When Harbin Clinic migrated from one EHR platform to another, leadership wanted to ensure that historical data was available to physicians and nurses, particularly as systems were being retired. And so they employed a common technique: maintaining a read-only license.
That technique, however, is also expensive, and can present compatibility issues.
There had to be a better way, thought Andy Goodwin, CIO and HIPAA Security Officer at Harbin. Fortunately there was, and it has made a significant impact in the organization’s quest to reduce its application footprint while ensuring data is accessible at the point of care.
“We were looking at how we could increase usability while decreasing costs,” said Goodwin, who spoke during a recent healthsystemCIO webinar along with Jason Lovett, Director of Application Services at Harbin, and Kel Pults, PhD, Chief Clinical Officer with MediQuant. The problem is that Harbin is a multispecialty group with multiple EHRs in place, despite the fact that athenahealth is the “record of truth.” And so, while the ultimate goal may be to reduce the number of systems and eliminate one-offs, in the meantime, leadership faces a challenge when it comes to data accessibility.
Like many organizations, Harbin looked to solve the issue by utilizing an enterprise archiving solution. But before any tools could be implemented, there were several factors that had to be considered, and questions that needed to be answered.
Below are some of the takeaways from the webinar (which can be accessed here):
- Ask questions. It starts with determining which data can be archived, and which can’t. According to Lovett, this can be done by asking a few questions: “Who’s the audience for the data found in these legacy systems? Is it strictly for legal or compliance purposes? That determines a lot of our approach,” he said. Other key questions, said Pults, include: “What does the provider need to see at the point of care? Do they need to keep a set of data for research? And what is needed for HIPAA purposes, as well as meeting state and federal requirements?”
- Think beyond clinical. It’s not just about clinical information; leaders need to know the current retention requirements for patient accounting, ERP, and other types of data as well, said Pults.
- Talk to providers. The best way to determine which data are most critical to physicians is by, you guessed it, talking to physicians. “You want it set up so the things that are most important to patient care can be accessed without having to jump through a lot of hoops,” said Lovett, including allergy information, which was cited as a must by Harbin providers. “These decisions have to be thought out carefully, and made hand-in-hand with clinicians that understand the impact of having or not having the data.”
- Don’t make archiving an afterthought. The time to start thinking about archiving, believe it or not, is during the EHR selection process, noted Pults. “Rather than it being an afterthought, think about it early so you can lay out a good plan — not just for implementing the new system, but how you’re going to archive and decommission the legacy systems that the application is going to replace.”
- Look at governance policies. As you make the move to a new EHR system, Pults advised assessing the governance and retention policies in place, as some might be “very outdated.” For Harbin Clinic, for example, the 20-plus years of acquired data included paper records. “That drove us to really define our policies around data archiving and what we wanted to keep,” said Lovett. “There’s no clear standard, so we established our own policies as to how long records are kept, and what type of records are kept.”
- Train users. Amidst all of this, leaders need to ensure minimal disruption to workflow. This had been a hurdle for Harbin Clinic in the past, with providers having to deal with extra log-ins that didn’t necessarily bring up the right data. The solution was not only to bring in MediQuant — which takes archived data from the legacy EHR and integrates it into the workflow — but also to provide proper training. “When users are trained on apps and can access data quickly, they can make better and quicker decisions,” he noted.
- Choose the right partner. Before a vendor is even selected, leaders need a clear vision of what data needs to be archived, what type of access is needed, and how easily it should be accessed, said Pults. Then, it’s time to choose a vendor. “As you look at the market, make sure you ask those questions, but that you also ask to see it in action. If they say it’s integrated into your EHR, challenge them to show you a real-life scenario,” she advised. “Define your parameters and look at how close the vendor can get to your ideal state of use for the data.”
- Make it a group effort. Beyond providers, leadership should ensure legal, compliance, and HIM are all involved in the vetting process, noted Goodwin. “It’s time consuming, but that validation is key.”
- Learn to let go. When it comes to data — particularly the enormous volume of data stored by healthcare organizations — it’s important to realize that not all of it should be archived, according to Pults. “Instead of automatically assuming everything is going to an archive, we work with clients to determine whether it makes sense. We’ll ask, ‘Is it something you’re going to access on a regular basis? What are the chances you’ll need to access it? What’s the ROI?’ Because we can take everything and put it into archives, but that’s not always what makes sense.”
Finally, as with any health IT initiative, it all ties back to improving patient care. And so, while it’s important to improve workflow and reduce costs, the end goal with data retention strategies is to enable clinicians to spend less time facing devices, and more time facing patients.
To view the archive of the webinar — Data Retention Strategies that Facilitate Application Decommissioning Decisions (Sponsored by MediQuant) — click here.