Empower Your Personnel with Data Conversion Lead for Personnel

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this will be about data conversions um in general and my disclaimer here as I as I love to do is obviously anything that we're sharing today is not legally binding mostly comprises of our experience plus tips and tricks down online Etc create this presentation um I'm aware that there are probably uh six or seven or eight different types of conversions and um everyone's got a little bit different situation um whether it be a are a large large um organization that um brings on practices in the health care environment every every other day it seems like or if you're um a smaller organization that can uh is is simply being purchased or being gobbled up into another group or merging things like that um I'll try to sort of make and give examples relevant to all um and then at the end we will open it up for any questions or any specifics that you guys might have that you'd like to see answered um all right so essentially um just a little bit of an intro here so obviously you know why do I need a data conversion for anybody thinking about it um you know in in the reform days if you're required to capture so many percentage of Grace ethn ethnicity language religion and gender and all that stuff you know obviously that that um those data points are needed in having them in a data conversion if you don't have all that and you just dump in a 100,000 patients without that data your numbers are going to look pretty bad when you're running a report so sometimes that can be um a pretty big reason um obviously the more data the better so you could argue quality of care improve performance um and that type of thing so obviously the more information you have the time the patient presents the better um so that's it's always good to have um and and why um would you need to convert again so um some of the some of the hassles is you um maybe if you take on a new system or you change systems or um you're finding that you bought a system and the sales guy sold it to you and it's not exactly as promised um you know maybe you need to bring in some of the data from your old system to help bolster that because that solution didn't didn't necessarily need meet your need um that's that's pretty much a big complaint you get from The Specialist out there but um that's that's one of the reasons or maybe you're leaving because um your vendor just wasn't giving you the loan that you needed um so you're going to convert away from them and convert onto a new system something like that is always always in the cards um and of course with any data conversion um little background here there are certain things that you have to do every time and we'll talk more about it but um there's always medical legal uh situations to be considered um maintaining the patience um legal record for X number of years is is certainly um part of the game here um and then of course other considerations like uh when it comes to system sales usually data conversions are the last thing anyone's thinking about it I mean even the the the broad term data conversion is so is so General that you think it can be done at any point but really it take it can take months at a time for something like this to happen and happen correctly um and it's sort of often an afterthought um picks a lot of uh planning and um an expertise obviously something you really really need to have a lot of people try to do that in house and that's okay but usually you want when you're doing a data conversion into the systems that are out there today especially the ones that are in these latest and greatest Healthcare reform versions they need to be they need to be done by folks to know what they're doing to hit all the right spots not somebody just combing through the database and sort of guessing at it um so there's there's a lot of considerations that um fall into that category that really need to be taken um seriously and then why do conversion fail uh this seems to this list will grow every time uh you do one and um so needless to say knowing these ahead of time can can absolutely be vital um planning yeah of course we'll talk more about that um data assessment not performed this is the whole garbage garbage in garbage out concept so um if the data that was purely free texted into the medication module um why isn't it participating in my drug interaction checking in my new system well probably because you didn't have an NDC ID to give to your programmer things like that so you have to do a really kind of an in-depth data assessment before you even decide if the data conversion is something you you should even consider doing uh testing of course is a huge one usually testing involves the programmer getting done and saying yep I'm done and I tested it uh when really they should have involved the clinical staff uh to actually go through workflow scenarios and really look into data and really see how it prints out on documents and oh I found duplication things like that so they want to involve your testing staff as much as humanly possible fashionable not to do so because well everyone's of course busy but um just stay and age uh they they're imperative uh timing issues if you're coming from anybody's image heavy I've got six terabytes of data that um are all patient images and I need every one of them and uh it might take them might take your um conversion staff 48 hours straight to process all of the the scripting behind that or just moving the files from secure hard drive to secure hard drive um can take an entire day for example and so maybe the concept of going down on a Friday and I've got two days to bring it up and have it ready Monday just gets thrown out the door it isn't physically possible you could put a gun to somebody's head and they couldn't do it so those are the things that need to be considered um when you talk about the timing issues and how to handle that um and and there are others but those are those are pretty big reasons why why they fail okay so there are PL there's always options when you go to consider doing a data conversion and it really matters um it gets really specific on what types of data you're converting and what your systems are capable of handling and the expertise handling it so you don't always necessarily need a conversion so let's talk about what the options are and a lot this is a fashionable one right here let's leave our old system up and running yeah because you know generally speaking you've got old AR that you need to work down so you leave the data or you leave that system up and some form of readon mode where you can still get in there and process through and work some of that AR down um and then maybe you don't have to do a conversion so that's a that's a pro you don't have to spend the money on it data conversion can be expensive however I'm sure as you might guess here um some of the con to that now you're living in two systems um and so you're you're working in one and you're entering new data but I I kid you not I um I just left the an implementation where that had happened a few months ago where um a data conversion was performed and they did a they did a few clinical pieces but at the end of the day there were a lot of questions that came that came up with the providers on on followup appointments needing to be scheduled and they needed to really see their last comprehensive note and to make any kind of real decision and they were toggling back and forth in their old system because they didn't do a document conversion they couldn't see their old note so they they were living in both systems and they'll probably be doing that for about a year because some of these providers at the specialty thought that they could see all their patients over the course of a year and then be able to Sunset that old system efficiently but that's uh that's a pretty big con it's almost like it would have been worth the money had they done their testing with the clinical stats to know they would have needed that um yeah also depends one of the Cs leaving that old system up is that they do require that you have a massive maintenance maybe even additional hosting and support and all of the costs that go along with just leaving a system up you've now doubled you've got your old system and you've got your new system so whatever those costs are involved um you know if it's going to cost you $20,000 for your data conversion you find out and then the maintenance costs are a little less it can be something you have to weigh out and see if you really need it um obviously if the old system goes down if it uh if it for any weird reason um they stop supporting it or the company goes under there's a lot of consolidation in emrs right now and and 100 systems are now into the top 30 and um you know the the system was cloud-based for example and it disappears um what if what if you can't get it back and you should have had a conversion that's a risk um so those are the things that uh most folks try to try to deal with when it comes to leaving your old system up and working in your new one another option and this is a favorite one of a lot of people is put it on the staff what we're going to do is two weeks before we start seeing patience and we go live with our new system we're going to have our staff get in there and hand enter all of our existing data from the old system on one screen we're going to put it in the new screen and we're just going to do it manually and that's going to be our chart abstraction electronic data conversion process and so I tell you what that's good news because um you're using your new EMR to its full functionality all that data is getting put in very precisely into all the necessary cross reference SQL tables that are tough to find when you do a data conversion you get that because you're using the system to do so um and then and then what you got the data right there F your hands uh F your fingertips if you're a provider but that is an ongoing process for a very long time do the staff have the bandwidth for it so you're almost you're almost certainly talking about hiring at least one more person to help with that process every time or your folks are just going to get worked into the ground which you know if if your if your patient visits are few and far between maybe you've got the bandwidth for it I don't know too many doctor offices like that most of the time these groups are back running up at 100% after a few weeks or three weeks and it's uh they don't have a lot of time for that so um that is uh that is tricky um and then the cons obviously are if uh if they are entering it and they're in a hurry and they're stress you know and they they enter in some data and make an error you know I think the chances of of that error increase as um as that pressure mounts um and then yeah it's resource intense so it's cost intensive so uh that uh that can be sort of your your office developing a limp and then limping through the rest of the process so that that's not my favorite um another option is of course a data conversion a fullon discret data conversion so we're not talking about making a big PDF out of everybody's chart which is the next slide spoiler alert um this is your fullon data conversion so um what we're talking about here is working with the vendor of the Legacy system to give you that discrete data I need Med you know whatever I need list out your clinical elements that we'd like to convert get it in the scope and give them to me securely and I will load that into my new system manual or through through scripting and you know obviously that's ideal because you get to keep all that accurate discreet data it's it's reportable it's um it's it you you have to live in two systems it's it's you know the Best of Both Worlds it's it can be cheap you don't have to pay another resource you don't have to keep you know the support licenses and the maintenance up for another software for however long you're going to do this side by side action um I know that Legacy data is fully accessible however um it can be expensive so data conversion elements and this is this is for years now um it's been going on to where uh systems are um converting um on top of each other it's called stacking and what'll happen is uh you get bought out from one system and uh they merge with another and merge with another and all of a sudden you've got these These Old IDs for um the last three demographic loads worth of patients and that's when duplicate data starts to occur you really have to kind of be careful about um the accuracy that gets converted um so that can be um that can be kind of that expertise piece that you really need your your coders need to be able to weed out duplicates that at a high level um that's sort of that garbage in garbage out that can be a con of uh of the discrete data conversion um and then yeah cost prohibitive so if if a data conversion cost $20,000 and and really you know it'll only be uh you know a small one or two dot group you know that just can't stomach that money I mean that's that's your meaningful use for Year One right there gone um what are we doing this for kind of a thing uh they might want to stomach that be over um over the course of months just paying a salary um so just three day conversions that that can be good although there are some pros and cons there and I alluded to this um this other option here regarding um this is this is pretty fashionable there are groups out there um that will do scanning and I'm sure everyone knows a vendor um that essentially you can if you still have paper You Can Box up your paper and you can send it over and they will scan it in and send you back a big group of PDFs that represent your patient chart and you get PDFs that way and those need to be converted that is a non-isr data conversion that's just a a loading of images into your new system or your legacy system can export PDFs so they've got a utility or a feature and this isn't necessarily CCD although sometimes they have the ability to turn that CCD into a PDF and Export it but it's usually on a one-off Case they'll try to get you to buy a piece of their system if you want to automate that and weaponize it to export all of your patients in such a fashion uh so essentially it can be expensive but sometimes they can export all of the contents to a PDF file and give it to you that can be ideal too as long as you get a master index list along with it so you got to make sure to get along with the images a big list of all of the patients and the relationship to those images because often times it's not going to be John do birthday. PDF you know you're not going to know what the image is unless you have that cross reference file so the Legacy vendor can give you that and then you'll have both pieces you'll need to import the data and quite often some of the bigger vendors out there next in clinical Works H script some of those ambulatory settings will have utilities that do this already so as long as the Legacy vendor gives you that stuff you can actually um get that that import utility from your vendor and I they might charge you a little bit for it but it's not going to be anything crazy sometimes it's free and load the file up and load your images into a couple of different folders and then they'll just cycle and automatically import all that stuff into your database and that is golden um you save on a costly discret conversion and you don't have two systems running um although the bad part of that um can really be a scenario where you've got a patient with a 200 Page PDF file as their entire chart and you're just kind of scrolling through it it's not indexed it's not categorized that can be trouble because you're looking for a lab result and it's on the last page of 200 Page PDF it's out of the question docs won't use it so they can give you PDFs in a meaningful way categories or something like that then you're then you're golden but if if they can't if if it's if you're handcuffed by the what the vendor the Legacy vendor can give you as just one big PDF the whole patient's chart uh you know medical legally maybe it's a good reason to have it but um workflow real life using those things is is often often quite a different story so anyway um PDF conversion is an option okay and my favorite opt um although it's kind of pie in the sky unless you're a bigger company because they it can take a couple resources to pull this off if you're a big organization that is looking to incrementally add practices as you go data conver you can live in data conversion hell for months and months and months and months all with all these groups however if they are um if they do find themselves and this is rare um with the ability to interface with you and hopefully it's they're all on the same software and they're just multiple location you can spin up an interface to keep the systems in syc as you roll them onto the new practices so under the new software so how this would work and we did I've done this a couple times um essentially you you set up a demographic interface for example and anytime a patient is added or removed from one practice or the other or added or updated you send those a4s and a8s to the other system so that the uh demographic information is the same in both places you do want to establish the system of Truth Etc you can it depends on how Savvy your programming interface folks are or how Savvy your uh software is rather um you know if you can if you can configure it sometimes software provided by vendors has you don't have the source code so you're stuck with whatever configuration options they have but you can take those and um keep that Insurance data up to date in real time almost um so that's that's something that you know can be considered now with clinical data that that gets kind of tricky demographics and insurance yeah you can keep those up to speed appointments absolutely um you can even do charge data if you wanted to although that's usually pretty um specific to one software and you want to keep that over there you know keep those um those that were created in the old system in the old system and do new charges in new system that's usually way people do that that's using that interface but um clinical elements like Med Val lab results stuff like that those are all interface but um interfacing them in real time can be difficult because it takes a such a large usually there's such a large cross reference that needs to be done before the interfaces can be turned on um a good example is allergies there's probably 50,000 different allergen types at the Latin level um and every one of those they don't really like a medication is can be easier because they have NDC IDs that you can match on however NDC IDs do actually change um rarely but they do change so ACC you do ndci plus a little piece of the medication name um to kind of be sure about that but essentially the allergen IDs don't you know in certain systems wherever you get your data First Data Bank whever don't really have the same allergy IDs and so you have you're stuck you know cross referencing them so there's a chance that the interface doesn't work for some time of data just because the effort is too high to get that linked up but essentially that's the perfect world I mean that's the that's the the Golden Goose situation here is when the interfaces are keeping data together and it's almost like a real-time conversion all the time um so you generally speaking when you have interfaces up like that you just don't need conversions because the interfaces themselves can you can actually trigger them to feed all the data over and not just do a a one-on-one they can be queued up to send an entire load over so things to consider usually I see folks doing demographics insurance and and lab results that can be kind of kept in sync um amongst them and some clinical elements but if there's pieces that you need that and that interfaces usually don't do um you're going to have trouble in that in that neighborhood so an example there would be um you know keeping the comprehensive note in sync well the documents themselves you know document interfaces do exist and they're usually inbound from hospitals for example um so it's it's very difficult because all those documents are usually stored um if they're stored in the database they live in some format that interfaces usually aren't familiar with yet so they'll have some dcom or B 64 data type um that the image is stored in that when exported you know if you've got the mer engine or something loaded up as the custom interface it can be really difficult to sort of build those agents or I'm sorry those channels um to decode that stuff and send it over as a PDF or a link to a PDF in real time it's kind of uh it can be a little more challenging um and it's not very often done in in these conversion situations where they have um tight timelines so anyway kind of depends on the data so it's something to consider if your vendors are nice and they'll play with each other um you might get lucky and have a good experience of using interfaces all right so uh generally speaking what's my conversion process maybe you're going through it right now and you want to know if your folks are doing the right thing it's not a complicated idea um but skipping one of these steps is going to shoot you right in the foot so I'm just going to show them to you let's see here so obviously First Step Discovery um and what risk are involved um it's always good to get that stuff out there first um to figure out what risk you're going to run into and what the plan is for all of those and um you know what your timeline is so usually the timeline's out there and someone says yep we're GNA go live July 10th absolutely and and then you know later on you figure out that everyone's on vacation everybody and their brother is on vacation between July 1st and July 20th and no work gets done and with a conversion you've got everybody involved from programmers on both sides to clinical folks to testers and so anyway you gotta watch the schedule on data conversions a lot of pieces that need to happen and a lot um you know people people get sick people go on vacation so you really got to be careful about that and usually that leads to discussion on these slas so service level agreements um usually you got to get those in place just to kind of cover yourself um in these extensive situations um cool and then one of the most most important processes that it's supposed to be done pre-sale but sales guys sometimes don't do that is kind of you're supposed to do your due diligence and look at the data before you decide to purchase a data conversion sometimes you'll find out at the last minute that there are problems it should have been caught early on that weren't um and that usually means devoting a um an engineer into a sales process which is uh never fun but a sales engineer as they are often called get in there look at the data and see how bad it is see how bad it is coming from the old system do they have unique identifiers is John and one system does he have a person number or unique person identifier that is assigned to no one else that I can use to make sure I don't have duplicates um when I talk when I start talking about matching to the rest of the data and all of a sudden you find out that you don't and you're matching on last name first name date of birth or last name first name social and date of birth and all of a sudden you're guaranteed guarante to have a 10% induced duplicate patient uh population and yeah everybody's got a tool to kind of work those down but it'll take you years and it's just a big nightmare and you'll hear people talking about that bot conversion for years you don't ever want to be a part of something like that um and then I kind of alluded to this earlier but mapping of the conversion um elements and creating those teams to kind of do that is huge and um you know what was um you know an insurance conversion what we have we have UHC um but another system has a UHC with 30 different PO Boxes and oh by the way they change every day well who's dealing with that who's maintaining that during this process and you have to identify those folks and make spreadsheets or have Team Foundation going and and put everything somewhere it's just you have to kind of create that workspace create that the the governance along the project who are going to be the contributors who are going to be the sponsors and the stakeholders those things have to be done early on or you're going to hit these walls and uh no one's GNA know who to turn to um and I I mentioned data mapping earlier talking about um uh allergy IDs but essentially it's going to be the same thing for your you know your your provider names and your your locations and in the old system we use one two three and new system we use something else um we have to get to do that mapping and you'd be surprised at how many elements there truly truly are with even something as small as an appointment you know you'll have an event type you'll have location you um what's your appointment type your resource is it a doctor or is it a room the appointment with is the appointment with the lab so these things you have to ask yourself all those questions and um and document everything because if someone does have to come up in the middle of it pick this project up then uh they're going to need all the uh help they can get and programmers love to not document everything that is our number one favorite thing to do is do our work and not comment and not document and uh if someone comes in behind you and they have no idea what happened cannot tell you the number of times that has happened um so somebody needs to oversee that project and make sure that documentation in there additional requirements uh format huge uh tough part about this one is a lot of times you're coming from one database to another and the vendor that you are exporting away from you're leaving and they don't want to work with you uh or they're not happy about it and so you're like hey can I get this data in a certain format nope uh we only exported one way sir here you go like they're not really excited to help you so sometimes you're and then the new version they're asking you You' got to put the data in this format and they give you how they want you to do it because they're the ones that have to convert this data so they're going to put the onus on you this middle ground and so you need to find out if that's something you're going to do that's back to the SLA on who's actually going to be doing that formatting so it can be difficult and usually you'll have to sign your life away to get a hold of one of these database specs if a vendor will actually give it to you uh however um I can count I've probably done 50 conversions and I can count on one hand the number of times the vendors un willing to give me a spec and uh from version to version they actually change so they can they become OBS pretty quick um but yeah they'll make you do a field by field uh definition of everything that's going to be converted and lay the data types out and and that can be that can be a very very cumbersome process for someone it's really nice to have though if you actually have it if they can say listen got to be like this I got a utility it'll make this whole process really easy but somebody's got to go in and give me this in a certain way and that is a requirement make that a requirement put it in the SLA make them give it to you they can they can do it just make sure you get that in the contract it'll make your life go a lot easier on the way out and you won't forget something I can't tell you how many times that's happen where you do the whole conversion and somebody goes who did who forgot to get gender and you kind of turn around and go oh yeah we need that too well if you would have had this requirment document laid out nicely and reviewed and approved by clinical staff we wouldn't have be in this in this problem in this situation all right so after the requirements done here comes the build um and I kind of already talked about mappings and and and that stuff so I'm going to skip that slide um okay so we get down into the conversion design so now you're actually scripting up the work and you're you're converting the data and you've determined that you've done all your mapping and now you're it it's it's on somebody to do this work and this is where you really need to be careful on who you decide is going to do this work you want somebody who has done this before at no point do you want to find yourself in a situation where the person is learning on your on your patient data how to do a conversion because they'll a data type will get screwed up and you'll convert all the ones and zeros to zeros and ones it will happen I guarantee it uh you'll be in a situation where at the last minute um you'll find yourself uh all this data got duplicated and we can't figure out why and it's it's nice to have someone who's done it before because they know the table structures they know the layout they know and they've been through this whole thing so uh you can rely on their expertise having done this already you get someone in there who is cheaper you know you get somebody's brother in there for $15 an hour and they can do a demographic Inver you got get what you pay for um so you know when you start talking about all the risks involved here that we discussed earlier um it it can be it can be a really good idea to kind of kind use someone use the group that's done these before because there'll be a lot to consider um that someone learning really might not you know understand and so that's kind of a piece of this is you know an example would be if if uh if they're if they are bringing in discrete elements and they need encounters for example to tie back each one of your elements you can't just load up um a bunch of meds and allergies and diagnosis codes and not know what data service you had and and how to get that to render into the history window of how many encounters they've had and all of a sudden this conversion is spinning out of control in their hands when um somebody that's done this before would have that under control so they do the build and then it comes to testing this is everyone's favorite thing to skip is full volume testing and obviously in a perfect world you would have multiple environments and you you convert the data in and you'd be able to to have um you know a primary testing environment for for all the data where you're converting every single element and then you can have another one where you convert some data and have um your production simulation and your your clinical staffs in there looking at it as well and you're kind of both running and not stepping on each other's toes and Reporting issues and tracking them in a software and just taking everything into consideration um that's ideal that is absolutely ideal but it's never followed here it is I'm going to give you every testing scenario because honestly as a programmer I can only test so much of your data you know it's the clinical folks and the end users that got to pull up their old system because they know how to get around it find every little nook and cranny of data that was supposed to be converted go toggle over to the new system and find it and say I can't find this tell me where it is that is truly needed by the clinical staff can't tell you how many times I'll lay that whole thing out I'll put an entire testing plan in front of a client they will open up their own mother and look down her chart and say you know Yep looks good and close it or they'll spot check three people and that is not enough that is just not enough you need more than one person testing more than one scenario there's every office has about four workflows everybody knows them you got your your provider workflow your intake staff workflow you got referrals over there you got schedulers over here you got Mas that are doing this and then you got the lab workflow and there's there's always these these handful of processes that get skipped every time it's one person taking a big broad look when it should be five different scenarios and they don't get done testing um so you got to keep keep a hold of that and then usually you know I mentioned tracking so put those all into a piece of software um and make sure you don't forget something and then get sign off my goodness the doctors are the ones who create the biggest amounts of screaming whenever the conversions don't go and they should um rightfully so those are the ones you're going to hear from um so you know as much as I hate to say it you know the staff are going to be the ones affected the most and doing the screaming but the docks are the ones that the uh sea levels are going to be listening to and the folks that are going to be those are the the people that are paying the bills you really have to to make sure that they get buying and if they sign off on the conversion and I I can count again count on the on the number of times on one hand that I've had a provider group you know signing off on something because it's it's time out of their day quite honestly which you know most providers are busy as all heck especially with these latest reform systems eating up more and more of their time um it can seem like the last thing on earth they would want to do but uh got to highly recommend that and then what's left nothing else but to go live and I alluded to this earlier um depending on how much data how complex it is and the time it takes the timing issues that we talked about how do you go live and that's a big one everyone just throws the date out there yeah we're going to do that but no one really talks about what it'll take and usually that's where when you do the test conversion you can time it you can say well it looks like it took us three and a half days to do our test conversion from start to finished we timed it out okay that's longer than a weekend now what are we dropping back to paper for a day are we going to you know run both systems in parallel like how do we do this to survive and that's where these Gap conversions or these catch-up conversions can happen to where you can do um a majority of the data gets converted over the allotment of time that you do have on a Friday night for example and then the practice will drop back the paper um on a Monday for example uh or a Monday through a Friday or maybe they drop back for a week or a couple days or some period of time where after that initial Big Bang conversion done is done that Monday or Tuesday they went to paper those two days you have to you you get to do this little catch-up conversion this little extra conversion where the where the office was still seeing people in the old Legacy system before they turned it off because they couldn't turn it off because the conversion wasn't done so you do the big bang and then you do this it's almost it seems It's frustratingly it seems pointless but you do a data pull of two days from the old system and then you deliver that to the programmers and then they basically at a dead run do a catch-up conversion as fast as humanly possible um on a given evening and then they take it uh live the next day and they can Sunset their old system so that's one approach um uh if you can if you're lucky enough to be to do a roll out conversion with interfaces fantastic um that reduces the manual activity but usually it's a big bang sty that's what the majority of the conversions I've done are they can be processed over a weekend so you you Friday night close the systems down do the export load all the data in after youve tested and everything and then you get on Sunday you get you get a day get buffer day to test all the stuff that you loaded in Saturday night and then Sunday test and then Monday morning you go live and then yeah you can leave the old system up for a day or two if you want or until you're comfortable with taking it down till you trust your Source system your new one and that's it so at the end of the day um lots of options as discussed and I'll post these slides um online um I'm going to do my level best to unmute everybody and anybody has a um a question of any kind um feel free to ask uh now I'm about halfway down this list because I'm unmuting everybody fantastic everyone is unmuted any questions whatsoever um any weird scenarios you guys are considering with data conversions that you would like to discuss hi Dan I got a quick question for you if that's all right yeah absolutely interested in know your experience on how often that you're using uh clinical ccds produced by the the the prior Source system and using those as just kind of out of the box and what they generally give you as what you use to see the the clinical record for the new system so you're not really importing that but you're just storing it in case you need to pull it up is that right so they provide you a big bunch of ccds and and they're on a folder no I'm I guess importing them yeah I'm I'm actually asking them are you have you done that before or do you have any experience or or heard of people utilizing that as rather than going in and pulling data out of the the prior source using you know SQL or whatever it is yeah just utilizing the CCD and parsing that and creating your own your own uh import process yeah exactly right um the one downside that I've done that twice now and the downside I've had both times is obviously I wasn't able to get the note I wasn't able to get documents and images they the CPD exp portability was was um handcuffed by the software's ability to export only certain elements so we were missing so you got I got a lot of modular data I got a lot of the the core elements that are in the um you know mu mu core set so the and allergies and problems and things like that the good stuff you you're able to get but some of that other data um doesn't come with those ccds but yeah folks usually you don't have um the automated import ability you get some tool that allows you do on a oneoff to import those ccds and so that's that's helpful if you needed on a oneoff but you have to you have to script some kind of batch file that runs that executable if you want to do it in automated fashion probably like you were like you were saying if if needed I'll go ahead and pull that up and create my own process is that kind of what you're were talking about yeah I think so I just as generally the speaking I just wanted to know your thoughts on doing using that option I don't I don't see a lot of people doing it either I guess a followup to that is do you get into a lot of the um of the custom workflow um within the the prior Source system so having to worry about um you know where things are stored in multiple places and and you get into that in a lot of your conversion efforts with your clients um I do when you say multiple places are you just within a given system yeah so for example you know there there's a you know an epic for example or or whatever other system you can use you there's a place for procedures where mammograms and you know any other procedures are put into the the clinical chart but then you may have a custom template or or they may be you know you may have practices storing it off in past surgical history and uh you know another place that they're not supposed to be doing it and you know Etc I'm just kind of wondering what your thoughts are on that yeah yeah absolutely and so less and less I've had less and less of that these days just because a lot of the stuff has to live in certain places for Meaningful use so the system says you know you've got to have your Encounters in these tables or your this type of data in these tables so I you're right it's definitely okay I'm G to put it there and then yeah it's it's all about where else do you want it and I I don't do it a lot just because uh if it's something custom you know I'll tie a pretty big price tag to it just because it's usually Uncharted Territory but you know if it's if it's something that isn't out of the you know it's not anything that you haven't a lot of those systems um you can't get yourself into too much trouble with as far as when you when you start you know some places like all scripts they give you an API and you can get in as much trouble as you want to those are those are kind of uh those those can be interesting just if you're coming in on some really custom work but you know your nextg of the world that have templates for example and those templates all live as SQL tables so you can load those up really easy um and do custom multiple places you're right that happens all the time yeah okay thanks yeah thank you anybody else have any questions all right I'll post these slides if uh if you have any questions you want to email me direct you see the uh uh email address on the screen there I've appreciate everybody coming out and hope you have a good rest of your week thanks everybody bye