RETIRE RETAIN, RENDER. Integrating and accessing your inactive patient information. EMC Perspective

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1 RETAIN, RENDER RETIRE Integrating and accessing your inactive patient information EMC Perspective Exploring the clinical archiving imperative and meeting the demands of patient-centered care.

2 EMC is a trusted healthcare solutions provider serving ABSTRACT Healthcare organizations today are looking for the best way to enhance clinician productivity, lower health information technology (HIT) costs, coordinate care and ultimately, improve patient outcomes. As a result, healthcare CIOs are faced with a key dilemma: finding a way to reduce the costs of managing their current application portfolio and infrastructure while reinvesting in health IT solutions that empower patient-centered care and improve outcomes. This Perspective explores the clinical archiving imperative and proposes an optimum solution for meeting the demands of patient-centered care. more than 5,000 healthcare customers worldwide. We provide purpose-built, healthcare-specific solutions that are developed and tested to work together seamlessly. And we re meeting the healthcare industry s challenges head on with the EMC Documentum Integrated Patient Record (IPR) solution suite transforming how enterprises view, organize, access, manage and use patient information to create efficiencies and optimize care delivery. Our solutions unite fragmented patient information, simply and securely, to provide a fully integrated, patient-centric view of all essential information beyond the EMR regardless of source, location or format within the enterprise and externally across the continuum of care. Learn more at Copyright 2014 EMC Corporation. All Rights Reserved. EMC believes the information in this publication is accurate as of its publication date. The information is subject to change without notice. The information in this publication is provided as is. EMC Corporation makes no representations or warranties of any kind with respect to the information in this publication, and specifically disclaims implied warranties of merchantability or fitness for a particular purpose. Use, copying, and distribution of any EMC software described in this publication requires an applicable software license. For the most up-to-date listing of EMC product names, see EMC Corporation Trademarks on EMC.com. VMware and are registered trademarks or trademarks of VMware, Inc. in the United States and/or other jurisdictions. All other trademarks used herein are the property of their respective owners. Part Number H October

3 TRANSFORMING HEALTH IT When the Budget is too Tight for Innovation Finding optimum solutions to meet the demands of patient-centered care.

4 HEALTHCARE CIOs FACING A CRITICAL IMPERATIVE: Struggling to meet demands while providing clinicians with rapid access to legacy data amid EMR / EHR migration. 70% of healthcare IT budgets support existing infrastructure ONLY 30% available for new investment and innovation Healthcare organizations today are looking for the best way to enhance clinician productivity, lower health information technology (HIT) costs, coordinate care and ultimately, improve patient outcomes. Toward this goal, the industry is readily adopting electronic medical records (EMRs)/electronic health records (EHRs) to create a complete view of the patient record. Yet to have this comprehensive view, clinicians still need to access data from other clinical systems information that may not be readily within reach. In the continued quest for highquality, affordable, patient-centered care, a sustainable solution for archiving clinical information one that provides clinicians with rapid access to legacy data is essential. Also, healthcare chief information officers (CIOs) face a critical imperative meeting the current demands of their clinicians and administrators while simultaneously transforming their HIT to deliver more flexible and 4

5 responsive care. But 70% of a typical IT budget is spent on maintaining the IT infrastructure and application portfolio, leaving little room for investing in new innovative projects. At the same time, CIOs are beginning to see growing incidences of shadow IT as users bypass their IT departments and contract directly with suppliers for services. Ultimately, then, healthcare CIOs are faced with a key dilemma: finding a way to reduce the costs of managing their current application portfolio and infrastructure while reinvesting in health IT solutions that empower patientcentered care and improve outcomes. This Perspective explores the clinical archiving imperative and proposes an optimum solution for meeting the demands of patientcentered care. 25% of the time LOB S are turning to outside service providers 5

6 ASSESSING The Challenges When Considering the Archival of Clinical Content Solving the issues of obsolete legacy systems, stringent compliance regulations and soaring costs

7 ASSESSING THE CHALLENGES In considering clinical archiving, the industry faces three major challenges: $ OBSOLETE LEGACY SYSTEMS Healthcare providers maintain a large number of systems for managing patient records and associated information. Some of these systems have become obsolete and are being consolidated and replaced by newer systems. Other systems that are currently in use have accumulated large volumes of data and documents. Once this information is no longer active, maintaining these systems is costly. And, often, system performance suffers. STRINGENT REGULATIONS Data contained in legacy systems is still important and needs to be preserved. Some information must be kept to comply with regulations. This information must be immutable; it cannot be deleted or altered. And it must be auditable available if auditors ask for it. SOARING COSTS Healthcare organizations would like to decommission these systems to save the costs of software licenses, servers, storage, and ongoing maintenance and administration. With the data glut, application performance and availability can suffer. Backup times get longer and costlier. To solve these issues, organizations need a cost-effective way to retire obsolete systems and archive all forms of applications and information so that their EMR/EHR users can quickly and easily search, view and retrieve archived patient records. Data coming in from multiple systems needs to be presented to clinicians in a natural, organized way. Decommissioning multiple clinical legacy applications and systems, and storing this patient information EMR data, documents, medical images, voice recordings, CDA documents in one central, unified archive that is integrated into the EMR/EHR gives clinicians and authorized users immediate access to all archived information. Integration also enables secure sharing of the complete patient record with every clinician across the enterprise and the continuum of care, regardless of their facility location. 7

8 ADDRESSING The Data Glut Maintaining legacy applications that are kept alive solely for their data.

9 Most healthcare provider organizations are bursting at the seams with patient data. Industry estimates indicate that the volume of healthcare data doubles each year. In the world of health information technology (HIT), the demands are steep and the stakes are high. HIT teams are working diligently to stay ahead of government mandates and looming deadlines for meaningful use and ICD-10 implementation. At the same time, they are asked not only to keep pace with rapidly emerging technologies but also to find an effective way to manage older systems all while supporting their organizations efforts to improve quality and patient outcomes. As new HIT systems are implemented, older legacy data systems are running in parallel requiring an already overextended IT staff to support and sustain access to a complex plethora of platforms. Many organizations are spending millions to maintain legacy applications that are kept alive solely for their data and are incurring ever-rising costs for servers, storage, application maintenance, database software and operations. This is an unnecessary drain on IT, not only for the high costs of maintaining data but also of deploying the scarce resources needed for system upkeep. HIT budgets can be readily exhausted, depleting funds to support the new systems needed to optimize patient care. Along with stretching IT budgets and capacity to the breaking point, this information overload can slow clinician productivity and jeopardize patient care. Healthcare organizations have addressed the legacy system challenge by adopting three key strategies, all of which have fallen short in solving the problem: Store Everything: Keeping all information in its source application is neither cost-effective nor scalable. Backup Everything: Backup, while necessary and important, does not solve this problem. Backups are temporary, hard to access, and periodically overwritten. They also offer limited access to data. Delete Everything: Deleting everything is also not an option because of regulatory mandates and internal policies for information retention to satisfy privacy, security and legal preservation requirements. 9

10 MANAGING LEGACY PATIENT DATA FOR THE NEEDS OF TOMORROW A different solution is needed for the data overload challenge one that retires legacy applications, retains the wealth of clinical information these applications hold and renders rapid access to legacy data. The ideal solution mus be: Comprehensive Have the capacity to ingest and retain all information types structured or unstructured in a consolidated repository Compliant Provide the ability to audit and preserve data and content for meeting a variety of regulatory and governance mandates Future Proof Store information in an open, industry-standard format for long-term retention and easy access Independent Have no dependencies on the originating application for managing or referencing the information Meaningful Integrate information from different systems into a coherent, logical structure that is meaningful to clinicians 10

11 NAVIGATING The Compliance Conundrum to Avoid Risk Retaining patients clinical data for mandated timeframes.

12 AVOIDING COMPLIANCE RISK AND REDUCING NONCOMPLIANCE EXPOSURE THREATS Providers typically keep adult and pediatric medical records longer than the time recommended by industry guidelines and regulations, often retaining them permanently. PATIENT RECORD LIFECYCLE To avoid compliance risk, healthcare organizations need t to retain patients clinical data for mandated timeframes. Retention laws require that even when patient health data is no longer needed for day-to-day access, it must be purposefully retained and preserved long-term (see box). t t t t t t t t t APPLICATION LIFECYCLE INFRASTRUCTURE LIFECYCLE Regulations also require that data be maintained in an immutable, tamper-proof environment to prevent it from being altered or deleted. Records must be secure and private, and auditors need to be able to trace user access to this information. Yet keeping older information in production applications can actually lead to noncompliance exposure. And maintaining old systems takes critical resources away from new installations, as IT staff, already overwrought, must manage an intricate blend of several legacy platforms. If support is inadequate, the risk is high that data in these systems will be exposed to unauthorized users, leading to a costly data breach, stiff financial penalties and an irreversibly damaged reputation. A MULTITUDE OF REGULATIONS GOVERNING HEALTH DATA To create a compliant health records retention program, many requirements must be considered. According to the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, HIPAA-covered entities need to maintain adult patient records for six years and for two years if a patient dies. If a child is born in a healthcare facility, the provider must retain that child s records until he or she reaches the age of majority, ranging by state from 18 to 21. Some states mandate that records be kept even longer. North Carolina requires that adult records be retained for 11 years, while New Hampshire requires that newborns records be kept for 25 years. The U.S. Food and Drug Administration also has medical image storage rules for certain specialties; for example, mammography scans must be retained for 10 years or until the next scan is done. 12

13 CONSIDERING The Business Case for Application Retirement Retiring legacy applications to eliminate the costs associated with their maintenance.

14 RETAINING LEGACY APPLICATIONS IS AN EXPENSIVE ENDEAVOR as much as several million dollars a year. Keeping all this data requires organizations to incur increased IT costs for operations, licensing and maintenance. The glut of data also increases the load on current production systems, compromising application performance and availability. And the more information accumulated, the longer and costlier the backup process. Much of this data is considered inactive at the point in the business process where it will no longer change and thus is in a static, final form % of data in operational systems is inactive. In legacy or obsolete systems, 100% of the data is inactive. 14

15 To solve the problem of inactive data, information can be moved from the production applications where it was created and archived to an optimized management platform that enables easy access for authorized users. Legacy applications containing inactive information can then be completely decommissioned, providing enormous opportunities to reduce costs. Retiring legacy applications eliminates the costs associated with their maintenance up to 70% of healthcare IT department budgets, according to Gartner s Worldwide Enterprise IT Spending Forecast. Application decommissioning enables organizations to recoup capital for funding innovation and process improvement, and making new investments in more efficient applications. 15

16 Application retirement also reduces operational and compliance risks. When data is located in legacy applications on mainframe systems, staff with the skill set to access the data may be limited. With a scarcity of legacy application specialists, organizations often use consultants to deal with these antiquated systems further ballooning costs. Responses to compliance audits and e-discovery requests may be delayed, resulting in multi-million-dollar penalties. The optimum solution for application retirement provides a systematic process for: DECOMMISSIONING ARCHIVING PRESERVING FREEING PROVIDING obsolete systems inactive data contents readily accessible for authorized users up IT staff time to work on a higher level clinicians with fast, natural, and intuitive access to the patient historical record enabling them to grasp the whole picture and thereby to make the right decisions for the patient 16

17 MANAGING The Information Lifecycle Viewing patient information from the perspective of its lifecycle.

18 Patient information needs to be viewed from the perspective of its lifecycle: ACTIVE PHASE ARCHIVING PHASE PURGE PHASE in which medical data is in active use where information needs to be accessible but will not be changing where data that is no longer needed can be eliminated The key requirement to be addressed is the second phase, archiving. This phase is the longest in the information lifecycle and needs to be viewed in a new way. The best approach to the archiving phase of the information lifecycle is to decommission legacy applications while moving legacy content into an easyto-access, standards-based, XML database one that is central, scalable and non-proprietary. This enables healthcare organizations to leverage existing technology to retire applications cost-effectively yet retain critical content for future use. Content is intelligently archived, stored in a central place throughout its lifecycle to comply with data continuity and regulatory requirements and is readily available as it is needed. It is rendered in a highly compressed, secure, immutable format that dramatically reduces storage consumption, eliminates associated maintenance costs and improves overall system performance. Hardware and software costs are lowered and workload reduced so that IT staff can be redeployed to focus on high-priority initiatives. 18

19 All clinical information is united to create a complete view of the patient, readily available to the EMR/EHR, eliminating the need to navigate multiple systems and user interfaces. Clinicians can easily, rapidly, and securely access, search, view, and download information, anytime, anywhere yielding greater clinical efficiency and coordination across the continuum of care. Archived data can be easily searched and reported on, readily available to meet compliance audits or e-discovery requests. AGGREGATED CONTENT Structured and unstructured data are pulled from multiple systems and multiple encounters, and then merged and reorganized in a logical way. In the aggregated view, all medical information is preserved in its natural form regardless of original source, location or format and is organized to facilitate search, analysis, data mining and enforcement of compliance policies. Because of this integration, the clinician is provided with a 360 degree view of the patient. SYSTEM-WIDE FLEXIBILITY With XML standards, organizations can design their own data models, rather than being constrained to a vendor s proprietary model. Context can be included along with the data, explaining what happened and why. Such a solution yields distinct benefits LIVE ACCESS Clinicians and authorized users have immediate, on-demand access provided through an intuitive viewer in the context of the medical record to the information they need, without having to log in to several disparate systems. They can view and retrieve patient data and documents, regardless of the system that originally created it. SECURE SHARING Organizations can control which users have access to which items in the archived records. Documents can be securely shared with every authorized user across the enterprise and throughout the continuum of care, regardless of their facility location. LOWERED COSTS The costs of maintaining legacy applications can be reduced dramatically. Savings are found in reducing storage, backup, restoration and upgrade costs; eliminating application and database licensing fees; and redeploying IT resources from old systems to new ones. As legacy systems are retired, and especially when multiple systems are retired, payback can be significant, with return-on-investment (ROI) in excess of 100% not uncommon. Use cases have shown return to be realized in as few as 8 months with cost savings of $6-8 million dollars realized over 3 years or less when retiring 5-14 legacy applications initially. Larger, more complex projects over 400 applications retired have shown the ability to save over $1 billion dollars. SIMPLIFIED DATA RETRIEVAL A web-based user interface enables search of data from retired applications as well as cross-application searching. Authorized users can search quickly for data and documents in exactly the same way and information can be viewed from a single portal. IMPROVED RECORDS COMPLIANCE Data is immutable; it cannot be deleted or altered. And it is auditable, available if the auditors ask for it. The chain of custody from the point of data extraction to future use is unbroken. 19

20 FOCUSING On Clinicians and Research to Improve Care for Patients Delivering the right information, in the right context, to the right person at the right time for the right care.

21 A clinical archiving solution should enable information to be easily collected and analyzed from multiple sources, integrated into current clinical systems. Beyond the IT imperatives for clinical archiving, the ultimate beneficiaries of an improved system are clinicians and patients. To improve patient outcomes, clinicians require an integrated, comprehensive view of the vast range of patient information, such as medical history, medications, vital-sign data, operating and procedure notes, lab results, pathology reports, medical images, cardiology tests, diagnostic procedures and orders. They must have access to this information exactly where it is needed: at the point of care. The optimum clinical archiving solution one that enables information to be easily collected and analyzed from multiple sources, integrated into current clinical systems for use at the point of care and shared across the continuum can help healthcare organizations speed care delivery and provide better care more cost effectively. Such a solution is a key step in capturing the full value of patient data to achieve better care management, more effective and efficient practices and improved patient outcomes. This ensures that patient information is easily accessible at any point in the future for clinical purposes, research, or data mining. With the ability to retrieve all archived patient records, documents and images efficiently, care teams can see the full picture of each patient s history, diagnosis and treatment. Leveraging unified patient information; they can collaborate to make more informed decisions for better patient outcomes. The ability to access all information that is known about each patient can turn expensive patient encounters into more affordable ones for the patient and for the healthcare organization and create a better care experience overall. Today, the opportunity is ripe to enable the processes that deliver the right information, in the right context, to the right person at the right time for the right care. The ultimate goal is to keep patients as healthy as possible while minimizing admissions, reducing costs and delivering more efficient, high-quality care. The right information, in the right context, to the right person at the right time. 21

22 LAUNCHING An Application Retirement Initiative Planning for the retirement of legacy applications and ensuring active collaboration between clinicians and IT.

23 Retiring legacy applications requires the active collaboration of the clinicians and the IT team. A comprehensive plan to which both teams are contributing is critical to success. The length of the process will depend on the number of source systems and their complexity. You may want to plan on two to three months. And bear in mind that you may also have to consider regulatory and organizational issues, retention and disposal policies. 23

24 THE OVERALL PROCESS CAN BE BRIEFLY OUTLINED AS FOLLOWS: 1 Identify Stakeholders Make sure you have an executive sponsor and invite key representatives from the clinical, IT, and security departments to join the core team. 2 Determine Data Determine the data that you want to archive and present to your users. In general, this will be a subset of the full set of data in the source systems. 3 Identify Systems Identify source systems that are candidates to be decommissioned, such as EMR systems, lab systems, and systems that create documents or other forms of unstructured content. 4 Estimate Costs 5 Document Requirements 6 Develop A Strategy Estimate the costs associated with these systems, including licensing costs, server costs, storage costs, and operational costs. The operational costs (backup, administration, upgrades) may dwarf the capital costs. Document requirements for the new system, including the data, security and user experience aspects. Decide how the users will gain access to the archived data. Based on the requirements, develop a strategy for extracting data from the source systems. This will involve IT experts who know how to query the systems. 7 Design / Configure 8 Extract Data 9 Test System Design or configure the user application for presenting the archived data. Extract the data from the source applications into a staging area. Validate that all the data has been completely and correctly archived. Then ingest into the archive. Test the system with IT users. Then let the clinical users give it a try. You will want their endorsement; so make sure to get them involved in the application design. Shut Down 10 Shut down the legacy system and begin recouping the money you were spending on license fees, servers, storage and operations. 24

25 SUMMARY Learn more about Clinical Archiving Visit our blog to be a part of the conversation. The challenges. The case for clinical archiving. The legacy data system challenges facing healthcare The optimum clinical archiving solution needs to: organizations are many: Archive all forms of information structured and New EMR systems are replacing multiple clinical unstructured systems Seamlessly interact with EMRs/EHRs and the rest These older systems are costly to maintain but of the IT environment to ensure search, view, and contain valuable patient information retrieval of archived patient records Clinical archiving attributes. The selected solution should: Give clinicians on-demand access to all archived patient information and a 360 degree view of the patient Enable the secure sharing of patient information across the enterprise and the continuum of care Legacy clinical applications need be retired to ensure access to a lifetime of patient information Allow multiple healthcare enterprises to share documents across a federated repository Improve patient outcomes and promote greater clinical efficiency and care coordination Ensure regulatory compliance Reduce total cost of ownership (TCO) and enhance the value of EMR/EHR investments 25