Netsmart Cloud Migration: A Guide for Post-Acute IT Leaders

The Mandate for Modernization

For IT Directors in Home Health, Hospice, and Senior Living, the industry direction is clear. The sector is moving decisively away from legacy on-premise solutions toward the integrated, cloud-based MyUnity platform.

But for organizations running legacy workhorses, specifically Netsmart Homecare (formerly Allscripts) or Netsmart Advisor (formerly McKesson), the move to MyUnity is not a simple version upgrade. It is a replatforming event that fundamentally changes how your organization handles data, reporting, and billing.

We frequently see internal IT teams treat this as a standard ETL (Extract, Transform, Load) project, only to face critical stalls during User Acceptance Testing (UAT). The friction usually stems from five specific technical “deltas” between the legacy architecture and the new cloud environment. If you are planning a migration in 2026, here is the technical reality you ought to prepare for.

1. The Reporting Delta: From Direct SQL to API

The most significant operational shock for teams moving from Netsmart Homecare to MyUnity is the loss of direct database access.

In your legacy environment, you likely have read-access to the SQL backend. Over the last decade, your team has probably built a library of custom Crystal Reports or SQL queries to handle non-standard compliance requests, operational workarounds, or board reporting. You control the schema and the query logic.

In MyUnity’s multi-tenant SaaS environment, that direct access disappears. You cannot patch a workflow gap with a quick SQL update. Reporting shifts to front-end configuration tools or standardized API endpoints (FHIR/HL7).

The Risk: Reports that rely on custom tables or non-standard fields in your legacy system will break immediately upon go-live.

The Fix: You must conduct a “Shadow Reporting Audit” during Phase 1. Identify every non-standard report currently in use by your Clinical Director and CFO. You will need a data analyst to map these requirements to MyUnity’s standard dashboards or build new connectors via Power BI early in the process. Do not wait until UAT to discover your Board Report is impossible to generate.

2. The Integration Gap: Standard Interfaces vs. Custom Workflows

A modern agency ecosystem is a web of third-party vendors. You likely integrate with Pharmacy Benefits Managers (like Delta Care RX), CRM platforms (Playmaker/Salesforce), and hardware providers (Pyxis).

In legacy Netsmart Homecare instances, these integrations were often built as custom point-to-point interfaces or flat-file exchanges tailored to your specific intake workflows. MyUnity utilizes a modern, standardized integration framework. While superior in stability, it is less flexible regarding custom data payloads.

The Risk: Standard interfaces may drop custom intake fields your team relies on for routing patients. We often see the “Delta RX” integration work technically, but fail operationally because it doesn’t pass a specific patient status code used by your pharmacy team.

The Fix: Map your integration touchpoints at the field level, not just the vendor level. Validate that the standard MyUnity interface supports every data point your third-party vendors currently receive. If gaps exist, you may need middleware solutions to bridge the difference.

3. The “Dirty Data” Architecture: Active vs. Historical

Migrating 15+ years of patient data from a legacy SQL database into a clean cloud environment is technically risky and operationally inefficient. Legacy databases are often plagued by duplicate patient records, retired payor codes, and voided claims that have accumulated since 2011.

The Risk: Pushing this “dirty data” into MyUnity bloats the new tenant, slows down search performance, and confuses clinical staff with obsolete payor options.

The Fix: Adopt a Split Migration Strategy:

• Active Census & Recent History (12–18 months): This data is scrubbed, validated, and migrated into MyUnity. This ensures continuity of care for current patients.

• Legacy Archive: Extract the remaining historical data to a secure, queryable cold storage archive (such as a separate SQL server or data warehouse). This satisfies retention regulations without polluting your new production environment.

4. RCM Complexity: Room & Board and Pass-Throughs

Hospice billing contains nuances that generic EHR configurations often miss. The most common failure point we see in MyUnity implementations is the configuration of Room & Board pass-throughs for skilled nursing facilities (SNFs).

The Risk: If the “Facility” and “Vendor” relationships are not configured perfectly in MyUnity, the system cannot automate the 95% pass-through logic. This forces your billing team to manually calculate and adjust hundreds of claims every month, causing massive revenue leakage and administrative burnout.

The Fix: Your Revenue Cycle Management (RCM) lead must be in the sandbox environment months before go-live. They need to validate that the new “Payor Plans” can handle your specific tiered rates, continuous care sliding scales, and multi-state taxation rules (especially relevant for agencies operating across NC/SC borders).

5. The Medicare Guide (VBID) Compliance Trap

For agencies participating in the Medicare Advantage Value-Based Insurance Design (VBID) Model, the data requirements are stringent. The “Medicare Guide” program requires the submission of specific “Supplemental Benefits” data that many legacy systems did not strictly enforce.

The Risk: If your migration map does not account for these new required fields, your VBID claims will face wholesale rejection. We have seen agencies delay go-live specifically because their legacy data lacked the granularity required for MyUnity’s VBID modules.

The Fix: Treat VBID compliance as a separate workstream. Verify that your clinical forms in MyUnity are mandatory for the specific supplemental data points required by the latest CMS technical specifications. These challenges are why many healthcare facilities bring in specialized Netsmart consulting early in the process.

The Bottom Line

Moving to the cloud is necessary for security and long-term viability. However, success requires a “Migration Architect” mindset. You need a team that understands the schema you are leaving and the strictures of the platform you are entering.

At HealthTECH, we are an EHR consulting firm that specializes in bridging this gap. We deploy functional consultants who have managed the specific transition from legacy Netsmart platforms like Netsmart Homecare, to MyUnity. We help you scrub the data, test the RCM logic, and ensure your organization is ready for the technical realities ahead.

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Need a Readiness Assessment? To discuss your current architecture and migration timeline, please reach out online to schedule a call with one of our experts. Or, call us at (866) 826-1270.