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.
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.
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.
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.
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.
- 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.