achieving legacy system retirement and data consolidation · 1 achieving legacy system retirement...
TRANSCRIPT
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Achieving Legacy System Retirement and Data Consolidation
Session 184, February 13, 2019
Lisa Stump, SVP and CIO, Yale New Haven Health
Bill Hudson, ACIO and VP of IT Operations, John Muir Health
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Lisa Stump
Has no real or apparent conflicts of interest to report.
Bill Hudson
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Learning objectives
• Background
• Deciding on an archive strategy
• The path to success
• Principles of archiving: what to archive
• Data governance: structure for a plan
• Engaging Operations: foundation for a plan
• Recommendations and lessons learned
Agenda
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• Illustrate the advantages and challenges of consolidating legacy
data in a central archive
• Illustrate how to build the business case for legacy system
retirement and consolidation of legacy data into an active archive
• Define the organizational roles to involve in the process to achieve
successful adoption of a solution
• Define the critical principles of legacy data consolidation and
legacy system decommissioning and discuss how to apply them
• Show the lessons learned from a legacy data consolidation and
retirement program
Learning Objectives
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Drivers for Enterprise Legacy Retirement & Archiving
Healthcare Market Transformations
• Federal mandates
ICD-10
Meaningful Use
• Acquisitions and mergers
• Budgetary pressure to consolidate applications
• Data-driven healthcare
• Streamline, Simplify, Save
Legacy Application
Replacement &
Retirement
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Drivers for Enterprise Legacy Retirement & Archiving
• Compliance: 7 – 28 years
• Continued need for access to clinical data
• Revenue cycle: billing continues
• Audits: RAC, Medicare, Medicaid, commercial carriers
• Research
• Cost of maintaining legacy applications
• Data spread over disparate systemsLegacy Retirement
Active Archiving
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Enterprise Legacy Landscape at JMH
• Reviewed all 500 of our applications
• Identified 162 candidates
• Worked with key staff to identify data elements to retain and applications to decommission
• We focused for 3 – 3 ½ months on the “Legacy Application Decommissioning Assessment”
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Enterprise Legacy Landscape at YNHHS
• Prioritized legacy clinical and revenue cycle applications post-EMR consolidation
• Timing based on data size and legacy maintenance cost
• Worked with key staff to identify data elements to retain
• Emphasized clinical benefit of extending longitudinal record back in time
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Why use an enterprise, centralized, active archive?
Reduce data footprint through selective archiving
Create single point of access/retrieval
Maintain data usability
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Active vs. Static Archive
Will the data be accessed often?
Examples: HIM staff responding to ROI requests;
Billers accessing for billing functions;
HR staff responding to audits;
Clinicians accessing clinical records
Is seamless access via other applications important or beneficial?
Example: Access lab records held in the archive via the new EMR
If YesIf Yes ActiveActive
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Use Cases & Secondary Use
• Archive used for day-to-day functions
Release of Information
Revenue cycle, billing
Patient care
HR functions
• Archive used to mine data for special requests, such as CDC study requests
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Archiving Options Considered
• Expensive and difficult to manageRetain the legacy
system
• Non-compliant, high risk, and expensiveDecommission the legacy system and
destroy data
• Print to paper, archive to PDFBackup raw data
• Static
• ActiveEnterprise archive with end user GUI
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Why We Used an Enterprise ActiveArchive
• Not a “typical” archive
• Includes workflow functionality
Billing accounts for active A/R (2+ years after last DOS)
Release of Information
Interoperability
• Allows for real-time end user access
• Reporting
• Discrete data elements and document images
• Secondary use of data
• Consistent workflow
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The Path to Success
• Building a business case
• Establishing data governance
• Engaging stakeholders
• Overcoming archiving challenges
• Project planning
• Choosing the systems to retire
• Choosing the data to archive
• Moving quickly to ensure adoption
• Communicate, Communicate, Communicate
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Critical Success Factors
• Achieve leadership support for sun-setting all applications
Involve department leadership to avoid resistance to decommissioning
• Successful data migration into active archive completed before decommissioning – key dependency
• Teamwork
Utilize efforts among many departments instead of maintaining dedicated resources
• Technology
Active archive, ability to handle required workflow
• Effective communications
Scope is broad and timeline is long
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Building a Business CaseUse Cases
Revenue Cycle Clinical
Data
Retention
Guidelines
Reimbursement/payment
history records: 10 years
Master patient index/visit
history: permanently
Adult records: 10 years
from most recent visit
Minor records: 28 years
Use Cases
Billing accounts; payment
posting
Financial reporting
Interface with billing
systems
Insurance & cash
collections
RAC audit responses
Physicians need to
reference for point of care
clinical history
HIM staff ability to
respond to ROI requests
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Building a Business Case Expected components of cost savings
Software support fees (top priority)
Hardware support fees
Internal support/help desk staff
Hardware refresh
Data center costs
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Building a Business Case Annual Cost Savings
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
1 2
Pre-project legacy costs Post Project Costs
Annual Savings
Yale JMH
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Yale JMH
Annualized Legacy Support Fees only $2,980,000 $2,780,000
Annualized Active Archive fees/costs
(Including new equipment)* $326,000 $304,000
Net Savings $2,654,000 $2,476,000
Additional cost savings not calculated:
• Net hardware refresh & data center costs
• Net savings on internal support/help desk staff
* For Yale, no new equipment; for JMH, new hardware figured into
self-hosted datacenter costs; Cost of learning new system:
negligible, easy to use.
Building the Business CaseIllustrate Savings with ROI Analysis
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What to ArchiveWorkflow and User Access
No workflow,
no GUI
No workflow,
no GUI
Replicate legacy
look, feel, and
workflow
Replicate legacy
look, feel, and
workflow
0% 100%Seek a balance based on need of
specific data set.
We retained essential workflow as
determined by end users and
governance group.
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What to ArchiveAmount of Data to Retain
Discard all data from
applications
Discard all data from
applications
Keep all data from
applications
Keep all data from
applications
0% 100%
Seek a balance based on need
of specific data set.
Legal and Compliance agree on
data to retain.
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Enterprise Data GovernanceModel employed at Yale New Haven Health
• All projects led through IT, providing consistent leadership
• IT had over-arching responsibility for selecting applications to retire and data to be retained, with input from business units and compliance
• SMEs from the business units performed data validation and software testing/acceptance
• SMEs who knew the legacy systems but had moved on to analyst roles within the organization were tapped for the enterprise archiving project
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Enterprise Data GovernanceModel employed at John Muir Health
• Governance board developed that selected applications to retire and data to retain
Comprised of Compliance, Legal, IT, HIM, Revenue Cycle, Clinical
Needed guidance and buy-in by all data stakeholders
• IT led the projects, with SMEs for testing and validation
• JMH employs an active archive expert who knows and supports the enterprise archiving system, just like any other major application
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Engaging OperationsEvaluating Data for Enterprise Archiving and Applications for Retirement
• Legacy application-specific questionnaire completed for each application (JMH)
• RFP conducted for archiving options
• Confirmed data retention periods through Legal, HIM, and Compliance sub-committees
• Project planning prioritized based upon cost reduction and contractual obligations
Stakeholders
Clinical
HIM
Research
Legal
Compliance
Revenue Cycle
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• Types of questions: how the information was used, any reporting needs, their perception/interpretation of what the future requirements would be
• Who was interviewed: direct operational users and their supervisors
• Departments:
– HIM: any legal medical record retention requirements
– Legal: regulatory/legal considerations
– Compliance: any retention requirements related to HIPAA and other regulations
– Treasury: advise regarding the financial systems
Interviewing Operations
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Business EngagementLegacy Retirement Planning Discussions
Stakeholders
Clinical
HIM
Research
Legal
Compliance
Revenue Cycle
• Set expectations: not an identical replication of the legacy application
• Involved operations team in archive decision
• Decided on an ActiveArchive
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Project OverviewNext phase after new HIS
An active archive was selected to address the following requirements:
• Provides longitudinal patient records that indicate original legacy
system
• Supports EMR integration – patient context viewing
• All YNHHS financial data will remain in an “active” state (complete
billing functionality) to accommodate compliance, billing, and
collection functions for a minimum of ten years
• All YNHHS clinical data will be available to providers, auditors, and
researchers for a minimum of ten years
• Meets ITS security and infrastructure standards
• Enables retirement of legacy systems post migration to the active
archive, realizing cost savings
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Overcoming Enterprise Archiving Challenges
• As an enterprise program, projects are rolled out over time
• Worked with vendor to test and stage the data ahead of
migrating it into the database, minimizing any downtime
• Managing end user expectations
Actual needs, define use cases
Central v. local storage
Archive will not replicate legacy system
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Enterprise Archive Cycle
Determine which applications to decommissionDiscovery
• WHO: Involve business unit leadership, Compliance, Legal
• WHEN: Shortly after selection of new HIS
• WHAT: Set criteria, identify use cases for legacy data: clinical, revenue cycle, ERP
Choose technology and service – Enterprise Active ArchiveSolution
• Involve business units in decision
• Get a “partner” to help solve problems; technology to manage workflow
Plan retirement phasesPlanning
Migrate data to Enterprise Active Archive & Retire Legacy AppsImplement
• Phased in over several years
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Active Archive Progression at YNHHS
SCM
Jan ‘16
Cerner
Sept ‘16
3M Chartview
Oct ‘17
Centricity EMR
Sept ‘17
QuadraMedInteGreate
(McKesson)
HAC (Horizon
Amb Care -McKesson)
Med-Informatix
Medipac
Feb ‘16
SDK
July ‘16
Meditech
May ‘18
Clinical Data (read only)
Financial Data (read/write)
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Enterprise Active Archive Integration with new EMR
Easy access to legacy data from
within new EMR under the
navigator section “PreEpicEMR”
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Quick Adoption
Uneventful go-live – no calls from users, including physicians
The Active Archive was easy to use
• Configured for end users
• Use cases were satisfied
Stakeholders were included in the selection and implementation process
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• Start early – ideally at the same time as selection of new HIS or during merger
• Include the business unit stakeholders: Revenue Cycle, Clinicians, HIM, Finance/HR, IS
• Manage expectations within the organization with a clear vision, project plan, and budget
• Engage in data retention ‘roadmapping’
• Set expectations early – active archive vs. the legacy applications
• Ensure a successful program with your own internal project manager/coordinator
• Ensure data validation beyond a simple record count test
Recommendations/Lessons Learned
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Questions?
Lisa Stump
Senior Vice President and CIO
Bill Hudson
Associate CIO, VP of IT Operations