The road is not as smooth as it looks when healthcare facilities are looking to update information systems, speed through M&A, or plan an expansion to create more competitive and comprehensive services. Organizational change can present challenges with each process, and archiving legacy data is no exception.
When it comes to archiving legacy data for applications using a MUMPS database for example, there may be pitfalls and even deep potholes that can extend project timelines, require rework, derail expectations and – more importantly – create risks to patient care and safety. Though newer systems have cropped up over the years, MUMPS-based information systems such as Epic are still used in over 40% of the hospitals in the U.S, and according to Judy Faulkner, CEO of Epic, the Epic application supports 54% of patient records in the U.S. alone (Glaze, 2015).
The first mistake is underestimating the size of the task. Many transactions and health system transformations are planned with an assumption that transferring data is as simple as loading a truck with file boxes, driving it to a new location and setting it down. Executives and dealmakers may not realize the potentially massive scope and complexities of this exercise.
A review of the five top archiving hazards can help ease the ride for everyone.
The Exacting Demands of Extracts
Before anything else, the first step in any archiving project is extracting years of data. A MUMPS system might have been programmed and evolved over the past 50 years (when it was first created) and likely includes terabytes of data that can take months to extract when working at full speed.
Often overlooked is the need for data access to have the full, contracted cooperation of the current data manager before extraction can even begin. Otherwise, it may be difficult to get security clearance, particularly from a third-party hosting and protecting its data. No access? No data. No data? No archive.
Once the extract team in the gets “in,” to the database, the extract can be performed. The method may vary between legacy applications based on the limitations of the legacy system. Some data can be provided in MS SQL back-up, while others may require additional work, such as generating summary documents from the legacy system or converting data to a usable and ingestible format.
Extracting discrete data can also take time depending on the database type. MUMPS can take several weeks depending on the number of servers holding the data, size of the database, and server stability. A risky server and slow bandwidth are examples of things that can slow down the extract process. In some cases, software hosted by a vendor requires that vendor to provide the extract to the archive partner. Be clear with the legacy vendor about how data must be delivered to avoid receiving limited data in limited formats for use. Any encrypted data must be unencrypted, which should be added to the overall project timeline, since archiving cannot start until the legacy data is out of the old system, quality reviewed, and it is ready to migrate into the new system. Missing or incomplete data can result in patient safety concerns as well as the inability to produce a legal medical record, making the extract, the first big step to success.
Untenable Expectations
It is important to manage expectations of calendar time, resources, the adequate commitment that will be needed and the quality of legacy data. During an acquisition or merger. both buyers and sellers might not have arranged to involve the correct and adequate resources for the unexpected workload. Sellers may even benefit from trivializing their involvement in a data transfer, and rarely stay dedicated throughout the process. For the organization acquiring the new facility, and as the new owner of the clinical data, ensuring adequate access and support time to the acquired data is important. Reserve time in the negotiated acquisition contracts to get that data out of the old system into the new one. It is common to bring the newly acquired facilities onto the current instance of HIS and move the acquired facility legacy data into an archive. This doesn’t happen overnight so don’t get yourself in a pinch with that support end date. Don’t forget…Most of the time the selling facility must provide the extract so keep that in mind.
Original expectations might also have to change in parallel to any scope creep – or extending projects to include unexpected fixes or “found” data in unexpected places. As hard as it seems, expectations of budget, workload, timing and quality should either be lowered or with recognized flexible ranges, planning for add-ons or a few unforeseen problems during implementation. Years’ worth of data entry, changes to documentation use and custom content all provide unexpected and not always welcome surprises in the data. Be prepared to be surprised!
HIM Hindsight
Because deals and organizational transformations have so many moving parts and goals, legacy data transfers are not always a priority during strategic planning, and the information manager is not often in the room. Pitfalls arise when healthcare leaders decide on scope and complete transition agreements before consulting with information management leaders, assuming their full value is limited to implementing the operational process. If brought into the planning process, health information management (HIM) teams can help to align retention policies and can ensure that the system has everything needed for legal medical records release and audit/compliance purposes.
There are many stakeholders to consider with an archiving initiative. Legacy data affects patient care, continued revenue capture, and all HIM.
Too often, the data verification process marks the first moment for HIM to examine the legacy data in the archive and ask about data, documents, and other files that might be needed. This is a perfect time to ensure overall data retention policies are up-to-date, and to update the definition of the legal medical record to include active archive. Unfortunately, delays and conflicts can add costs, slow the implementation process and leave potential holes in the quality of data needed for future use. Bring HIM to the table early as an important stakeholder in the overall success of the archive project.
HIM without a financial plan
The CFO and accounting team might already be planning for tremendous savings and a big return-on-investment with the benefits of active archive management. The key word here is “investment.”
It requires that initial commitment of capital and resources with expertise to be engaged during the archive process. A large organization and with a substantial number of systems to archive will need a dedicated team to make this happen. Due diligence and focus on the legacy system data is needed to help the archive team decide on needs versus wants and to provide insights on the legacy system. Lack of engagement and project resources can cause project delays, restarts and confusion for both the healthcare organization and vendor project teams. The overall goal is to build a relationship that contains trust, support, teamwork, and a shared goal of meeting timelines, and helping to achieve a large return on investment, while providing a solution that supports various perspectives including patient safety, clinical point-of-care access, audit/compliance, legal medical record, and research.
By defining a specific level of investment and scope of work, it is possible to avoid multiple amendments that chip away at that short-term value.
Resource Planning!
Many planners do not consider the surprises that will be found in older systems, particularly if the systems pre-date the tenure of people currently managing them – often back as far as 15 or more years on legacy systems. They cannot forecast all expenses accurately without digging into the old systems. They might plan timing with expectations of significant support from resources that never arrive or resources that are re-assigned mid-process. Aside from the financial investment, due diligence on the scope is important pre-contract and a full discovery once the data is received will also need to happen. This means talking to and working with the legacy system subject matter experts.
Recognizing and avoiding these five possible pitfalls is important for the business success of healthcare facilities and for the patient care that stands at the core of everything you do. Set the stage with a quality extraction, set realistic timeline expectations, make sure HIM is at the table, be prepared to provide adequate resources, and know that no matter how prepared you are and think you know the data in your system, you will undoubtedly find some surprising things in there!
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Reference
Glaze, J. (2015). Epic Systems draws on literature greats for its next expansion. Retrieved January 2, 2022, from https://madison.com/news/local/govt-and-politics/epic-systems-draws-on-literature-greats-for-its-next-expansion/article_4d1cf67c-2abf-5cfd-8ce1-2da60ed84194.html