A recent survey by the ECRI Institute strongly suggests that healthcare providers continue to struggle to apply their health IT tools safely and consistently.
Patricia Stahura, RN, MSN, an ECRI senior analyst and consultant, says, “The information must be accurate and must be written so that future clinicians looking at the EHR can understand it. If you have faulty information or missing test results, you are predisposed to making a diagnostic error. You need to have all the information and test results available, and you have to know when and where to look for that information to make the right diagnosis. If you don’t get the diagnosis right, appropriate care cannot follow.”
Easier said than done. Not only is it a colossal organizational challenge to contain and employ the Big Data healthcare organizations have been accumulating for decades, it is a vexing question about how much of the information in care records is indispensable.
As many as 15% of these groups are running outdated operating systems and more than 66% are still sending or receiving summaries of care records via mail or fax. The obvious inefficiencies of these aging processes also comes with significant ongoing operational costs. So there are good reasons to transition data to archival. Technological advances and business decisions also play a part.
For one system, Catholic Health Initiatives, the decision to archive was made at the first opportunity. April Morris, Program Manager, says, “We have 600 plus applications across the enterprise that were ready for retirement. And this number continues to grow, incurring significant costs just to maintain and operate them.”
At Partners Healthcare, Project Director Douglas Miller reports the key driver came from the corporate level: leadership mandated a transition to Epic as the provider’s core EHR. To do so, Miller says, “We needed to account for the data in three EHRs that were going to be retired and we needed a strategy that would provide access to that patient data at EPIC so our providers would have access to patient history and other data.”
Which leads to consideration of the issue nobody wants to discuss. As Anthony Guerra, editor of HealthsystemCIO put it during a recent Galen webinar, “Do you get rid of everything? Or do you keep it in case there’s a need for an element nobody thought of? Is nothing ever deleted?”
According to April Morris, the answer from both clinicians and patients is a resounding negative. “They want their data forever. But, if you’re speaking to compliance or security, where there are time limits on how long you keep that data, it creates risk for the organization to keep things longer than is necessary. As a whole, we must weigh record destruction and purging against the operational burden of retaining the data and the desire of caregivers and patients to have a permanent health record.”
At CHS, Morris says “we try to consider the issue in terms of whether the purpose of archiving will be for clinical continuity or for the ability to react to legal and medical requests. This can and should require real soul-searching, deep questions about our mission. Ultimately we chose an archival solution (Galen’s VitalCenter) that can be used for clinical care continuity as well as academic research or medical requests. We designed our model to be repeatable, so, even though each legacy application can be unique we limit the scope of our search for data thus gaining velocity and value.”
Douglas Miller agrees that archival needed to be conducted with both legal and medical issues in mind, even though the circumstances at Partners were different from those Morris faced at CHS. “With the mandate to move to Epic,” he says, “we were not really allowed to bring much data from our legacy systems over. But, we could bring immunizations, allergy problems, and some parts of patient records. We implemented VitalCenter Online Archival because it archives patient history but still allows clinicians to view that data and confidently apply the same high level of care.”
For Partners Healthcare the answer was a data viewer that could be launched at go-live at the same time as Epic. “We considered keeping legacy systems around in a read-only state, but that would have been very costly over time. We decided upon a solution that could not only archive but function, not just to replicate legacy systems but be close enough to functionally deliver value to our clinicians and other providers.”
Users who have selected VitalCenter Online Archival can open the tool within the online Epic session. For data security, Epic maintains control of the VitalCenter Online Archival sessions and providers can open up any patient data in the archive related to a particular patient.
In both these situations and many others, VitalCenter Online Archival is addressing the critical nature of retiring legacy applications and securely providing access to archived data.