Lessons Learned from our EMR Upgrade – Part 3

It is after 11 PM and I have just arrived home after a meeting with our practice leadership.   Why so late?  The meeting doesn’t start until 7 PM.  We docs can’t afford to take time out of our practices to meet during the day.  We moonlight as CEOs, CIOs, managers, etc. for our own practices.

This was the first meeting since March that was not dominated by unhappy discussions about the system upgrade.  It wasn’t even mentioned.  Tonight’s EMR discussions were forward looking, including e-prescribing, which just went live for us yesterday, and the pending results of our meaningful use gap analysis that will come out next week.  I think we have reached an appropriate point to take some perspective on our difficult upgrade.

To state the obvious first, we bit off too much at once.  Going 6 years without a software upgrade is bad enough.   But doing a major database conversion at the same time?  And buying all new servers?  And switching to VMware?  What the heck were we thinking?

As I mentioned yesterday we were afraid of using the database merge program (a.k.a. the migration tool) on our precious database until the vendor got more experience with it.  We also thought it was a reasonable strategy to feel all the pain all at once rather than spread it out over several smaller steps.  Regarding our 6 figure server purchase we were trying to cheat the old rule that any computer you buy will be obsolete by the time you get it home and plug it in.

In retrospect those were all good thoughts.  They just weren’t enough.  We failed to realize that while the migration tool was getting better through time, our database and applications were at the same time getting bigger and more complicated.  Every year we added an average of 50,000 new patients to our database.  We also added applications like our web portal and more automated document scanning / indexing.  Time also allows strange things to happen…such as when one office accidentally started scanning clinical documents into the practice management database.  Tens of thousands of documents were in the wrong place.  We picked up on it ahead of time and thought we had fixed it but the migration tool still had a problem with those image files.  Sometimes I wonder if we should have upgraded sooner and taken our chances with a less mature migration tool running on a smaller, less complicated, less entropy-riddled database.

The upgrade was harder and far more stressful than the original implementation in 2005.  I think this was because we no longer had paper charts as a lifeboat when the system wasn’t working well.  The gradual, no-hassle approach to EMR implementation that I wrote about months ago is not an option when you are switching databases.  I have a new found respect for practices that are forced to switch EMR programs.

VMware was a much bigger hassle than I expected.

When one considers that the upgrade occurred at the end of 6 years of relatively hassle-free system performance it really wasn’t that bad.   But it sure felt bad at the time, not knowing when or if we were going to get the bugs fixed.


About the author

Dr. Michael Koriwchak

Dr. Michael Koriwchak

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations.
Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia.
With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.


  • Read Dr. Koiwchak’s comments on whether older doctors should be allowed to opt out of EMR. 4 of our 10 docs are 65+. As a cost savings, an attempt to continue efficient work flow by freeing up older docs from the transition, and a purely practical approach we would like to move only the 6 younger docs to EMR. Does anyone know if this would preclude fulfillment of meaningful use criteria?

  • If my understanding is correct MU is done on an individual doctor basis, not by practice. So you can get an EMR system for the practice, let the 6 younger docs do MU, and each one gets a check individually.

  • Betty,
    Dr. Koriwchak is right. Meaningful Use is on a per provider basis. Although, the only other thing to be cautious of is that your older doctors who don’t show meaningful use will be subject to the medicare penalties once they go into effect.

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