Document Complexities

Converting healthcare documents from legacy EHR systems can be highly complex due to the dispersion of data across multiple systems in different formats and varying definitions.

Patient data can be stored in various locations, including your EHR software, radiology information systems (RIS), pharmacy management systems, and other third-party applications. Some data formats are unique to specific EHR software, leading to compatibility issues during the migration.

Aesto’s document conversion process is integral to the overall strategy for archiving legacy EHR data, ensuring all documents are easily accessible in Aesto’s DataCapture Platform.

Learn more about Aesto’s solutions for overcoming technical challenges with document conversions.

Defining Document Types

Physical Documents

• Paper-Based Records: Any records or forms that have been scanned or manually entered.
• System Reports: Reports that display information at a specific point in time.
• Patient Clinical Information: Generated Clinical data representing a single point in time.
• Non-Editable Documents: Files that cannot be edited, represented by a single file, can be opened independently, and do not require unique viewing software.
• Common File Formats: PDF, TIFF

Generated Documents

A generated document is a file created by software or a system, typically based on predefined templates or input data. When viewed in the EHR system, these documents are often automatically produced, pulling relevant information from discrete data stored in the database.

Specialized programming in the EHR system generates a document to display for the user. These programs will pull information from several sources to render one displayed image.

Typical file formats include:

• XML with corresponding stylesheets
• Microsoft Word & Microsoft Excel
• HTML
• TXT
• HL7
• JPG
• HiEdit
• RTF

Document Conversion Challenges

Generated documents can present numerous challenges for a project, sometimes introducing unforeseen technical difficulties that may result in delays. Challenges the Aesto team has encountered include:

• Various Stylesheets Utilized to Format an XML File: Stylesheets define how the data in an XML file should be presented. Formatting inconsistencies may arise if multiple stylesheets are used when converting XML files.
• Embedded Macros in Microsoft Files: Microsoft files, such as Word documents or Excel spreadsheets, may contain embedded macros, programs that automate tasks. These macros can interfere with the conversion and affect how the data is displayed.
• Document Encryption & Storage on Hard Drives: Some documents may be encrypted or stored on hard drives with restricted access. Proper authorization or decryption methods must be in place for the Aesto team to proceed with the conversion.
• Uncommon Database Backups: Database backups may use uncommon or proprietary formats, requiring specialized tools or custom solutions to extract the data.
• File Types Unique to One EHR System: Some EHR vendors may use file types specific to their system that are not commonly used or recognized by other systems. These unique file types can lead to compatibility issues.
• HL7 Messages Requiring a Custom Interface: HL7 (Health Level Seven) messages are a standard format used for exchanging healthcare information. However, due to variations in how different systems implement the standard, HL7 messages may require a custom interface to process and extract the data.
• RPA Process to Screen Scrape Documents: Robotic Process Automation (RPA) can automate document extractions by “screen scraping” the information directly from the user interface. However, if document layouts vary, this method may not always yield accurate results.
• Creation of Custom Reports: Custom reports generated by the legacy system may have unique formatting or data structures that require specialized processing to extract and convert the information accurately.
• Rendering of Documents in a Web Browser: Documents viewed in a web browser may appear differently than how they displayed in the legacy EHR system due to formatting discrepancies during the conversion.
• Generation of Individual Documents: The legacy system may generate documents individually rather than in batches, increasing processing time and complexity.
• Custom Report Builders Storing Data in Different Locations: Custom report builders in a legacy EHR system may store the structure and data separately from the central database. Retrieving the data from multiple sources will require additional steps and time.
• Large Volume of Documents: The volume of documents can impact the overall project timeline, as larger data sets increase the complexity and time required for a successful conversion. 

Aesto’s Conversion Scope & QA Process

Ensuring accuracy and maintaining clinical relevance are paramount in successful document conversions with Aesto Health. Aesto’s comprehensive scope and quality assurance (QA) process includes:

• The Exclusion of Corrupt Documents: Physical documents that are corrupted and cannot be opened will be excluded from the dataset sent to a client’s new EHR vendor. Additionally, these documents can be removed from DataCapture if needed.
• Legacy System Documents: Unlike the EHR system, DataCapture does not generate documents instantly, as creating large documents requires substantial time. Therefore, all documents from a legacy system must be created before being imported into DataCapture.
• Electronic Signatures: In cases where a document contains both an electronic signature and a signature.jpg overlay, Aesto’s DataCapture Platform only preserves the electronic signature. Whether signed, typed, generated, or imaged, E-signatures are legally binding in the U.S. and many other countries worldwide.
• Rendering Generated Documents: Aesto’s generated documents are rendered from discrete data tables and often require customized software for proper display. As a result, they might appear differently from what’s seen in a client’s legacy EHR system. While differences in document formatting, such as the font type, color, size, and other aesthetic aspects, may arise, Aesto’s main priority is preserving clinical relevance throughout the migration.
• Project Scope Confirmation: The project scope will be clearly defined and approved by the client at the document category level within Aesto’s DataCapture Platform before quality assurance begins.
• Aesto’s Internal Document QA Process consists of the following steps for a subset of patients:
  1. Verifying physical document content and types.
  2. Ensuring documents are downloadable and accessible within DataCapture.
  3. Confirming clinical relevance of generated documents.
  4. Validating the inclusion of documents in the patient’s Release of Information.

Aesto’s Implementation Model for Documents

Steps & Considerations Include:

• Document Scope Assessment: Aesto will conduct a dedicated assessment for document conversions to aid in defining the complete project scope and update the project plan accordingly.
• Initial Conversion Process: When applicable, Aesto will initiate the document conversion using the primary backup provided. At this stage, certain document types or categories can be obtained from the legacy EHR system, and specific generated document processes can begin. For projects where this option is unavailable, the final backup provided will initiate the document conversion process.
• Phased or Batch Approach: When applicable, Aesto will handle document conversions in phases or batches. A batch of documents can automatically pass through DataCapture, completing steps for Aesto Internal QA, Client QA, Archive Viewable, and EHR imports.

If you have any questions about document conversions, contact your dedicated Aesto Project Manager.