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.

 

 

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