Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

EMR Data Archival Strategy Deep Dive – Tackling EHR & EMR Transition Series

Posted on November 14, 2016 I Written By

The following is a guest blog post by Robert Downey, VP of Product Development at Galen Healthcare Solutions.

Inside the world of data archival (Download this Free Data Archive Whitepaper for a deep dive into the subject), there are nearly as many different types of archives as there are vendors. Many of the existing archival solutions that have gained popularity with large healthcare organizations are ones that are also frequently utilized by other sectors and often claim to be able to “archive anything.”

This can be very appealing, as an organization going through a merger will often retire dozens or even hundreds of systems, some clinical, but most only tangentially related to the delivery of care. HR systems, general ledger financial systems, inventory management, time tracking, inventory tracking systems, and CRMs are just a few of the systems that might also be slated for the chopping block. The idea of retiring all of these into a single logical archival solution is very appealing, but this approach can be a dangerous one. The needs of healthcare organizations are not necessarily the same as the needs of other sectors.
ehr-data-archiving-process
To understand why some archival approaches are superior to others, it’s useful to visualize the way each of the solutions extract, store, and visualize data. The methodologies used typically trade fidelity (how well it preserves the original shape and precision of the data) for accessibility (how easy it is to get at the information you need), and they trade how easily the solution can archive disparate sources of data (such as archiving both an EMR and a time-tracking system) with, again, accessibility.

There are certainly other ways to judge an archival solution. For instance, an important factor may be whether or not the solution is hosted by the archival vendor on-premises or remotely. Some factors, such as the reliability of the system, service level agreements, or its overall licensing cost are big inputs into the equation as well, but those aren’t necessarily specific to the overall archival strategy utilized by the solution. There are also factors that are so critical, such as security and regulatory compliance, that deficiencies in these areas are deal-breakers. Now that we have the criteria with which to judge the solution, let’s delve into the specific archival strategies being used in the marketplace.

Raw Data Backups
raw-healthcare-data-backups
A shockingly large number of organizations treat raw data backups of the various databases and file systems as their archival solution. There are some scenarios in which this may be good enough, such as when the source system is not so much being retired as it is being upgraded or otherwise still maintained. Another scenario might be when the data in question comes from systems so well known that the organization won’t have significant issues retrieving information when it becomes necessary. The greatest benefit to this approach is that acquiring the data is fairly trivial. Underlying data stores almost always offer easy built-in backup mechanisms. Indeed, the ability to back up data is a certification requirement for EMRs, as well as a HIPAA and HITECH legal requirement. This strategy also offers “perfect” data fidelity, as the data is in the raw, original format.
health-data-archive-fidelity
Once it actually comes time to access the “archived” data, however, the organization is forced to fully reverse engineer the underlying database schemas and file system encodings. This leads to mammoth costs and protracted timelines for even simple data visualization, and it’s a major undertaking to offer any kind of significant direct clinician or compliance access to data.

Another danger with raw database backups is that many clinical system vendors have language in their licensing related to the “reverse engineering” of their products. So while it may be “your” data, the vendor may consider their schema intellectual property — and the act of deciphering it, not to mention keeping a copy of it after the licensing agreements with the system vendor have been terminated — may well be a direct violation of the original licensing agreement.

Hybrid Modeled / Extracted Schema
extracted-schema-data-archiving
A common approach utilized by healthcare-specific archival solutions is to create a lightweight EMR and practice management schema that includes the most common data attributes from many different source system vendors and then map the data in the source system to this fully modeled schema. The mapping involved is usually limited to fieldtype mapping rather than dictionary mapping, although occasionally, dictionary data which feeds user interface aspects such as grouping (problem categories, for instance) may require some high-level mapping.

This approach usually yields excellent clinical accessibility because the vendor can create highly focused clinical workflows just like an EMR vendor can. Since these visualizations don’t need to be created or altered based on the source system being archived, it means that there is generally no data visualization implementation cost.
healthcare-data-archiving
As the mapping is limited to the schema, the extraction and load phase is usually not as expensive as a full EMR data migration, but because every required source field must have a place in the target archival schema, the process is typically more time-consuming and expensive than the hybrid modeled / extracted schema or non-discrete document approaches. That said, vendors that have a solid library of extraction processes for various source systems can often offer lower initial implementation costs than would otherwise be possible.

The compliance accessibility and data fidelity of this strategy can be problematic, however, as unknown fields are often dropped and data types are frequently normalized. This fundamentally alters a substantial portion of the data being archived in the same way that a full data migration can — although, again, not as severely given the typical lack of data dictionary mapping requirements. In some cases, vendors will recommend that a full backup of the original data be kept in addition to the “live” archive, providing some level of data fidelity problem mitigation. Should a compliance request require this information, however, the organization may be left in a similar position to those utilizing raw data backups or extracted schema stores with no pre-built visualizations.

Archival solutions utilizing this strategy may also frequently require augmentation by the vendor as new sources of data are encountered. This can make the implementation phase longer, as those changes typically need to happen before any data can be loaded.

Summary
There will never be a one-size-fits-all archival solution across organizations, and even within an organization, when determining the strategy for multiple systems. Another key takeaway is to always be wary of all the “phases of implementation.” Many vendors will attempt to win deals with quick and inexpensive initial implementations, but they leave significant work for when the data actually needs to be visualized in a meaningful way. That task either falls on the organization, or it must be further contracted with the archival solution provider.

It also is valuable to consider solutions specifically designed for archival purposes and, ideally, one that focuses on the healthcare sector. There are simply too many archival-specific scenarios to utilize a general purpose data backup, and many organizations find that the healthcare-specific requirements make general purpose archival products ill-suited for their needs.

Download Galen Healthcare’s full archival whitepaper to evaluate available EMR data migration & EMR data archival options and processes critical to EMR replacement and legacy system decommissioning.

About Robert Downey
Robert is Vice President, Product Development, at Galen Healthcare Solutions. He has nearly 10 years of healthcare IT experience and over 20 years in Software Engineering. Robert is responsible for design and development of Galen’s products and supporting technology, including the VitalCenter Online Archival solution. He is an expert in healthcare IT and software development, as well as cloud based solutions delivery. Connect with Robert on LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Hospital CIOs Say Better Data Security Is Key Goal

Posted on November 9, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study has concluded that while they obviously have other goals, an overwhelming majority of healthcare CIOs see data protection as their key objective for the near future. The study, which was sponsored by Spok and administered by CHIME, more than 100 IT leaders were polled on their perspective on communications and healthcare.

In addition to underscoring the importance of data security efforts, the study also highlighted the extent to which CIOs are being asked to add new functions and wear new hats (notably patient satisfaction management).

Goals and investments
When asked what business goals they expected to be focused on for the next 18 months, the top goal of 12 possible options was “strengthening data security,” which was chosen by 81%. “Increasing patient satisfaction” followed relatively closely at 70%, and “improving physician satisfaction” was selected by 65% of respondents.

When asked which factors were most important in making investments in communications-related technologies for their hospital, the top factor of 11 possible options was “best meets clinician/organizational needs” with 82% selecting that choice, followed by “ease of use for end users (e.g. physician/nurse) at 80% and “ability to integrate with current systems (e.g. EHR) at 75%.

When it came to worfklows they hoped to support with better tools, “care coordination for treatment planning” was the clear leader, chosen by 67% of respondents, followed by patient discharge (48%), “patient handoffs within hospital” (46%) and “patient handoffs between health services and facilities” chosen by 40% of respondents selected.

Mobile developments
Turning to mobile, Spok asked healthcare CIOs which of nine technology use cases were driving the selection and deployment of mobile apps. The top choices, by far, were “secure messaging in communications among care team” at 84% and “EHR access/integrations” with 83%.

A significant number of respondents (68%) said they were currently in the process of rolling out a secure texting solution. Respondents said their biggest challenges in doing so were “physician adoption/stakeholder buy-in” at 60% and “technical setup and provisioning” at 40%. A substantial majority (78%) said they’d judge the success of their rollout by the rate the solution was adopted by by physicians.

Finally, when Spok asked the CIOs to take a look at the future and predict which issues will be most important to them three years from now, the top-rated choice was “patient centered care,” which was chosen by 29% of respondents,” “EHR integrations” and “business intelligence.”

A couple of surprises
While much of this is predictable, I was surprised by a couple things.

First, the study doesn’t seem to have been designed for statistical significance, it’s still worth noting that so many CIOs said improving patient satisfaction was one of their top three goals for the next 18 months. I’m not sure what they can do to achieve this end, but clearly they’re trying. (Exactly what steps they should take is a subject for another article.)

Also, I didn’t expect to see so many CIOs engaged in rolling out secure texting, partly because I would’ve expected such rollouts to already have been in place at this point, and partly because I assume that more CIOs would be more focused on higher-level mobile apps (such as EHR interfaces). I guess that while mobile clinical integration efforts are maturing, many healthcare facilities aren’t ready to take them on yet.

Physician Transparency List

Posted on November 4, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When social media initially started to become popular, a man named Ed Bennet did this amazing job creating a list of hospitals that were doing things on social media (ie. Facebook and Twitter). It was a really incredible look into how hospitals were approaching Twitter and Facebook. At the time, no one knew what they were doing. We were all trying to figure out. It was a dynamic and fun time, but also a bit scary since we were all shooting from the hip.

Over time, most hospitals have adopted a full social media strategy and have professionals that are quite familiar with the options available. Certainly, there are some that execute their hospital social media strategy better than others, but very few hospitals aren’t active in some way on social media.

In typical Ed fashion, he’s moved on from social media and has now created a Physician Transparency List which highlights the ways hospitals are displaying various physician ratings on their hospital website. I love that he calls it a transparency list since so many organizations are afraid of these physician ratings. So, it takes a bit of bravery to be willing to post the ratings on your hospital website.

So far Ed has 35 hospitals on that list, but I believe over the next 3-4 years we’ll see most hospitals doing some form of physician transparency on their hospital website. It very much feels like social media where it started with a few hospitals and then spread to many more.

The reality is that these physician ratings are going to be available to the public. So, why not put them on your hospital website? At least then you control the experience the user has and you can give them the opportunity to engage with you and your organization. In fact, I think that’s where so many hospitals have done a poor job. It’s one thing to display a rating. It’s a whole other thing to create easy opportunities for patients viewing your physicians’ ratings to engage with your organization. It’s such a missed opportunity for most hospitals.

I look forward to seeing Ed’s list continue to grow. Plus, it will be great to see how hospitals are taking advantage of this opportunity to be transparent and engage with patients.

Are CIOs Now Vendor Management Organizations?

Posted on October 21, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Over my past 11 years blogging on healthcare IT, I’ve seen a dramatic shift in the role a CIO plays in healthcare organizations. This was highlighted really well to me in a recent interview I did with Steve Prather, CEO of Dizzion. He commented that hospital CIOs are now mostly vendor management organizations.

I thought this was the perfect way to describe the shift. One challenge with this shift is that many hospital CEOs haven’t realized that this is what’s happening. In many hospital executives minds, the CIO is still generating code, implementing servers, network switches, rolling out desktops, and cabling. In most cases, this couldn’t be further from the truth. Yes, the CIO still has to make sure there’s a high quality network, servers, and desktops, but that does little to describe the work a CIO actually does.

Instead of getting into the nitty gritty, most CIOs have become professional vendor managers. This has become the reality as most of what people think of IT (servers, desktop, networks, email, etc) have become commodity services. There’s very little strategic advantage to do these things in-house. They’ve become such commodity services that it costs much less to outsource many of these services to an outside vendor.

What does this mean for the CIO? Instead of being Microsoft or Cisco certified, they need to be well versed in relationship management. That’s a big shift in philosophy and a very different skill set. In fact, most people who have those type of tech skills and certification are people that can struggle with relationships. There are exceptions, but that’s generally the case. CIOs that can’t handle relationships are going to suffer going forward.

Lest we think that this is a change that’s specific to healthcare, it’s not. This shifting CIO role is happening across every industry. In fact, it highlights why it’s not a bad idea to consider CIOs from outside of healthcare. If you can’t find a CIO who has healthcare experience, you could still find a great CIO from outside healthcare as long as they have the right relationship management skills.

Getting the Team in an EHR State of Mind

Posted on September 23, 2016 I Written By

For the past twenty years, I been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

Recently I had the opportunity to do something different, fun, and unexpected – I opened a team meeting with a music video.

I am currently leading an EHR implementation. Each month, I hold a meeting of the nearly 80 hospital staff members who are part of the project. The meetings combine sharing information about the project with each other, team building activities, and teaching them about change management, process improvement, and team dynamics techniques. I am always looking for a way to make each meeting interesting and memorable.

This month I wanted to initiate a good dialog in the meeting about a topic I wanted to address head-on: Why do Physicians Hate EHRs? And what are we, as a team, going to do about it to make our physicians love their EHR?

It reminded me of a great video crated by a physician right here in Las Vegas, ZDoggMD, whose videos I found through Healthcarescene.com. Viewing it again, it was indeed the perfect way to set the stage for this discussion. Fun, entertaining and such an accurate representation of how physicians feel about these applications.

The video itself got the team excited, motivated, and laughing – and led to one of the most engaging, productive, and thought-provoking conversations we have had on the project.

For the project leaders out there – I would recommend trying this type of technique with your teams.

For any physician or anyone else who has used an EHR and has not seen this music video, enjoy and share if it represents your point of view about EHR applications:

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Clinical System Replacement & Decommissioning: Migrate or Archive? – Tackling EHR & EMR Transition Series

Posted on September 21, 2016 I Written By

clinical-system-complexity
(See Full Healthcare Data Archival Infographic)

A Maturing Healthcare IT Landscape
If 2010 was the year of EMR implementations and optimization driven by initiatives like Meaningful Use, the ARRA, and Obamacare, then 2015 might be known as the year that clinical application retirement became a prevalent topic for many mature healthcare organizations.

Application retirement is nothing new. Large organizations both inside and outside of healthcare have had application retirement strategies in place (typically doled out by expensive consulting companies with fancy matrices, methodologies, and graphs in tow) for a decade or more. Anytime an organization outlives a large IT system (or, in many cases, that system’s vendor), retirement becomes a pressing need. In the case of healthcare, the two largest driving factors forcing clinical application retirement are the consolidation of organizations into large integrated care delivery networks, and replacement of existing electronic healthcare record systems due to poor usability or inadequate functionality.

Migration and Archival – Not Migration Versus Archival
One question that often comes up early on in the process of clinical application retirement is whether it’s necessary at all if the data in these systems is also being migrated into a new EMR. Conversely, the question of whether the cost of a migration is worth it if the archival solution being considered supports some sort of continuity of care solution like seamless single sign on from the new EMR. In most cases, it turns out that the ideal approach is migration and archival.

Just Migrate?
The process of EMR data migration almost always results in some fairly fundamental alteration of the legacy EMR data. The data models used by different EMRs are typically quite different, and it’s not a matter of export/import. Instead, it’s a true ETL process – extract, transform, load.

The shape of the data is changed. Sometimes data types undergo conversions, such as a number to a string, which if done poorly can result in loss of precision. Data sets, such as order codes, result codes, diagnosis categories, note types, and various other types of dictionaries are mapped from the values in the legacy EMR to the values used by the new EMR. Fields that have no apparent corollary in the new EMR are often just dropped entirely. It’s frequently not possible to know for sure what the data actually looked like in the legacy system once this process is complete and the legacy system is actually retired.
legacy-ehr-archive
Not only that, but from a clinical perspective, it’s probably not useful to take 15 years of legacy data and load that directly into your new EMR. Most organizations opt for something more likely to be relevant, while still remaining safe; perhaps 3 to 5 years of data. While the state and federal requirements for archival are clear on how long you need to preserve data (from 6 years to forever, depending on a variety of factors), they aren’t nice enough to say that the data you need to preserve is limited to what’s usually currently clinically relevant. In other words, that 10-year-old test result is still, technically, part of the legal medical record.
legal-medical-record-and-continuity-of-care
Some EMR vendors will even outright limit the mechanisms for data import to something like a CCD (clinical continuity document) import, which inherently limits the scope and quantity of available data that can be preserved.

Just Archive?
Ok. You give up. Obviously a migration isn’t going to cover us, and if the archive has everything we need legally and clinically, let’s skip that time consuming and expensive migration and just archive. Well, you can do that, but just archiving means that your organization is abandoning millions of dollars of hard won documentation and all the automation and analytics that goes with that.

An EMR is a lot more than a place to store clinical documentation. Virtually all modern EMRs have substantial functionality surrounding clinical decision support, health maintenance planning, and quality reporting. They also often are crucial source of data for analytics suites that are the pillars of population health management. In short, not migrating this data means you should have just stuck with paper charts until your latest and greatest EMR was available.

It’s certainly possible to bring over data in a manual, piece meal fashion as patients are seen or based on some other reasonably predicable event whose workflow can be augmented. This will, eventually, patch up the gaps in data that not performing a migration results in. If your organization is willing to suffer the significant, but probably short to medium term repercussions of temporarily losing this data in your EMR and related operational data repositories, then migration might not be necessary.

Not All Archives Are Created Equal
Inside the world of data archival, there are nearly as many different types of archives as there are vendors. Many of the existing archival solutions that have gained popularity with large healthcare organizations are ones that are also frequently utilized by other sectors and often claim to be able to “archive anything”. This can be very appealing, as an organization going through a merger will often retire dozens or even hundreds of systems, some clinical, but most only tangentially related to the delivery of care. HR systems, general ledger financial systems, inventory management, time tracking, and CRMs are just a few of the systems that might also be slated for the chopping block. The idea of retiring all of these into a single logical archiving is very appealing, but this approach can be a dangerous one. The needs of healthcare are not necessarily the same as the needs of other sectors.

Some factors that make healthcare different include:

  • The highly complex data models used by electronic healthcare record systems.
  • The common need for specialized user interfaces to properly visualize the data.
  • The continuing need for clinicians to seamlessly access the archived data with minimal workflow interruption.
  • The incredible variety of source systems that are in need of archival.
  • The lack of data format standards to make it easy to determine what needs to be archived.
  • The need for HIPPA and HITECH compliance (think encryption and auditing).
  • The massive size of the data to be archived, the need to constantly add new sources of data to an existing archive as the organization expands.
  • The frequent need to rapidly produce specific subsets of archived data during an eDiscovery proceeding or other legal compliance scenarios.

Summary:

  • There must be a clear distinction made between “migrated” or “converted” data and archived data, as the drivers and considerations for each are different. Retiring a legacy application and housing the data in an archival solution has markedly different requirements than migrating data from an existing clinical application to another.
  • Retiring legacy systems typically do not necessitate changing the “shape” of the data to fit a particular model. A data archival solution facilitates legacy system retirement, providing a storage solution for clinical data archival in compliance with state and federal regulations for protected health information (PHI).
  • With EMR migration, data typically needs to be mapped and translated to facilitate proper import into the target system. This is critical for the clinical impact and workflow integration required to support a discrete clinical data migration.

Download the full archival whitepaper to evaluate available EMR data migration & EMR data archival options and processes critical to EMR replacement and legacy system decommissioning.

About Robert Downey
Robert is Vice President, Product Development, at Galen Healthcare Solutions. He has nearly 10 years of healthcare IT experience and over 20 years in Software Engineering. Robert is responsible for design and development of Galen’s products and supporting technology, including the VitalCenter Online Archival solution. He is an expert in healthcare IT and software development, as well as cloud based solutions delivery. Connect with Robert on LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Bad Handwriting Could Cost a Doctor His License

Posted on September 16, 2016 I Written By

For the past twenty years, I been working with healthcare organizations to implement technologies and improve business processes for nearly twenty years. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

I admit that I don’t have very good handwriting. My signature is no better, and often leads people to ask if I am a doctor. Because it is commonly known that doctors don’t excel at handwriting skills. Thankfully, I rarely hand-write anything anymore. With computers, I can write quickly while still producing a result that is easy to read.

One benefit of an EHR solution is that we don’t have to worry about deciphering handwritting! But for one Nevada doctor, poor penmanship may lead to the loss of his medical license!

Read this story in the Review Journal for more information or this excerpt of the situation below:

The Nevada State Medical Board has formally threatened to revoke the medical license of Dr. James Gabroy, a 69-year-old Henderson internist who has never had malpractice or professional incompetence problems, nor has he ever had sexual misconduct, patient abandonment or fraudulent billing issues.

why is the board taking action against Gabroy — punishment ranges from a $5,000 fine to license revocation — with a Sept. 28 hearing scheduled in Reno?

His handwriting.

Citing confidentiality, Ed Cousineau, the board’s executive director, won’t stray far from the Oct. 23, 2015, board complaint that alleges the medical records of three unnamed patients were illegible, inaccurate and incomplete.

Are we heading for an environment where you’ll have to have an EHR in order to have a medical license?

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

10 Reasons for Full EHR Data Migration – Tackling EHR & EMR Transition Series

Posted on September 7, 2016 I Written By

top-10-reasons-for-ehr-data-migration

(Check Out the Full Top 10 Reasons for EHR Data Migration Infographic)

At Galen Healthcare Solutions we’ve found some important considerations and benefits during EHR data migration, including:

  • Legacy application licensing, and on-going support & maintenance.
  • Avoidance of data redundancy and improvement of data integrity.
  • Productivity and efficiency gains through enhanced clinical decisions support and consolidated clinical data access.
  • Enhanced regulatory reporting with programs including PQRS & PCMH.

When undertaking an EHR replacement project, there is a general misconception that the all of underlying patient clinical data is migrated systematically with ease. However, due to cost and complexity constraints, in most cases only patient demographics and basic clinical data elements are migrated to the new EHR system. In these cases, the legacy system is left operational in a read-only capacity; used as “system of record” for compliance, audits and responses for requests for information. Contrary to popular thought, this approach can actually end up being costlier than pursuing EHR data migration and archival, especially considering clinical efficiencies and patient care benefits associated with each of the latter.
legacy-ehr-data-migration
Understanding available EHR data migration & EHR data archival options and processes are vital to EHR replacement. Not doing so potentially leaves providers and staff inaccurate, unusable or missing data at go-live, compromising patient care. It’s important to evaluate scoping considerations, including options for import of discrete and non-discrete migrated data the new EHR systems provides, expertise of internal or external resources to migrate the data, and data retention requirements. Typically, the data elements & amount/duration of data to be migrated vs. archived is driven by organizational requirements related to continuity of care, patient safety, and population-based reporting requirements. Further, care needs to be taken to ensure data integrity when migrating clinical data – mapping nomenclatures and dictionaries where possible to avoid duplication, and facilitating reconciliation of the data to the existing chart in the target system.

At the heart of the EHR data migration process, it’s important that clinically driven workflows across various user roles are supported, transitioned, and maintained to the greatest extent possible. EHR data migration and archival allows for successful retirement of antiquated legacy applications, and ensures seamless and successful transition to the new EHR system.

Evaluate options, define scope and formulate a strategy for EHR data migration by downloading our EHR Migration Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Thoughts On Hospital Telecommunications Infrastructure

Posted on August 31, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Given the prevalence of broadband telecom networks in place today, hospital IT leaders may feel secure – that their networks can handle whatever demands are thrown at them. But given the progress of new health IT initiatives and data use, they still might face bandwidth problems. And as healthcare technical architect Lanny Hart notes in a piece for SearchHealthIT, the networks need to accommodate new security demands as well.

These days, he notes healthcare networks must carry not only more-established data and voice data, but also growing volumes of EMR traffic. Not only that, hospital IT execs need to plan for connected device traffic and patient/visitor access to Wi-Fi, along with protecting the network from increasingly sophisticated data thieves hungry for health data.

So what’s a healthcare CIO to do when thinking about building out hospital telecommunications infrastructure?  Here’s some of Hart’s suggestions:

  • When building your network, keep cybersecurity at the top of your priorities, whether you handle it at the network layer or on applications layered over the network.
  • Use an efficient network topology. At most, create a hub-and-spoke design rather than a daisy chain of linked sub-networks and switches.
  • Avoid establishing a single point of failure for networks. Use two separate runs of fiber or cable from the network’s edge switches to ensure redundancy and increase uptime.
  • Use virtual local area networks for PACS and for separate hospital departments.
  • Segment access to your virtual networks – including your guest Wi-Fi service – allowing only authorized users to access individual networks.
  • Build as much wireless network connectivity into new hospital construction, and blend wireless and wired networks when you upgrade networks in older buildings.
  • When planning network infrastructure, bear in mind that hospital networks can’t be completely wireless yet, because big hardware devices like CT scans and MRIs can’t run off of wireless connections.
  • Bigger hospitals that use real-time location services should factor that traffic in when planning network capacity.

In addition to all of these considerations, I’d argue that hospital network planners need to keep a close eye on changes in network usage that affect where demand is going. For example, consider the ongoing shift from desktop computers to mobile devices use of cellular networks have on network bandwidth requirements.

If physicians and other clinical staffers are using cell connections to roam, they’re probably transferring large files and perhaps using video as well. (Of course, their video use is likely to increase as telemedicine rollouts move ahead.)

If you’re paying for those connections, why not evaluate whether there’s ways you could save by extending Internet connectivity? After all, closing gaps in your wireless network could both improve your clinicians’ mobile experience and help you understand how they work. It never hurts to know where the data is headed!

Decommissioning Legacy EHR systems with Data Archival – Tackling EHR & EMR Transition Series

Posted on August 25, 2016 I Written By

EMR Data Archival

In their latest infographic (Check out the full infographic), Galen Healthcare Solutions provides critical information and statistics surrounding EMR data archival including:

  • Healthcare Data Growth
  • Healthcare Data Archival Drivers
    • Mergers & Acquisitions
    • Legacy System Retention Requirements
  • Healthcare Data Archival Benefits
  • Average Patient Digital Footprint
  • Industry Leading Archival Solution

Healthcare Information Technology leaders face challenges in keeping pace with new initiatives and consequently, managing a growing collection of legacy systems. With drivers including mergers & acquisitions, vendor consolidation, application dissatisfaction and product sunsets, it’s estimated that 50% of health systems are projected to be on second-generation technology by 2020, according to the IDC. As these new systems are implemented, multiple legacy systems are left behind, requiring healthcare IT staff to provide support and maintain access.

The strategy of keeping a patchwork of legacy systems running in order to maintain access to data is risky, resource intensive and can be quite costly given licensing, support, and maintenance needs. Decommissioning legacy systems with a proven archival system reduces cost and labor, minimizes risk, ensures compliance, simplifies access and consolidates data.

  • Reduce Costs: Streamlining the long-term storage of historical PHI now will save money in the long-run. Not only will it reduce costs paid for the support and technical maintenance of the legacy system, but it will also save on training new staff on the new system over the next 7-25 years. In addition, incorporating data archival efforts with a discrete data migration provides significant economies of scale.
  • Minimize Risk: Preserving historical patient data is the responsibility of every provider. As servers and operating systems age, they become more prone to data corruption or loss. The archiving of patient data to a simplified and more stable storage solution ensures long-term access to the right information when it’s needed for an audit or legal inquiry. Incorporating a data archive avoids the costly and cumbersome task of a full data conversion.
  • Ensure Compliance: Providers are required to retain data for nearly a decade or more past the date of service. In addition, the costs of producing record for e-Discovery range from $5K to $30K/ GB (Source: Minnesota Journal of Law, Science & Technology). Check with your legal counsel, HIM Director, medical society or AHIMA on medical record retention requirements that affect the facility type or practice specialty in your state.
  • Simplify Access: We all want data at the touch of a button. Gone are the days of storing historical patient printouts in a binder or inactive medical charts in a basement or storage unit. By scanning and archiving medical documents, data, and images, the information becomes immediately accessible to those who need it.
  • Consolidate Data: Decades worth of data from disparate legacy software applications is archived for immediate access via any browser-based workstation or device. Also, medical document scanning and archiving provides access to patient paper charts.

Because the decision to decommission can impact many people and departments, organizations require a well-documented plan and associated technology to ensure data integrity.

Download the full archival whitepaper to understand the drivers that impact archival scope specific to both the industry and your organization.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.