3 Overlooked Legacy System Management Areas of Risk

As a hospital or health system’s technology evolves in the transition to value-based care, legacy EHR systems are often overlooked, leaving organizations vulnerable to security, workflow and interoperability challenges. Today, let’s address how to handle three areas of risk for managing legacy systems.

  1. Network infrastructure initiatives

For any major network infrastructure changes, like a core switch replacement, the legacy team should work hand-in-hand with the infrastructure team to strategically plan out project scope and proactive mitigation steps for potential outages. Ensure that departments dependent on your legacy systems have appropriate downtime procedures, as operations identifies a nursing unit and clinical department priority list for bringing the systems online. The legacy team should coordinate with clinical operations to help the communication department develop a communications plan to deploy at scheduled intervals notifying operational users of an outage event. During an outage window, legacy analysts should complete system validation tasks prior to end-user release, ensuring that all applications are fully functional within each clinical area as they come online.

  1. System or application upgrades

Coordinating with IS and system vendors, mitigate risk during system upgrades by identifying impacted systems or applications along with the date, time and duration of upgrade activities. Determine areas and workflow affected and their level of impact. During an upgrade event, legacy analysts must monitor their upgrade plan to ensure tasks are completed as scheduled, while communicating any deviations. Working with clinical users, they can identify if any workarounds are necessary to support operational workflow during upgrade activities.

  1. Data identification, usage, validation and extraction

To ease data conversion, a legacy systems analyst should work with the conversion team and new vendor analysts to identify data requirements, file transfer locations, naming convention and resources needed to support the project. The legacy team can then utilize a data sampling for validation, while confirming the requested file delivery schedule. Working closely with the conversion team, legacy analysts can thoroughly review sample data that is converted against the source legacy system for accuracy. The conversion and legacy teams should meet regularly, maintaining thorough communication. This will eliminate task redundancy, data accuracy and smooth transition as the organization prepares for the new system.

Network infrastructure, system upgrades and data identification and extraction are three risk areas often forgotten amidst the many moving pieces of a new system transition. By following these tips with strong communication, detailed documentation and proactive strategy, legacy system teams can ease impact on end-users without thwarting daily patient care.

 

 

Do’s and Don’ts for Common Health IT Interview Questions

Regardless of your specific HIT software or application specialty, the questions interviewers ask and the topics they touch on are often similar across the industry. The following three interview conversation tips are useful for any health IT systems consultant, whether you work with Epic, Cerner, Allscripts or another major EHR vendor.

  1. Implementation deadlines

Don’t: Bring up blown deadlines and blame them on user resistance.

Example: “There were some issues in the build phase, and the implementation took longer than expected because of physician push-back.”

Do: Highlight the methods you used to help user buy-in for the system changes. Discuss your communication skills, specific contributions to past projects and how your work impacted overall project success or end-user adoption. Clients want to hear how well you perform under challenging conditions, not excuses for failures.

Example: “There was some pushback at first, but I was able to show users how the new product would make their lives easier. I did this by talking directly with end users to understand their concerns, educating them on how the new product works and how it will improve their workflow. Once they realized it wasn’t just change for the sake of change, we could push through the typical resistance and complete the implementation on time.”

 

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  1. Past challenges

Don’t: Throw your previous client or consulting firm under the bus when asked about past challenges.

Example: “The last project I worked on was with a hospital that had a lot of issues. They were disorganized, their processes were confusing and the whole thing was a mess.”

Do: Focus on how you overcame the challenge instead.

Example: “When I first arrived, lines of communication were not optimal, and it was hurting the ability to accomplish project goals. I made sure everyone was on the same page by acting as liaison for my team. I worked with other departments to ensure responsibilities and timelines were clearly mutually defined. This pushed analysts in other departments to talk to each other about their needs and issues. That way, we could make sure everyone on the team, organization-wide, worked cohesively.”

  1. Rating your team performance 

Don’t: Tell the interviewer how much better or harder you worked compared to other analysts. This can make you seem like you’re not a team player.

Example: “There were six of us on the team, but I was the one who the client liked best and the only one who had a contract extension. I did almost all the job myself because the other analysts were inexperienced and didn’t know what they were doing.”

Do: Focus on describing how your work contributed to positive outcomes for the team. If you found yourself taking on extra work, say it in a way that doesn’t put the rest of the team down.

Example: “There were six of us working together on my last implementation, and I put in extra time to mentor less-experienced members of the team and ensure their work was of the best quality. When we ran into snags, I had no problem stepping up to help resolve the problem, so the implementation could be a success.”

By approaching these three topics from a positive angle, you can greatly increase your chances of interview success, showing that you are an experienced team player. Stay tuned for additional HIT career insight from the HITStoltenblog, and email us at stoltenberg@stoltenberg.com for any new topic requests.

-Melanie Streeter, Health IT Systems Recruiter

 

 

Data Abstraction & Conversion Best Practices for New Epic System Go Live (Part II)

In the first post of this two-part series, we discussed legacy system cleanup, new system data entry and pre-load best practices as your healthcare organization prepares for its new Epic EHR system. Let’s discuss three additional tips for data abstraction and conversion work for your strategic EHR transition.

  1. Staffing aid
    As discussed in the last post, it can take some time to load your scheduled patients into Epic prior to go live. The process of reviewing the patient in the legacy system and entering/reviewing the data in Epic is tedious work. However, it is a great learning opportunity for clinical staff, who should start practicing the process as soon as possible. Many organizations need to supplement staff to accommodate the number of scheduled patients for the first 2-3 weeks after go live. Some organizations utilize residents or retired staff for this work. Many others use HIT consulting firms to cost-effectively supplement the labor. If your organization uses a third-party firm, make sure their resources have direct experience with this critical assignment. Not only will the resources need to know Epic, but they will also need to know the legacy systems, depending on how many different source systems the patient data will be coming from.
  2. CCD load
    If possible, utilize a Continuity of Care Document (CCD) load from the legacy system. A CCD is an electronic document exchange standard for sharing patient summary information. This format of data can be extracted from the legacy system and loaded via HL7 into Epic once the demographic data is loaded into Epic for each patient. Users will see the data and have the chance to reconcile this data and add it to the Epic patient chart. This significantly reduces data entry time into Epic. Each scheduled patient will still need to be reviewed and verified against the legacy system for accuracy.
  3. Data audit
    With the patient data transition complete, it is critical to audit data that has been entered into Epic. A common best practice is to have providers select 10% to double check for data accuracy. The data audit is a learning opportunity for clinical staff to learn the system prior to go live and that critical first patient visit.

With the big day for Epic go live approaching, you can now rest assured that those first scheduled patients have matched critical data ready and waiting for new system use. With these best practices in place, end users will feel more comfortable and prepared for their clinical care visits. Within a few weeks, as staff have developed muscle memory of the new Epic system, they can reap the benefits of a unified IT landscape across the continuum of care.

-Lisa Alkin-Imhof, Epic Practice Director

 

Data Abstraction & Conversion Best Practices for New Epic System Go Live (Part I)

The EHR market is set to grow to $39.7 billion by 2022. As patients and providers alike push for better access to data for informed care management and decision-making, healthcare organizations are making significant investments in their EHR systems for cohesive care coordination in the transition to value-based care.

If you are like many leading health IT professionals today, your organization has made a multi-million-dollar purchase of a new Epic EHR system. Now what? After months, and possibly years, of planning for your new Epic system, one of the biggest issues for IT end users has been the first Epic ambulatory visit with patients. Why? As with anything new, the system is a major change for your providers and staff. It will take time for them to learn the new system functionality and develop muscle memory to navigate through seamlessly.

One of the most important things you can do to improve the go-live process is to make sure key patient data is entered prior to both the go live and the first patient visit. Minimum key data points on each patient should include schedule visits, allergies, active medications, active problem list, immunizations and preferred pharmacy.

How can you smooth the new system adoption process?

In part I of this two-part blog series, consider the following three takeaways for EHR system data abstraction and conversion:

  1. Legacy system data cleanup
    12 months before your Epic go live, begin cleaning up the key data in your legacy system. Why so early? Many patients only visit their doctors once a year. By beginning the cleanup processes one year prior, you will have plenty of time to make sure the most accurate information is transferred into your new system. This is especially pertinent for the problem lists and medications. Doing so greatly speeds up data load into the new system and ensures with each subsequent visit that providers are addressing the active patient problems. Keep in mind though that if you have data in your legacy system that is no longer valid, this is your opportunity to start fresh.
  2. New Epic system patient data entry
    How much time does it take to enter the data into the new system? Depending on the complexity of your patient population, it can take anywhere from 5-10 minutes per patient to enter and validate a patient’s data into Epic for the first time. Remember, this is a new skill for your staff to learn, so it will likely take them longer at first to enter data as they learn the new system.
  3. Data pre-loading best practice
    How soon do I begin entering this data into Epic? The best practice is to pre-load your first 2-3 weeks of scheduled patients into Epic prior to go live. This allows your staff to have the patient data ready during the first few weeks of actual new system use. It also reduces stress on your staff, allowing them time to learn and adapt to the new system. Depending on the number of active patients and scheduled appointments, multiply the average of 5-10 minutes for best and worst-case proactive planning of time needed for data entry prior to the go-live date.

Check back for part II covering data conversion staffing solutions, CCD load and auditing.

-Lisa Alkin-Imhof, Epic Practice Director

12 Times Nurses Made a Difference in Disaster Relief

In celebration of National Nurses Week, check out the following guest blog:

Throughout history, countless stories endure of nurses rushing to the frontline for those in need. To honor the vital role nurse play in healthcare, the U.S. celebrates National Nurses Week each year May 6-12. From founding the American Red Cross to recent natural disaster relief response, dedicated nurses shed their scrubs to serve others in any setting. Today, let’s highlight 12 times nurses made a difference with hurricane and earthquake relief.

Nurses Serve After Hurricane Maria

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Regarded as the worst natural disaster on record in Puerto Rico and Dominica, Hurricane Maria took the lives of 550 people and caused an estimated $103 billion in damage. The September cyclone left 80,000 Puerto Ricans without power or medical supplies, leaving medical relief largely to foreign aid organizations.

  • They Begged for More Aid — The nation’s largest nurses’ union, National Nurses United, sent more than 50 nurses to Puerto Rico and Dominica in the days following the hurricane as part of the organization’s Registered Nurse Response Network. The nurses returned home and shared shocking conditions with the media, urging the federal government to send more relief.
  • They Set Up Urgent Care Centers — Haiti is no stranger to natural disaster, so naturally, Heart to Heart International’s Haitian Response Team jumped into action after the devastating hurricane. A team of 10 Haitian doctors and nurses brought medical and humanitarian aid in the form of a makeshift urgent care center. They were some of the only humanitarian responders to provide care in rural Puerto Rico.
  • They Helped the Elderly — According to CNN, after the hurricane, a team of nurses helped deter an elderly woman’s suicide by alerting the mayor of the situation. They also assisted a woman trapped inside an assisted living facility, who had not eaten in three days.
  • They Transported Patients to the Mainland — According to nurse Camrai Damore and respiratory therapist Mark Puknaitis — two Chicago area Maria responders —nurses aided the sick and injured by transferring those with serious medical conditions to the mainland for better quality care.
  • They Visited the Sick at Home — One of the most devastating effects of Hurricane Maria was the total crumble of the infrastructure of many cities. As a result, nurses made in-home visits to suffering Puerto Ricans who were unable to leave their homes. They also helped to set up temporary shelters that were more accessible than hospitals and clinics.

Healing After Harvey

Back in the continental U.S., the country was recovering from another natural disaster. In August, Hurricane Harvey became the first major hurricane to make landfall in the U.S. since 2005. It inflicted nearly $200 billion in damage and displaced more than 30,000 people in the process, primarily in the Houston metropolitan area. It didn’t take long after the storm settled for nurses to come to the rescue from all over the country.

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  • They Responded by the Hundreds — Within four days following Harvey, more
    than 300 nurses made their way to Houston to provide essential medical relief to
    the masses, stethoscopes and all. The group of nurses had a broad range of specializations, including NICU, OR and ER nursing.
  • They Brought Supplies — That massive wave of 300 nurses didn’t head to Houston empty-handed. Instead, they brought generators, linens, water tanks, food and medicine. This was especially important due to the fact that Houstonians were forced to completely evacuate several hospitals, but still needed to be prepared for a massive response. Supplies allowed them to administer care just about anywhere.
  • They Covered Shifts — According to reports, a large volume of Houston medical professionals were left homeless due to water damage. Nurses from other parts of the state and the country flocked to Houston to help cover shifts of medical professionals who were forced to deal with personal fallout from the storm.
  • They Helped Clean Up — Days after the storm, medical professionals were forced to return to work, where much had been destroyed due to moisture, mildew and mold. Many nurses who flocked to the region after the hurricane spent their evening hours cleaning up debris and handing out supplies.

Administering Urgent Care to Earthquake Victims

Just weeks after Hurricane Harvey rocked the nation, central Mexico was hit with a 7.1-magnitude earthquake that left 370 people dead and more than 6,000 injured in and around Mexico City. The strong shakes lasted for about 20 seconds, collapsing more than 40 buildings in the process.

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  • They Jumped to Action Immediately — According to the Red Cross, some 500 volunteers — many of them nurses — jumped to action in the hours immediately following the disaster. The Mexican Red Cross deployed more than 90 ambulances and several hundred paramedics, who provided life-saving aid within hours.
  • They Cared for Kids and Babies — Among the collapsed and damaged buildings were a series of schools, many of which had children inside. One of the greatest challenges for responders to the Mexican quake was figuring out how to care for the many injured children. Makeshift hospitals were set up, and nurses jumped into action to provide care.
  • They Delivered Babies — In one inspiring tale from the quake, nurses delivered a healthy baby in the middle of the quake in one of the worst affected neighborhoods. While the rest of the hospital evacuated, nurses ushered Jessica Mendoza to a safe place, so she could give birth to a healthy baby boy.

These heartwarming tales are just a glimmer of the heroic work nurses conduct each day. Keep these stories in mind this week as you thank the nurses around you.

Created in coordination with
Deborah Swanson, Content Coordinator, realcaregivers.allheart.com

Insights From the Sixth Annual Health IT Industry Outlook Survey

Over 300 HIT professionals shared their insights in the sixth annual Health IT Industry Outlook survey. The results focus on health IT leaders working collaboratively to stay on top of evolving staffing, EHR system and technological advancement trends for operational efficiency and proactive patient care. Hospital IT departments continue to struggle with strained resources and competing projects. As the industry pushes forward with value-based care, the ability to optimize technology and workflow within an organization is vital for success. Here are four key takeaways from the 2018 survey:

  1. Need for a cross-disciplinary team

Within the survey, measuring improvement in patient care quality was rated as the top business objective (40 percent) by health IT leaders. Outdated passive measurement processes no longer work in today’s complex health systems. Considering competitive pressure in the new healthcare landscape, each hospital department must eliminate communication silos for a cohesive strategic conversation. To proactively establish efficient workflow, reporting needs and streamlined communication, create a cross-disciplinary team from all areas impacted by a new or optimized EHR system. Healthcare organizations need to look at the full picture of patient care to make proactive decisions.

Survey Teaser #1

  1. HIT staffing solutions

Optimizing IT/EHR performance (32 percent) and overcoming IT staff shortages (31 percent) were cited almost equally as the most significant challenges in 2018 among survey participants. To strategically address healthcare IT staffing challenges, identify support gaps by creating a visual support map covering all facilities, applications and tools impacted by a new EHR or large-scale IT deployment. You can be creative in staffing by looking to local sources such as area colleges to utilize students in IT, healthcare administration, education, nursing or healthcare-related programs. This can be helpful during short-term projects like system go-lives or vendor upgrade support.

  1. Integration for quality care improvement

Clinical application and implementation support (32 percent) remain the top 2018 IT outsourcing requests, followed by hospital IT service desk support (28 percent). While EHR adoption is nearly universal across the country, there is much more depth to a full system implementation than an initial go live. Integration is essential for improving care quality and ensures that health organizations have a comprehensive, accurate and reliable perspective on their care performance reporting. HIT leaders can combat health system interoperability challenges by focusing on tight integration of IT platforms and data across internal hospitals, practices, providers and even patients at home. A clinically consultative HIT service desk can help identify siloed issues with workflow and end-user errors while serving as a single source of contact.

  1. Making MACRA a habit

Finally, the survey found that most organizations stills struggle to align reporting priorities with practices within year 2 of MACRA. Forty percent of survey participants reported feeling underprepared for year 2, and only 12 percent felt very prepared. When organizations are short-handed for IT support and optimization, it can impact other initiatives such as MACRA reporting strategy. By making the data capture and analysis more automated and consistent, preparation can be easier. The result will be more detailed documentation, better EHR utilization and QPP category maximization – making strategic MIPS participation a more simplified process.

HIMSS18 Pushes Immediate Patient-Centered Change

We have all heard the saying, “the customer is always right.” Consumers should drive how a business functions, next steps and where the industry is headed. In healthcare, it is no different. Patients expectations are raising higher standards in technology, experience and outcomes. The providers who fail to recognize the patient-centric culture forming will struggle to stay competitive.

HIMSS18 brought a multitude of insights to over 45,000 healthcare IT professionals on how to provide better patient outcomes. Technology is booming in healthcare, but adoption still lags behind other industries. Here are four themes from HIMSS18 to competitively propel healthcare providers:

  • Consumerism is here to stay. Patients are looking for a patient experience built on consumer preferences, personalization, flexibility and clear communication. This can include digital options for registration and billing, better ways to share EHRs digitally and personalized physician-to-patient interactions. Providers must use patient communities as an eye toward the next direction of their organizations.
  • Healthcare is moving from diagnosis and treatment to anticipation and prevention. Start looking at technology abilities not only as a tool or data storage, but to analyze and predict. Smart data enables insights toward physician care decision making, patient experience improvement, readmission reduction, population health management and prescription monitoring. The latter comes into play with the country’s opioid crisis, as prescribing systems are now working to flag addiction patterns and medication discrepancies.
  • Artificial Intelligence is the name of the game. AI has been introduced before, but its presence is finally in practical application in healthcare. Artificial intelligence will allow healthcare professionals to analyze the healthcare data they already have stored, alarm physicians of things that should be noted and let physicians better focus on patient experience while the machines look for gaps in data. The next step though is to make the technology accessible in practice at the point of care without adding workflow burden to end users.
  • Disruption is key. Healthcare organizations must focus on the consumer and how technology will evolve their abilities. Some say that health systems will be known as tech companies with a healthcare focus considering all of the technology advances leading to the future of healthcare.

Here’s a look at how several CHIME provider organizations are staying ahead with these themes: http://bit.ly/2Fs5dNU

HIMSS18 elicited many insights for the future of health IT. After all, it is not every day that you get to talk about machine learning detecting cancerous tissue. Then again, HIMSS brought up many tactics applicable to any healthcare organization despite differences in budget, patient communities, region or specific EHR. The conference teases what’s on the horizon for care possibilities but also grounds us with consideration of where reporting, CIO pain points, physician burnout and standardization need to be addressed.