Record exportability is the ability to retrieve patient information from an electronic health record (EHR) for an authorized purpose. The purpose behind why users export determines what the export should include. Perhaps an audit trail is needed for auditing purposes or a history behind a note for an attorney. A saved chart alone cannot fulfill every request.

Teams can begin the export process by using HIPAA compliant email to send records. Including a written scope, such as the records, who needs to receive them, and the date ranges, then helps records, compliance, and IT teams produce the right information without circulating more patient data than the task calls for.

 

Audits need more than a readable chart

The systematic review Using electronic health record audit logs to study clinical activity states, “While originally designed to aid access control, EHR audit logs have been used to observe diverse clinical activities.” An audit log is what keeps track of activity in an organization's EHR. It can be used to see what actions were performed on a patient chart, such as whether someone viewed or modified the record.

When teams need to perform an audit on documentation or chart access, they should know if a chart can be exported alongside those records. They may be able to print a record that will show what was typed in the note but not the history behind it. Access is therefore dependent on an audit need. The audit lead can request what they need through HIPAA compliant email, naming the patient or authorized record set, data range, and requested logs. The response document can provide them with what was exported, when it was produced, and where the protected files were made available. This allows for a chain of email for further requests and can be used as another audit trail on the EHR to see activity from a secondary source.

 

Lawsuits may require the history behind a record

The Narrative Review of Electronic Health Record Systems in Anesthesia explains, “Metadata, ‘data about the data’, provides insight into record authenticity, clinician involvement in care, and communication between providers.” Metadata can offer a wealth of information, including creation and modification times. During litigation, this information helps legal teams understand when information was entered or changed.

The review above shows that metadata is not routinely included when a chart is printed or sent elsewhere. The information preserved or produced during litigation is dependent on the case and the applicable legal requirements. An export format on its own will not establish whether a record will be admitted as evidence. Once the required information is established, the records team within an organization can then coordinate with counsel before narrowing or altering the relevant export. HIPAA compliant email can then be used to carry the preservation instructions, approved scope, and confirmation that the original files and logs were secured. Restrict access to the files and use the organization’s approved method to transfer them to authorized recipients. That gives reviewers a clearer account of what was preserved and shared.

 

Vendor changes require a decision about which data moves

The study Defining Data Migration Across Multidisciplinary Ambulatory Clinics Using Participatory Design advises, “Institutions undergoing an EHR transition should actively involve physician end-users and key stakeholders.” Data migration is simply exporting data from an old system to a new one. They found that different specialties wanted varying types of information and varying amounts of information. This helps staff know what to export to the new system and what to leave in the legacy system while still being able to access it. Organizations should ensure staff go through notes, labs, medication, and any attachments with reviewers. It is also necessary to identify which systems have data stored in them, as there may be other programs not included in the EHR export.

Staff can use HIPAA compliant email to send out the proposed data migration and allow the different clinical teams to make changes. Staff can keep their process free from patient information unless it is needed to help demonstrate an example. It will help your new vendor understand what you are looking for and allow the end user to identify anything they feel is missing before the system is shut down.

 

A successful download still needs a usability check

Mapped record testing allows staff to see if the information will appear in the right field on their organizations new system. When pulling samples from old and new records they can identify data that may not show up or will appear incorrect. It is helpful to use various test patients that will represent many records and history before changing vendors. It is beneficial to make sure that important information can be found on the patient's chart. If an issue is found, document what it is and who will resolve it.

Exception reports and information should be sent by HIPAA compliant email to your designated migration staff. Make sure to include only pertinent information about the patient that will allow for the problem to be found. Have a written resolution available so that staff can ensure the issue was resolved. The federal EHI export certification criterion states that the recipient must be able to export the information electronically in a way that the certified product can store. If the user can export that data in PDF format, it may meet this criterion. Unless PDFs are images, in which case they may not. Remember that just because a product is certified does not mean the product will export correctly to a new system or that staff will be able to pull certain activity logs.

 

FAQs

Can I use a download from the patient portal to replace an export when migrating from an EHR?

Most likely no. There could be data in the export that you don't have in the patient portal and vice versa.

 

Who should have the ability to export all patients?

It should be done by staff that you grant access to under your policies and procedure for your organization.

 

What if imaging or billing data lives in another system?

Add that system to the data inventory and confirm how its records will remain available or be transferred.