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Deriving ROI from Data-driven EMR Clinical Optimization

Posted on June 28, 2017 I Written By

The following is a guest blog post by Justin Campbell Vice President, Strategy, at Galen Healthcare Solutions.  Learn more about their work by downloading their EHR Clinical Optimization Whitepaper.

Resistance to change is natural. People are uncomfortable with it. Organizations are frightened by it. Acceptance of healthcare information technology took a long time and even in these first two decades of a new century, despite incentives such as the Meaningful Use program, and promises of increased efficiency, implementation of Electronic Medical Records has been a bumpy ride.

Between 2008 and 2016, healthcare organizations spent more than 20 billion dollars adopting electronic health record systems. Many different approaches were applied. Many HCOs decided to act quickly, using what we now call a “Big Bang” fix. Installations of generic systems were in place but users of the new systems were unhappy. In 2013, with the process well underway throughout the nation, two thirds of doctors polled said they used EMR systems unwillingly, with 87% of these aggravated physicians complaining about usability and 92% of physician practices complaining that their EMRs were “clunky” and/or too difficult. Specifically, only 35% reported that it had become easier to respond to patient issues, one third said they could not more effectively manage patient treatment plans, and despite the belief that technology would permit caregivers to spend more time with their patients, only 10% said this was occurring.

The medical side was not alone in expressing dissatisfaction. Hospital executive and IT employees who had replaced their Electronic Health Record systems reported higher than expected costs, layoffs, declining revenues, disenfranchised clinicians and serious misgivings about the benefits gained:

  • 14% of all hospitals that replaced their original EMR since 2011 were losing inpatient revenue at a pace that would not support the total cost of their replacement EMR
  • 87% of hospitals facing financial challenges now regret the decision to change systems
  • 63% of executive-level respondents admitted they feared losing their jobs as a result of the EMR replacement process
  • 66% of the system users believe that interoperability and patient data exchange functionality have declined.


Not all reviews are negative. There is strong support and appreciation for EMRs in some Healthcare Delivery Organizations (HDOs) who believe well-designed EMRs save time and support clinical workflows. But, there is no escaping the majority sentiment: EMRs are not designed for the way providers think and work.

Today, most HDOs are at a crossroads. They can start over with a new EMR or optimize the one they have. The case for a do-over is supported by sub-standard vendor support for their existing systems and the increase in mergers and acquisitions, which drive system consolidation. One fifth of large practices and clinics report they intend to replace their EMRs and studies show that the EMR replacement markets will likely grow at an annual rate of 7%-8% over the next five years. The case for the status quo is made primarily by the HCOs that do not have the financial resources to undertake EMR replacement.

All options face the same key inter-related questions: how to generate additional margin? How to maximize return on technology investments? Which path will best serve the HCO, caregivers and patients?

This is a bit of vicious circle. HCOs are cash-strapped and the transition from fee for service to value-based care exerts downward cost pressures, exacerbating the problem. But patchwork fixes have not resolved that problem. Alternatively, some attempted to do too much too quickly and became frustrated because they lacked the depth of experience and knowledge to perform remediation. And, as KPMG concluded after studying the problem, “The length of time to resolve the issues increased and frustrations mounted as clinical, senior management, IT and human resources staff found themselves spinning their wheels.”

Like a patient being pressured to swallow medicine, HDOs are beginning to accept their situation. According to a recent survey conducted by KPMG in collaboration with CHIME, 38% of 112 respondents ranked EMR/EMR optimization as their top choice for the majority of their capital investments for the next three years.

EMR adoption is already approaching maximum levels. Consequently, healthcare delivery organizations have begun to shift their EMR strategies from short-term clinical documentation data repositories to long-term assets with substantial functionality in support of clinical decisions, health maintenance planning and quality reporting. They are coming to see their IT investments as platforms rather than limited systems of record or glorified data banks. In short, they now understand that the capture of information is only the most basic attribute of an EMR, and that instead, the EMR in which they invest can be flexible and extensible, capable of adopting emerging technologies that are driving insights to the point of care.

Assess opportunity, formulate strategy, improve usability & derive additional ROI & by downloading our EHR Clinical Optimization 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.

EMR Replacement & Migration Perspective: Tim Schoener, VP/CIO, UPMC Susquehanna

Posted on December 8, 2016 I Written By

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In the midst of a merger with a major Pennsylvania healthcare organization, Tim Schoener is wholly focused on EHR transition. He outlines Susquennaha’s plan for each aspect of transition, offering innovative and unique approaches to each. In addition, Schoener provides cogent insights regarding the intricacies involved with a multi-database system, the expenses associated with archival solutions, and the challenges associated with migrating records. This interview touches on many of the considerations necessary for a successful EHR transition as Schoener discusses minimizing surprises during a transition; why migrating a year’s worth of results is optimal; and how their document management system fulfills archival needs.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Looking for additional EMR replacement perspectives & lessons learned? View a recent panel where HCO leaders discussed their experiences with EHR transition, data migration & archival.

KEY INSIGHTS

Absolutely, we have problem lists that can’t be reconciled; there’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all.

We’re being told, if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.

Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

Let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move.

It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare.

CHIME is a great way to challenge yourself as a CIO and in your leadership. It pushes me in my leadership skills and helps to focus me back to what’s critical in the industry.
tim-schoener
Campbell: Tell me a little about yourself and your organization’s initiatives

Schoener: I’m Tim Schoener, the VP/CIO of, originally Susquehanna Health, which, as of October 1st, is now a part of the University of Pittsburgh Medical Center (UPMC) and re-named to UPMC Susquehanna. We’re located in central Pennsylvania, four hours away from Pittsburgh.

A major IT initiative for us is that we’re swapping out our EMR over the next couple of years. We are currently a Cerner Soarian customer. In fact, we were the initial Soarian beta site for Financials and second for Clinicals. We determined we eventually need to migrate to something else – that’s an Epic or Cerner decision for us at this point. UPMC’s enterprise model is Cerner and Epic, Cerner on the acute care side and Epic on the ambulatory side. As of this writing, we’ve made the decision to migrate to the UPMC blended model. Over the past nine months we’ve been focused on an EMR governance process, trying to get our team aligned on the journey that we’re about to take and by late next year we will likely be starting an implementation.

We currently leverage NextGen on the Ambulatory side, with approximately 300 providers that use that software product. We’re a four hospital system: two of which are critical access, one which is predominately outpatient, and the other a predominately inpatient facility. We were about a $600MM organization prior to our UPMC acquisition.

Campbell: Related to your current implementation, tell me a little bit about your data governance strategy and dictionary mapping that may occur between NextGen and Soarian.

Schoener: We definitely have a lot of interfaces, a lot of integration between the two core systems. From an integration perspective, we have context sharing, so physicians can contextually launch and interoperate from NextGen to Soarian, and vice-versa. We do pass some data back and forth—allergies and meds can be shared through a reconciliation process—but we certainly aren’t integrated. It’s the state of healthcare.

Campbell: That’s why you anticipate moving to a single platform, single database?

Schoener: Absolutely, we have problem lists that are not reconciled. There’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all. Meds and allergies are pretty much all we get in terms of outpatient to inpatient clinical data sharing today.

Campbell: Do you leverage an archival solution for any legacy data?

Schoener: We use EMC and have large data storage with them. I wouldn’t call it archival, but we have an electronic document management system – Soarian’s eHIM.

There’s a huge amount of data out there and I know you have some questions related to our thinking with respect to migration. I have some thoughts around that related to levering our document management system versus archiving into a separate system. I’m pretty certain we would be thinking ‘why not use eHIM as our archival process, and just put other data in that repository as necessary?’ For results data, for instance, what we’re thinking of migrating, or what our providers are requesting, is a years’ worth of results. ‘Give me a year’s worth of results, and then make sure everything else is available in eHIM.’

Campbell: As such, your default is to migrate a year’s worth of data?

Schoener: Yes. We would presume that the provider is probably not going to refer back to lab results or radiology results beyond a year, other than for health maintenance kind of things such as mammograms, pap smears, PSAs; those types of things.

Campbell: What expectations have you set with physicians when they go live on the new EMR?

Schoener: From an ambulatory perspective, we’re thinking that it would be nice to have the most recent note from the EMR available. All of the other notes for that patient would be consolidated into one note via a single pdf attachment. The note that’s the separate most recent note, we envision that being in a folder for that particular date. That note would reside in the appropriate folder location just like it would in the current EMR. Our goal is to bring the clinical data forward to the new EMR, taking all the other notes and placing them in a “previous notes” folder.

Campbell: Can you elaborate on your consideration of PAMI (Problems, Allergies, Medications, Immunizations) as part of the data migration?

Schoener: Sure. The disaster scenario would be the physician sits down with patient for first time with new EMR, and there are no meds, no allergies, and no problems! They’ll spend 25 minutes just gathering information, that would not work.

We’re thinking of deploying a group of nurses to assist with the data conversion and migration process. Our intent is to have them to retrieve CCDAs to populate those things I mentioned by consuming them right into the medical record, based on the physicians’ input. We expect there to be a reconciliation process to clean-up potential duplicates. Or, to be candid, we’ve talked about automating the CCDA process, consuming discrete clinical items from it by writing scripts and importing into the new EMR. I think we’re leaning towards having some staff involved in the process though.

Now if you share the same database between your acute and ambulatory EMR, and the patient was in ambulatory setting but now they’ve been admitted, it’s the same database: the meds are there, the problems are there, the allergies are there; it’s beautiful, right? If they weren’t, then the admission nurse is going to have to follow the same CCDA consume process that the ambulatory nurse followed. Or you start from scratch. On the acute side, we start from scratch a lot. Patients come in and we basically just start asking questions in the ER or in an acute care setting. We start asking for their meds, allergies, or problems – whatever they may have available.

Campbell: We’ve discussed notes, results and PAMI. Are there other clinical data elements that you’ve examined? How will you handle those?

Schoener: From an acute care perspective, our physicians are very interested in seeing the last H & P (History & Physical Examination) and the last operative note, so we’re going to consider two different ideas. One would be that all of that data would still reside in document management, which has the ability to be sorted. It’s currently very chart centric. For instance, you can easily pull the patient’s last acute care stay. There is the ability, however, to sort by H & P, operative note, or discharge summary—something along those lines for the separate buckets of information. Therefore, a physician could view the most recent H & P or view all sorted chronologically. In addition, they’ll be able to seamlessly launch directly from the new EMR to the old EMR, bypassing authentication, which is important to mitigate context switching.

One of the areas we’re struggling with is the growth chart. A physician would love the ability to see a child’s information from start to finish, not just from the time of the EMR transition. So that means some sort of birth height/weight data that we would want to retrieve and import into the new system so a growth chart could be generated. The other option is to somehow generate some sort of PDF of a growth chart up until the place where we transitioned to the new EMR. The latter however, would result in multiple growth charts, and a physician’s not going to be happy with that. So we’re trying to figure that one out.

Another area of concern is blood pressure data. We’re struggling with what to do with a patient we’re monitoring for blood pressure. We’d like to see more than one blood pressure reading and have some history on that.

Campbell: Thank you for elaborating on those items. What about data that is not migrated. How will that be addressed and persisted going forward?

Schoener: For the most part, everything else would be available in the document management system. We can generate that data from document our document management system and make it available to be queried by OIG or whoever else requires that data from a quality perspective. We are aware that an archival solution is very expensive. We’re being told, ‘if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.’ If that’s what the advisors and consultants are saying, then our thought is that probably isn’t going to be the direction we’re going to go. We’re likely going to stick with some type of document management system for archival.

Campbell: Very good. How are you gathering feedback from different specialties and departments? Do you have a governance process in place?

Schoener: So as you may have gathered, we’re getting ready. I don’t want surprises. I want physicians to be prepared and to set expectations for what’s going to be available. What I just described to you, we’ve vetted that out with our primary care docs. Now we’re going to take that to our cardiologists and ask them what they think. Then on to our urologists to allow them to weigh in. Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

There will definitely be a learning curve with the new EMR, but we want to be clear and set expectations with respect to data migration and conversion, so that when the physician does use the new EMR they’re not saying ‘that darn Cerner or Epic.’  It’s more ‘that’s a part of the data migration process and we weren’t able to accomplish that.’

Campbell: What about legacy applications support. Will all of your staff be dedicated to the new project?

Schoener: I mean, let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move. We still haven’t decided what to do.

Campbell: I agree that no staff member wants to be left behind. I’ve talked to organizations where they use folks for both and it just doesn’t end well. You can’t expect them to do both, learning the new system while supporting the old one.

Schoener: I guess it depends on the capacity and the expectation of that particular project they’re working on. Maybe there is a person who has less involvement with the new EMR and they have availability where they can support both, although it’s unlikely. Sometimes you end up having someone who wants to retire within the time period. In that case, they can almost work their way to retirement and then not ever support the new EMR, although that situation is also unlikely.

It’s a great question, and one we’re going to have to have folks help us determine.

Campbell: Shifting gears a little bit, what are your thoughts on health data retention requirements? Too loose? Too stringent?  As you know, it varies state-to-state, from 7-10 years, but I feel like there’s a huge responsibility that is placed on organizations to be the custodians of that data. Do you agree?

Schoener: I think that’s just healthcare. A lot of it is legal considerations and our need to protect ourselves. That’s why do we do a lot of the things we do. We’re protecting ourselves from lawsuits and litigation. I think it’s expected; it’s just the nature of the business. Just think of what we had in a paper world. We used to have rooms and rooms full of charts and now that’s all gone. With our current process, any paper that comes in is scanned in within the first 24 hours. So it’s not something I worry about. My focus now is making sure our providers can perform excellent patient care on the new EMR.

Campbell: Could you provide some advice, insight or wisdom for healthcare organizations pursuing EMR/EHR replacement & transition?

Schoener: Get ready for some fun! Affiliations and acquisitions are greatly impacting these decisions. It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare. One bit of wisdom for anyone is: if you’re not interested in that type of transition and change occurring, healthcare’s not for you. That’s the nature of the business we’re in.

I would say from an EHR transition process, I found that having an advisor is extremely beneficial to help me think outside of my day-to-day operations. They’re able to look outside of your organization and ask the right questions. If you pick the right advisor, they’ll protect you and protect your organization. I think it’s been very healthy for us to have someone from the outside give us counsel and advice because it’s a tough process. It’s extremely expensive, and extremely polarizing.

Campbell: Outside of the networking, what did you come to CHIME focused on this year?

Schoener: CHIME is a great way to challenge yourself as a CIO and in your leadership, it pushes me in my leadership skills and helps to focus me back to what’s critical in the industry. It helps me to think more strategic and broad, not to get too engaged in one particular topic. I think it’s just great for professional development. CHIMEs the best out there with respect to what I do.

This interview has been edited and condensed.

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

About Tim Schoener
Tim Schoener is the Vice President/Chief Information Officer for UPMC Susquehanna, a new partner of UPMC since October 1, 2016, which is a four-hospital integrated health system in northcentral Pennsylvania including Divine Providence Hospital, Muncy Valley Hospital, Soldiers + Sailors Memorial Hospital and Williamsport Regional Medical Center. UPMC Susquehanna has been Most Wired for 14 of the last 16 years and also HIMSS Level 6. Tim has worked at Susquehanna for over 24 years, 19 of those years in Information Technology.  He also has responsibilities for health records, management engineering and biomedical engineering. He is a CHCIO, HIMSS Fellow and CPHIMS certified. Tim received his undergraduate degree from The Pennsylvania State University with a BSIE in Industrial Engineering and his MBA from Liberty University. 

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.

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.

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.

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.

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.

EHR Data Migration – Tackling EHR & EMR Transition Series

Posted on August 10, 2016 I Written By

EHR Data Migration
(See Full EHR Data Migration Infographic)

In this infographic, Galen Healthcare Solutions provides critical information and statistics pertaining to EHR data migration including:

  • Healthcare Data Growth
  • EHR Data Migration Drivers
    • Mergers & Acquisitions
    • System Consolidation
  • EHR Data Migration Challenges
  • Industry Leading EHR Migration Solution

The demand for data migration within the U.S. healthcare market is growing exponentially. The increase in mergers and acquisitions is driving system consolidation as is the increasing number of HCOs seeking EHR replacements to address usability and productivity concerns. A recent survey by Black Book Rankings found that nearly one-fifth of large practices and clinics intend to undergo an EHR replacement by the end of 2016. In addition, a 2015 Kalaroma report shows that the EHR replacement market will grow at an annual rate of 7-8% over the next five years.

EHR Data Migration Process

The process of migrating from one EHR to another is among the most difficult technical and functional projects a healthcare organization will ever confront. The EHR transition requires vendor selection, assessment and scoping, legacy system optimization, data migration, legacy application support, data archival, and new system implementation. If organizations fail to address any of these components properly, their migration could leave healthcare providers without the information needed to make the best patient care decisions, and organizations without easy access to the historical data necessary for participating in quality reporting initiatives and other current and emerging value based care reimbursement methodologies.

Learn more about EHR transition, replacement and migration strategies, methodologies, tips & tricks, and best practices 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

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.