Migrate from Essential MD Software Suite to Twenty CRM

Essential MD has no documented API — migration is CSV-first

Essential MD Software Suite does not expose a public REST or GraphQL API for automated data extraction. All migration activity must begin with CSV exports from the Essential MD admin interface. Large practices with hundreds of thousands of appointment records may face row limits in admin CSV exports and require batched or multi-file extraction. We validate record counts against the export files before committing to a migration timeline, and we handle inconsistent date formats (MM/DD/YYYY vs. DD/MM/YYYY) that commonly appear in admin-exported CSVs from older practice management systems.

HIPAA-sensitive fields require custom field creation in Twenty before migration

Medical Record Numbers (MRN), Social Security number fragments, allergies, and conditions have no native field in Twenty CRM's standard People object. These fields must be created in Twenty's data model UI (Settings → Data Model → People → Add Field) before the migration batch runs, otherwise the CSV import will drop them silently. We deliver a custom field creation checklist as part of the pre-migration plan — fields include MRN__c (text), Allergies__c (long text), Conditions__c (multi-select), SSN_Last_Four__c (text, encrypted), and Insurance_Group_Number__c (text). Fields with controlled vocabularies must have their pick-list options populated to match Essential MD's source values before the import file is submitted.

Appointment-to-Opportunity routing loses native appointment object semantics

Twenty CRM has no dedicated appointment object. Essential MD appointment records — with appointment_date, appointment_time, provider_name, appointment_type, and status — must be routed into Twenty's Opportunity or Task objects. Completed appointments route to Opportunities (stage = Closed Won, closeDate = appointment date) with custom fields for appointment_type and provider_name. Pending appointments route to Opportunities with stage = Scheduled. Follow-up reminders become Tasks with a due date matching the reminder target. The routing logic is configured in the migration plan; it cannot be retroactively inferred by Twenty after import because Opportunity stage history does not capture the temporal sequencing of appointment types.

Automation rules and reminder sequences cannot migrate and must be rebuilt

Essential MD appointment reminder sequences (e.g., 'send SMS 24 hours before appointment, email 1 hour before, create no-show follow-up task if status becomes no-show') and billing alert triggers are automation constructs with no export mechanism. These must be rebuilt in Twenty's workflow builder (Organization tier) or via the REST/GraphQL API. The Reddit r/CRM thread on Twenty notes that the workflow builder can handle day-to-day automation but requires manual configuration for multi-step sequences. We export Essential MD automation rule definitions as text documents with screenshots so your Twenty admin has a rebuild reference. This work is outside the data migration scope and is quoted separately.

Multi-insurance patients require junction-object handling in Twenty

Essential MD allows a patient to have multiple active insurance plans (primary, secondary, tertiary) stored with group numbers, policy numbers, and subscriber relationships. Twenty's People object has a single companyId link, which represents only one company relationship. Patients with secondary or tertiary insurance require a custom Account Contact Relationship or a separate custom junction object (e.g., PatientInsurance) that links People to Companies with a plan_type field (Primary, Secondary, Tertiary). This mapping decision must be made before migration runs, as it affects both the People import and the Companies import sequencing.