system is in reasonable working order. You cannot know how well the transition has gone without knowing where to start. Systems degrade (which is why you convert), but they should be in working order for a good conversion. The old system should have functional reports on the counts of patients, responsible parties, insurance carriers, open claims, patient balances and patient charts/exams. If your system is in disarray, a certain amount of unraveling will need to be done. If there is not a good starting point, create one. Go back to the last paper reports that balanced (if necessary) and use those. If you need to go back more than one accounting quarter, a “perfect” conversion may not be possible. When multiple closes of the month go beyond one quarter while accounting structures are out of balance, it can have unexpected consequences in many practice management systems. Building that starting point will help measure and validate the data conversion. Spending time here to audit your current system to establish data yardsticks will be worth every minute by facilitating a good conversion to the new system. You and your staff should be auditors and testers to validate the outcome. If you do not have users whom you trust on staff, you will need to become the “power user” to audit the data conversion. Human eyes and validation are part of a successful data conversion. The audits will determine success, so don’t shy away from them. They may be tedious, but errors are found this way. Comparing old versus new Comparing the old system through its user interfaces to the new target system’s user interfaces will help you validate the conversion code’s accuracy. This audit process will also validate the new system’s stability by having users make requests of the new data store. To try out the new system, select a day for a pre-conversion test using data from the month-end close. A closely monitored process of closing the month in preparation for a pre-test is helpful in many ways. The month’s close is the jumping off point for the system conversion. This process also prepares everyone for the backlog that will occur when live conversion is launched. Backlog is the amount of time the live data conversion will take — the shadow time between the old and new systems. Month-end cutoffs lend themselves to this procedure as they are a natural breaking point to jump to a new system. During this time your practice is still operating and everything is being done on paper and/or in the old system. Backlog is most likely only about a day or two, but it can be just a few hours or as long as a week depending upon complexity. Any data entry done previously will need to be redone and entered into the new system. The pre-conversion month-end is for testing, so there is no need to worry about backlog here. Instead, data conversion and validation will be done at this time. If there are sufficient resources, running the two systems in parallel for a time can help reveal issues with the new workflows, which can be addressed before going live. It is imperative that you treat the pre-conversion test as if it was live. The most important part of this is exercising the system and validating the converted data. Check on the patient counts by running reports in the new system and comparing them to the old system month-end reports. Check on the carrier counts the same way. Finally, review all the financial reports and make sure the new A/R matches the old, and do the same with the accounts payable. Make sure the insurance claims are properly documented and accounted for on the patient transaction histories. If everything balances in the pre-conversion test, you are on your way to a successful conversion. But a good rule of thumb is to not assume that everything is balanced. Look for discrepancies in ancillary data structures, such as appointment scheduling, patient charts and procedure rates. By doing this now, the live production conversion will go smoother. Ask your staff to help identify the accounts that should be reviewed, including the patient who has been with the practice the longest. This patient will have the most history to be converted, which means a lot of data will have been run through the conversion process. Also look for which patient visits your office the most, because this individual will be pushing the limits of possible code boundaries in the conversion process. Also review credit balances; these are usually oddball accounts that can trip up the conversion code. If your patients all look good, then follow the same process with the insurance carriers. Check the oldest carrier for validity and the one that generally receives the most monthly claims from the practice. These accounts will most likely trip up the conversion code by bringing in outlier data sets. Finally, randomly check other patients and carriers. A 1% audit only requires you to check 10 of your 1,000 accounts. In doing these audits, verifying data such as addresses and other patient demographics become easier. When auditing patient demographics, look for patients with an apostrophe in their name (O’Neill) or addresses such as “100 Land o’ Lakes St.” The apostrophe is a special character in many database languages that can trip up conversion code. By going through all your accounts and physically verifying the data, you and your staff will become familiar with the new system. This can ensure the post-conversion goes better as well, because you and your staff are using the new system in the pre-conversion test audit. Don’t fall back on old habits (or systems) Finally, make sure the old system has been completely phased out. Using the old system to look up accounts may seem like a way to save money, but the costs in productivity can be extensive. The learning curve with the new system can be steeper by returning to the old system. New systems should have hooks in them to support data lookups that were not necessarily completely converted into the new system, such as old transaction histories or retired carriers. Utilize these hooks instead of maintaining the old system in house. It will make the transition to the new system easier. Exclusively using the new system post-conversion will help with training and acceptance among you and your staff to move forward. Once there is buy-in, the backlog will need to be entered. This should not be too painful, especially if the staff has been in the new system auditing and validating. They will know their way around the new system and it will be further reinforced by the backlog data entry. This methodology has worked for me on many data conversion projects. The attention to details such as money and patient counts ensures scrutiny. Your engagement with staff to audit and validate — first in the test conversion month and then in the live conversion month — gives you a leg up on training. This might pay more dividends than any other aspect of the methodology because you will hit the ground running in your new practice management system. Key steps Prep your old system for conversion. Have the vendor do a test conversion. Audit the test conversion to the new system. Have the vendor make adjustments and redo steps two and three if issues arise. Have the vendor do live conversion, while your staff operates on paper. Vet the new system and conversion. Buy in on conversion and do the backlog. Start using the new practice management system. Remember: Each conversion is unique and each practice has its custom workflows, but following the eight steps above will help ensure a smooth transition to your new practice management system.