No matter how complex an initiative, and no matter how many obstacles stand in the way, the solution — or at least, a key component of it — is communication. And not just what’s being said, but also what’s being heard.
Application portfolio management is no exception. For organizations headed down that path, one of the key challenges comes in deciding what legacy data can be archived. The problem, according to Jim Hammer, VP of Operations and Product Development with Harmony Healthcare IT, is that when leaders ask clinical providers what needs to be migrated, the reply is often, ‘everything,’ which usually isn’t feasible.
This is where communication comes into play, he said during a panel discussion with Ed Duryee, Director of Information Systems, Columbus Regional Healthcare System; Tom Branigan, Senior Project Manager, Spectrum Health; and Kory Hudson, Director of Information Systems, Singing River Health System. What leaders may not realize is that their reasoning in asking for all the data stems from fear. “They want to make sure the data is stable, reliable, and up-to-date so that they can provide patient care.”
What providers may not realize, however, is that it isn’t just a financial strain that results from application bloating. For Spectrum Health, a Michigan-based system that’s rapidly expanding, bringing on new practices and hospitals often means dealing with duplicate or obsolete applications. To that end, they’ve created integration and migration teams that comb through portfolios and identify what’s no longer needed.
Even with that governance in place, one key question still surfaces. “Who actually owns the data from these applications? If a practice comes on board with your health system, do they retain that data? Are they responsible for that going forward? Those questions need to be answered,” said Branigan. “Based on those answers, you can figure out what you’re going to do with these legacy applications.”
At Columbus Regional Healthcare System, Duryee has faced similar issues with what he termed islands of automation. “If a department director and VP make a compelling case, they can get support for keeping their niche applications, at least for a while,” he said. “That’s one way that portfolios can get bloated.”
This, according to Hudson, is where governance — or, as the case may be, a lack thereof — plays a critical role. “Ultimately, you need an overall organizational strategic plan. If you allow each department to go down their own path, you end up with all these disparate systems.”
Making a case for data archiving
Those silos, of course, need to be supported, which can be labor-intensive as well as expensive. The logical solution is to move the data to an archiving solution; but for many organizations, there isn’t enough room in the budget to transition all the data at once. And even if there was, the return on investment won’t appear right away.
In fact, it can take three or four years before cost savings are realized, said Branigan. “It’s a hard sell when you think about the initial upfront cost.” However, it’s important to consider that many applications contain clinical data, which must be retained for 20 years. When tidbits like that are presented to leadership, “they can see the long-term benefits,” he noted, adding that when the savings do come in, they can be significant. “The key is to have a leadership team that is forward thinking and on board with the benefits of what this brings.”
There are different categories of savings, according to Hammer. The “hard, tangible” cost savings include items like maintenance costs, renewal fees, and data center infrastructure costs, while “soft” savings come in a number of areas, including compliance and risk aversion, as well as training and support for older applications.
Hudson concurred, adding, “When you have silos of information, you have to continue to support those solutions.” Devising an effective archiving strategy, however, can be difficult — particularly for an organization like Singing River, which recently completed the acquisition of Garden Park Medical Center in Gulfport.
Core principles of APM
That’s where companies like Harmony Healthcare IT can play a key role. According to Hammer, most of their customers have a solution in place — such as ServiceNow — to maintain a master inventory of the systems. For those going through mergers and acquisitions, it can be complicated just trying to “wrap their heads around what the portfolio looks like.”
In these situations, Harmony can help adjust the strategy as more applications are added. “We typically know what we’re going to archive based on past policy and procedure around compliance and governance,” Hammer said. “We can usually attack that pretty straightforward in terms of the requirements as we go system by system down the list.”
The other important benefit Harmony offers is the ability to identify costs that can be negotiated down, such as application renewal fees. “Depending on when systems come offline, those costs can be minimized against the larger renewal period,” he noted.
That, however, is just part of the story. As important as the technical angle is, what’s even more critical is addressing the human factors, according to the panelists. During the discussion, they shared best practices based on their experiences.
- Everyone signs off. At Spectrum Health, a record retention committee — which includes representation from legal, compliance, HIM, and IT — meets monthly to review proposals and determine whether it’s in the best interest of the long-term strategic plan to archive the data, said Branigan. “The committee is so crucial with the work that I do, because if they approve something, it trickles down throughout the organization that everyone has signed off on this. We’ve all agreed this is the best path forward.”
- Show, don’t tell. It’s not enough to simply tell physicians that the data they need will be available; they need to see it firsthand, said Hammer, who advised IT leaders to make sure vendors know the source application and can demonstrate its capabilities. Doing so, he noted, can help build a level of comfort that will prove beneficial in the long-term.
- Stringent validation. According to Branigan, Spectrum goes through a “stringent validation process for every application we archive.” Using a select group of patients, his team looks at every piece of data in the record and compares it to the data that was archived to ensure everything was copied over. The compliance team then reviews it. These stages, he noted, help ensure that “the data quality of that sunset application is now retained in the new format.”
- Treat it like a live solution. As Hudson pointed out, when an application is being sunset, “you’re not going to get rid of that data until the new application is up and running and burned in for a good period of time — even years, in some cases.” And if the lights are being kept on in those sunset applications—which they are, if data needs to be extracted—they need to be included in the overall business continuity plan, including backup procedures. “They’re not sent offshore or put out to pasture as soon as you’ve brought in a new application; you still need to manage that like you would any solution that’s active for your users.”
- Limit data access. From a security standpoint, it’s wise to grant access only to teams or individuals that require it, noted Branigan. His team implemented a process by which users must present requests to HIM — even if they’ve had access in the past. “It’s the best way to ensure data remains secure,” he said.
Finally, with data archiving, as with most initiatives, the IT leader’s role must go beyond that of tech expert, said Hudson. “You need to pull folks together and strategize on what’s needed for the organization. You’re not just an IT shop. You’re not just a support department. The role has reached the pinnacle where you need to lead.” Part of that, he added, is to anticipate the needs of operational leaders, and “put solutions in front of them before they even realize they need them.”
Not an easy feat, by any stretch. But with the right strategy and the right partnerships in place, it’s possible.