Application Retirement Planning: Compliance, Cost & Access

4/16/2015

Martin Prince - Vice President - Baylor Scott & White Health Christine Foley – Vice President - MediQuant

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Martin Prince Has no real or apparent conflicts of interest to report. Christine Foley Has no real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives 1. Define the composition of the infrastructure (governance) and the elements

of a sound plan to retire applications and maintain data retention compliance 2. Illustrate how early adoption of an overall data retention roadmap to achieve

data retention and timely application retirement accelerated savings 3. Demonstrate a process to “socialize” a plan to secure buy-in with business

units and overcome fears/objectives 4. Show how the consolidation of legacy data from disparate, retired systems

results in added cost savings and efficiencies 5. Identify lessons learned from the creation and implementation of a

comprehensive system retirement plan

An Introduction to the Benefits Realized for the Value of Health IT

Drivers of Change in Healthcare Market

Healthcare Market Transformations:

o Federal Mandates (ICD-10 and

Meaningful Use)

o Acquisitions and Mergers

o Budgetary Pressures to Consolidate Applications

o Data Driven Healthcare

Data Retention Drivers: o Federal/State Compliance and

Retention Requirements for Clinical Records

o Continued Need for Accessing Clinical Records

o Audits: RAC, Medicare, Medicaid, Commercial Carriers

o Billing Requirements

Legacy Application Challenges

Retirement Strategy Development

Goal:

- Decommission all legacy applications

- Make well informed decisions on what data needs to be retained and most appropriate method for doing so taking into consideration:

- Retention requirements - Use cases for accessing the data - Cost or storage of data

Data Retention Roadmap Evaluation & Execution Process

Phase 1

Legacy Application Analysis & Discovery

Phase 2

Design, Detailed Planning & Archival Solution Selection

Phase 3

Archive Solution Procurement & Implementation

Phase 1

Legacy Application Analysis & Discovery

Inventory of Existing Applications

Identify data type

Identify key owners of the data

Document key contract dates and termination options

Assess hardware/software stability risk

Phase 2

Design, Detailed Planning & Archive Solution Selection

Analysis of Existing Applications

Dis

cove

ry S

essi

ons

Document Use Cases for Data

Confirm Data Retention Guidelines

Identify Contract Extension/Termination

Options

Option 1

Option 2

Option 3

End Goal = Determine Data Archival Options

Business Engagement/Guidance

IS

Corporate Compliance

Research and

Education Department Leadership

Legal Guidance from each of the following areas is

needed on an application by

application basis, as appropriate:

Building a Business Case Discovery Work

Revenue Cycle • Reimbursement/

Payment History Records (10 years)

• Master Patient Index/ Visit History (permanently)

Clinical: • Adult records (10 years

from most recent visit) • Minor records (28

years)

Data Retention Guideline

Revenue Cycle •Billing/Payment Posting •RAC Audit Responses

Clinical: • Physicians need to

reference for point of care clinical history

• HIM staff ability to respond to ROI requests

Use Case

Potential Data Archival Options

Utility – No Source Data

Stored

Retain Source System

Back Up of Raw Data

Archive with End User GUI

Needed

Building the Business Case ROI Analysis

Example: legacy costs: Software maintenance fees $120,000 Infrastructure Support $50,000 Hardware refresh (annualized) $6,000 Internal help desk (partial FTE) $12,000 Data center costs $12,000 1 Yr. Total $200,000 Legacy Cost for 7 years $1,400,000

Example:“Active Archive” cost: Data extract & migration (vendor) $80,000 Project management, internal $10,000 New software (7 years, SaaS) $336,000 7 Yr. Total, Active Archive $426,000

ROI: Savings over 7 years: $974,000 (70%)

Phase 3

Archive Solution Procurement & Implementation

Execute Plan

Charter steering/governance committee for overall initiative

Identify project specific resources needed

Develop project plan/timeline

Migrate data as appropriate

Decommission legacy application

Charter Steering/Governance Committee Key Responsibilities

Ensure compliance requirements and needs of business users are met

Set ground rules for organization of the data

Prioritize applications for archival

Approve project timelines

Oversee check points on project progress

Participate in key messaging to organization

Sponsor end user adoption ownership

Build Steering/Governance Committee Membership - Clinical

HIM Leader

Provider Leader

Nursing Leader

Compliance

Clinical Application Leader

IT

Legal

Baylor Scott & White Case Study

Scott & White Healthcare*

21

*Prior to merging with Baylor Healthcare

12 Hospitals / 65+ Clinics

14,000 Employees

1,000+ Employed Physicians and Scientists

$2.4 B in Operating Revenue

215,000+ member health plan

Data Retention Roadmap Planned Phased Approach

Phase 1

Legacy Application Analysis & Discovery

Phase 2

Design, Detailed Planning & Archival Solution Selection

Phase 3

Archive Solution Procurement & Implementation

Completed FY12 Completed FY13-14 In Progress FY14-15

Phase 1

Legacy Application Analysis & Discovery

Application Consolidation Core Methodology – Drivers & Considerations

24

Data Base Technology

•Cache/Mumps •Proprietary Databases •DB2 •Mainframe (VSAM, ISAM, etc.) •Oracle •SQL •MS Access

Retention Requirements

•Regulatory •Legal •Compliance •Research •Clinical Needs •ACO Data Points •Line of Business

Data Types

•Images •Discrete data points •Marked up text •Proprietary Reports

Archive Solution(s)

Business Engagement Round 1 - Gap Analysis - Retention Needs

IS

HIM

Corporate Compliance

Legal Revenue

Cycle Operations

Providers

Research and

Education

Steps taken: Formed committees/sub-committees

w/leadership representation by functional area Assigned one IS Vice President with primary

responsibility for decommissioning legacy applications

Communicated EHR project objective to reduce

overall cost and complexities

Utilized application portfolio during future state design with committees to identify duplication in function

Application Archival Recommendation

*Central Texas Division - Quantities represent a tally of each application (or module) assigned within the specific grouping

Total: 263

[CATEGORY

NAME]s, [VALUE]

[CATEGORY

NAME], [VALUE]

Other, 12%

Revenue Cycle, 9%

Enterprise HIS, 17%

Ancillary, 13%

Applications to be Decommissioned (163)

Applications To Keep Running (100)

[CATEGORY

NAME], [VALUE]

[CATEGORY

NAME], [VALUE]

Ancillary, 91%

Phase 2

Design, Detailed Planning & Archive Solution Selection

Business Engagement Round 2– Legacy Retirement Planning Discussions

28

IS

HIM

Corporate Compliance

Legal Revenue

Cycle Operations

Providers

Research and

Education

Steps taken: Legacy application specific questionnaire

completed for each application by committee participants (data retention & usage)

RFP conducted for Revenue Cycle & Active A/R processing

Confirmed data retention periods through Legal, HIM, and Compliance sub-committees

Project planning prioritized based upon cost reduction and contractual obligations

Tactical Archival Plan

Function Data Type Purpose Archive Solution

Revenue Cycle • Revenue Cycle Discrete data • Revenue Cycle Images

• Active A/R, Billing functionality

• Legal/risk audits

MediQuant (DataArk) • Hosted solution • Active interfaces – 835,

837, Agency, DSS

Clinical Research • Discrete Clinical data preserved in original context

• Marked-up Text (EMRx)

• Clinical research • Legal/risk audits

Historical Data Repository (HDR) TBD

Clinical • Dictated Notes • Clinical Images (test results) • Scanned Images • Documents/Reports from legacy

clinical systems

• Patient care • HIM ROI

OnBase • “Historical Data” button

added inside Epic that launches the viewer that contains the historical clinical data

ERP Data Reporting

• HR & Payroll data • Supply Chain data • Inactive AR • AP & GL data • Non-Clinical Images

• Business & compliance reporting

Oracle Business Intelligence (OBI)

Phase 3 Archive Solution Procurement &

Implementation

Execute Plan

Successes

• Turning off applications (a first for S&W)

• Repurposing O/S and DB licenses for future expansion

• Providing legacy data at a

lower cost of ownership

Challenges

• Maintaining business engagement throughout the entire project

• Competing priorities • Estimating the work effort • Data quality and integrity

issues

Legacy Team

Maintaining Business Engagement Impact on People

Original Team

New Epic Team

Navigating Change Leading Change Focus Group

Action items for management

Leadership • Demonstrate a unified

commitment to the new direction

• Managers actively remove barriers for staff

• Open door policy and forum to mine for conflict

Team Building

• Encourage team huddles • Shared goals to provide clear

direction • Have a Change Champion to

demonstrate what change is about and why it’s important to the organization and the individual

Questions What have you seen help people successfully navigate change? What has prevented successful change?

What would help your team?

Answers • Accountability (staff,

managers, leaders) • Opportunities for

relationship building • Fear of change • Not proactively addressing

problems/barriers • Lack of communication and

follow up • Leadership approach with

positive attitude • Daily huddle to provide

focus • Reinforce / encourage

positive messages

Learnings

Myth #1 Reducing the number of applications will reduce costs.

20% of the applications account for 80% of the costs

Learnings Beware of the Myths

Myth #2 Reducing the number of applications will reduce complexity.

The contribution to system complexity of all of the small applications is much less than the contribution of one large application.

Learnings Beware of the Myths

Other Learnings

Be careful not to under estimate the level and impact of effort

Not only a technology project; it can impose significant ‘people’ change on the organization

This is not a part time initiative; it requires a dedicated team

You’ll need to invest money to save money.

A Review of Benefits Realized for the Value of Health IT

http://www.himss.org/ValueSuite

App Consolidation – Expected Cost Savings Central Texas Division

FY2014 FY2017

Enterprise HIS, 49%

Revenue Cycle, 29%

Legacy EMR, 4%

Small/Med Hospitals, 6%

Ancillary, 9% [CATEGORY

NAME], Other, [VALUE]

Questions

Martin Prince Phone: 254-724-6139 MPRINCE@SW.org

Christine Foley 440-746-2300 ext. 232 cfoley@mediquant.com or info@mediquant.com