Application rationalization is not what most would consider a buzzworthy topic. It’s rarely mentioned among the top trends in a given year. And yet, it has become increasingly important, particularly as mergers and acquisitions continue to reshape the landscape.
“We need to do this,” said Stephanie Lahr, MD, CIO and CMIO, Monument Health, during a recent panel discussion. “It’s not the shiny, exciting piece, but it may be what allows us to do those things.”
As leaders are learning, without having a clear understanding of which applications and data are being used, organizations can’t move forward with digital health initiatives. “It’s not glamorous,” said Justin Campbell (VP, Strategy, Galen Healthcare Solutions), who also spoke on the panel, along with Susan Carman, CIO at Mohawk Valley Health System. “But it’s necessary to deliver agility to your organization.”
Not only does portfolio management have to be addressed; it must be part of a “living, breathing discussion that involves all key stakeholders — including IT — and it has to happen upfront,” Campbell added
This, of course, hasn’t always been the case, which has resulted in significant challenges across organizations. And although the tide seems to be turning, there are still hurdles that need to be cleared.
During the discussion, the panelists shared best practices for navigating the application portfolio rationalization process in a way that enables users to access the data they need.
What’s out there?
It starts with determining what’s out there, said Lahr. “You can’t make decisions if you don’t know what you have. The first step is creating an ongoing iterative process around understanding what applications live in your organization and how you’re going to maintain that.” Once that’s done, teams can start to determine which data they need.
For example, “Do you need the actual report from a procedure from 15 years ago, or just the salient information?” she noted. Although it may seem beneficial to have access to everything, “the reality is that no clinician has time to go through 72 systems, even if it’s at their fingertips.”
Which data do we need?
This is where having a solid data governance strategy is crucial, according to Carman. At Mohawk, a multidisciplinary committee has been appointed to assess the data and make the decisions that she believes shouldn’t fall solely on IT. “Our role is to support the operational strategy. And while we may have strong ideas on what should happen, it needs to be vetted by the people who are going to be looking at the data and utilizing it. You have to get that governance piece figured out.”
This also comes into play during the acquisition process, which has posed challenges to Carman’s teams in the past. What often happened is that practices wanted to continue to use their own systems instead of migrating to Epic. And so, they created a checklist to help ease the process, and incorporated into the negotiation a requirement that the entity being acquired would convert their data to Mohawk’s archived cloud system.
“It’s part of the package and part of the cost structure,” she noted. “That way, we don’t end up with extraneous servers backing up our whole data center and all of these other issues centered around data that we’re not sure what to do with.” Having an agreement in place can benefit both sides, according to Carman, and has been well-received by clinicians.
Defining what’s legal
It can also provide a sense of comfort if users know they’ll still be able to access the information they need. Where it can get dicey is in defining what makes up the legal clinical record.
If an organization decides to archive the data, they’re now responsible for it, which comes with a lot of ramifications. This is where it’s critical to be willing to work with compliance and legal teams, noted Lahr. “We need to partner with them, because sometimes the clinical inclination is to keep it all forever. And that’s probably not in anybody’s best interest.”
At Mohawk, Carman’s team considers all electronic data, as well as information on paper, to be part of the legal medical record. They’re working now to determine whether paper records need to be converted by a document imaging system and moved to the archive. “There’s a lot of ways to go about this,” she said. “At this point, we’re still vetting all of that out.”
It’s a process that’s constantly evolving, said Lahr, and one that requires collaboration among a number of teams, including information management, clinical, compliance and legal.
“It cuts both ways,” said Campbell. “If you retain data, what is the probability that the data is going to be of clinical use for the physician at the point of care? And on the other end, what is the probability that clinical data provides a liability to you?” For that reason, a robust purging policy must be in place with any archiving endeavor “so that you can automatically take care of these things and comply with the wishes of those in HIM and legal. But it is something that takes sitting down and evaluating the definition of when things fall off of the record, and when you no longer have to retain it.”
Achieving this requires a level of visibility that hasn’t always been the case for many organizations, but is absolutely essential going forward, noted Lahr. “We need to create visibility and understanding across the organization and identify that this is a priority.” By eliminating some of the costs, organizations will be able to do more, she added.
Campbell concurred, noting that without successfully managing and rationalizing applications, organizations won’t have the agility needed to move forward. “Again, it’s not glamourous, but it’s necessary.”
To view the archive of this webinar — Keys to Successful Application Portfolio Rationalization Initiatives (Sponsored by Galen Healthcare Solutions) — click here.
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