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.



Tips for Negotiating with EHR Vendors

Before signing the contract with a new EHR vendor, think about the immediate and future implications on your healthcare organization, end users, workflow, business operations and the patient community. Be willing to consider the following questions when approaching this daunting IT decision:

  1. What is the main goal we are trying to achieve?

    Don’t buy or opt in for additional or added features when you don’t need them for your practice. Additional functionality and available modules can always be negotiated from a pricing standpoint (which you should be able to be lock in for at least two years) as an option exercised at a later date if the scope of the practice changes and there is a need for the additional product. Another thing to remember is, just like cars and furniture, software is always on sale. The level of discount you are able to achieve will depend on a number of factors, including success of the vendor, timing in the quarter or fiscal year and length of agreement you are willing to enter into.

  2. What’s the best way to achieve win-win outcomes in the negotiation with a new EHR vendor?

    Remember that the best executed software agreement is one that both the customer and the vendor feel good about. The goal is for the agreement to be a win-win result. It should provide a quality and supportable product for the medical practice in an agreement that the vendor feels good about to provide the appropriate support. With a win-win agreement, the vendor is much more likely to go the extra mile in assisting the customer when issues arise outside of the normal support process.

    There doesn’t necessarily need to be a bad guy in the negotiating scenario if open and honest communication is on the table during the negotiation process. Both the customer and the vendor are going to having non-negotiable items that they cannot concede on for various reasons. These should be communicated at the appropriate time during the process. Good representation from the right individuals from both a financial and clinical perspective will help to ensure that expectations are communicated for what is required and what the vendor is offering to meet the needs.

  3. What else should you consider when working with a new EHR vendor?

    Reference checks are the key to making this very important decision for your practice. Ask for a minimum of three references and at least one of those references should be a “bad” reference provided by the vendor. Although it may not have necessarily completely been the vendors’ fault for the bad references, it will provide you, the potential customer, with some insight on why that reference failed with the implementation or has not been able to fully utilize the capabilities the vendor is proposing to your healthcare organization. Good references are just that, but take the time to learn as much as possible from them about how they feel they successfully implemented the product. What was their staffing model? How long did the implementation take? Did it stay within the budget parameters? What would they have done differently to make it an even better implementation? Exchange contact information with the good references in hopes of communicating with them further in the future.

Best of luck with your negotiations!

Maximizing the Full Potential of Meaningful Use

During this year’s annual HIMSS conference, we conducted our second annual industry survey to identify and address the leading challenges and topics in healthcare technology today. We set out to receive insights, opinions and perspectives from health IT leaders by asking five questions that incorporated the most often-cited subjects and issues from our customers, as well as our own observations on the current industry environment. Recently, we released the complete survey findings – find them here. The results painted an interesting portrait of the industry’s journey so far to a transformed healthcare system, and we’d like to dive deeper into what this all actually means in terms of the future.

This is the first post of our HIMSS industry survey blog series. We welcome your comments!

If your organization has met meaningful use, do you feel you’ve been able to maximize the full potential of MU?

Response: No (70%), Yes (30%)

I can’t say that I’m surprised by this response. It’s one we see and hear about often, particularly during an RFP process, and it’s a common sentiment from hospital IT staff and leadership who want to feel like the time and money being spent on meaningful use attestation has been worth the investment.

My response to them is this: The meaningful use process must be approached as a marathon, not a sprint. It’s far more than checking off a series of boxes in order to receive incentives and avoid penalties – and it goes beyond a “one and done” project that can be completed and forgotten about.

MU is a strategy, discipline and process that facilitates healthcare transformation and eases the transition to the things we all want to see in the near future, such as population health management, full patient engagement and value-based, accountable care. In most cases, HCOs need to adopt a marathon mentality to address new and emerging trends and developments, and best position their organization for success.


Changing the MU mentality from a 50-yard dash to a marathon can be done through a commitment to thinking “outside the box.” Some suggested ways to do so:

  • Identify trusted external experts and consultants with the perspective and experience to find “low-hanging fruit” in the form of measures, goals, plans, programs and projects. Doing so will prevent the wearing down of financial, human and technology resources as the healthcare organization strives to reap major dividends and position itself for subsequent stages of MU and healthcare transformation.
  • Cooperate, compromise and collaborate. Involve players from finance, operations and clinical care in MU discussions, decisions and short- and long-term planning. Also, network with other providers to discuss best practices.
  • Promote the significance of MU to your organization. Help professionals understand that MU is not another HIT project, tool or fad, but a long-term, organization-wide initiative and national movement aimed at data capture and sharing, information exchange among providers, patient engagement and improved outcomes.
  • Focus on the big picture, but remember the milestones. Avoid discussions only of final and proposed rules, objectives and comments to understand the function and scope of each MU stage and MU as a whole.
  •  Play up the relationship between the stages of MU and HIMSS stages 1-7. The Electronic Medical Record Adoption Model from HIMSS Analytics allows healthcare organizations to chart their accomplishments and compare “progress toward paperless” with other providers. Some organizations rely on HIMSS EHR adoption data to justify plans and programs to the C-suite and report MU accomplishments.
  • Look to industry resources for best practices, case studies and support. Among the organizations to reference are HIMSS, American Hospital Association, American Medical Association and College for Health Information Management Executives.

For more information:

Stay tuned for the remaining posts in our series!


A First-Time Attendee Recaps the HIMSS 2013 Conference




The New Orleans Ernest N. Morial Convention Center held 1.1 million square feet of HIMSS13 excitement.

The following post highlights a Stoltenberg Consultant Development Program team member’s HIMSS experience:

From March 3-7, the HIMSS 2013 Conference and Exhibition, the largest healthcare IT gathering with as many as 34,000 attendees, was held in New Orleans, LA.  It was my first time attending HIMSS, and I enjoyed every moment of it. Upon walking into the convention hall, I was surprised of the size and complexity of the booths before my eyes, and I couldn’t even see every booth. The isles stretched beyond my view, with booths set up for live demos, in-booth speeches, ER/ICU rooms, booths with a complete bar set up within it, and even booths spanning so large it was like walking in a house with multiple levels. Our own booth was set up with a Geodesic dome which was completely unique compared to the other booths. Trying to view all of the booths in the time frame allowable for the first day was not even a remote possibility. The range of possibilities and vendors that can encompass the words “healthcare IT” was astounding for a first time attendee to experience. I could not believe that this many people were invested in healthcare IT. Just the sheer number of EHR vendors was astounding, who were there to help healthcare providers meet government standards.

Stoltenberg’s booth theme Building a Better HIT Community featured a Geodesic dome and 12-foot fabric tree.

While surveying some participants and exhibitors, one issue stood clear as a major discussion at HIMSS 2013 and as a major discussion for the upcoming year, Meaningful Use. There is such a high demand for healthcare IT personnel, it is important to get the word out that clients need assistance with meeting government requirements. Every day, several educational sessions were offered for the major issues being talked about today, including Meaningful Use, Health Information Exchange, and ICD-10. I was able to attend a few of these educational sessions.

The floor was busy all week with attendees visiting exhibitor presentations, educational sessions, and live demos.

I was able to share my incite to attendees on what it is to be a Junior Consultant and the opportunities that I am gaining versus what I would have a few years ago when news grads were not given the opportunity to become consultants. The responses I received about the program were all very positive, with most people surprised that there is such a program available. I was also able to explain the work I have done on the Stoltenberg Help Desk and how beneficial it is for our clients.

HIMSS was a great experience to network and meet people, expand educationally, and to see what is occurring in the industry. As a new grad with limited healthcare industry knowledge, it was amazing to hear about new innovations that many major vendors are creating. It would have been great to be able to see every booth, but in the three days, it is not realistically possible.  Just remember, if you are a first time attendee, it doesn’t matter what type of shoes you wear! In the future I feel as though the conference may need to be extended in order to allow participants the ability to experience more of the booths, especially if the convention is going to keep growing as the years go by. Overall as a first time attendee, HIMSS was an overwhelmingly great experience on many levels.

Stoltenberg team members conducted an industry survey from the show floor to gauge hot topics for 2013.

HIT Policy Leader Places Focus on Client Needs over Vendor Dollars

ImageIn the Feb. 7 Healthcare IT News article, Diana Manos elaborates on comments made by Farzad Mostashari, MD, National Coordinator for Health Information Technology.  His comments came at a meeting of the Health IT Policy Committee.  In these comments, Mostashari eluded to the unfair practices of some EHR vendors.  He also threatened increased governmental regulations to control those practices if they continue.

I do agree there are vendors and consulting firms in our sector that see a dollar as more important than “doing what is best for the client.”  That has plagued HIT for as long as there has been HIT.  Since ARRA and HITECH, this issue has grown.  Any sector that sees the business growth HIT has had over the last couple of years, draws the attention of people that see dollars instead of opportunity to make a difference and impact our healthcare system overall.  This is not new but might be more prolific than in the past.  Mostashari focused on vendors that use unfair “data lock-ins,” contract language that has a chilling effect on clients changing vendors and false claims of interrupted reporting abilities as examples of these unethical but legal practices. In response, he said regulations might be what is required to fix this issue.

My question is why would the regulatory process be required?  As consumers of vendor and consulting firm services, the power rest with the client.  If a vendor or consulting firm is clearly looking only for the almighty dollar and does not have a genuine priority of doing what is best for the client, why would its services be purchased?  As consumers, we all have the ability to set the standards we expect by what we choose to purchase and what we choose not to purchase.  Since there are vendors and consulting firms that clearly have the best intention for their clients, there are other options instead of purchasing services from one that is only driven by the profit.  More regulations are not needed. These vendors and firms can only take advantage of someone when the client signs the contract agreeing to those terms.

In today’s market where so many mergers are occurring, where vendors and consulting firms are becoming behemoths in the HIT market, these practices of putting profits in front of customers will only increase. Using vendors and consulting firms that have resisted this trend to merge so they can continue to focus on each individual client’s needs becomes critical to stopping the growth of unfair practices that put the dollar above the needs of the client. Use your pen to send a message to create the standards you want to see become the norm. Every signature on a contract sends a message to our industry.

Community Hospitals Moving Toward Stage 2 Meaningful Use

Community Hospitals Moving Toward Stage 2 Meaningful Use

Within the Feb. 7 EHR Intelligence CIO Series feature “Moving from Stage 1 to Stage 2 Meaningful Use” author Kyle Murphy interviews EMH Vice President of Clinical Operations and Information Systems/Chief Clinical and Information Officer Charlotte Wray, addressing the goals set for the community hospital system’s movement toward Stage 2 MU. Check out this piece tailored toward rural and community hospitals making note of the first-hand experience behind it.

Find the article here. 

Find out more about EMH here.