Active Record Retention and Legacy System Decommissioning:

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1 Active Record Retention and Legacy System Decommissioning: Use Cases and Lessons Learned from Successful Projects NMHIMA Spring Conference April 18, 2017 Presented by Tony Paparella, President

2 The Triumph and the Party. New EMR and revenue cycle systems installed concurrently Staff highly engaged in the new HIS implementation Considered a great success!

3 and there was celebration and great merriment across the organization after a successful implementation.

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5 Then the Hangover 100 s legacy applications that were no longer needed.and the associated costs CURE: retire legacy applications, retain the data in an active archive Establish good data stewardship Identify data to archive and identify data to destroy Archive the data to retain its original meaning, essential active functions, and make accessible to users Decommission the legacy systems

6 Critical Factors for Success Legacy Retirement & Data Retention Active leadership support for retiring applications Buy-in from departments and users Expectation setting among users & departments Technology: Active archiving, ability to handle workflow & use cases Migrate data prior to decommissioning Prioritize the projects in line with new systems

7 Drivers of Change in Healthcare Market o o o o Healthcare Market Transformations: Federal Mandates (ICD-10 and Meaningful Use) Acquisitions and Mergers Budgetary Pressures to Consolidate Applications Data Driven Healthcare o o o o Data Retention Drivers: Federal/State Compliance and Retention Requirements for Clinical Records Continued Need for Accessing Clinical Records Audits: RAC, Medicare, Medicaid, Commercial Carriers Billing Requirements Legacy Application Challenges

8 The Lifecycle of Data Healthcare adds post production workflow Database Archiving for Long-Term Data Retention accessed January 2010

9 How Long to Keep data? General perception: keep patient data for 7 yrs. In actuality, many different regulations, laws and guidelines range from 2 to 30 years, some examples: 5 10 years for Medicare, Medicaid and Commercial carriers RAC Audits, MSP Audits, Commercial take backs HIPAA: 6 years for PHI requests & disclosures State Laws: 6 30 years, e.g.: Massachusetts was 30 years Pennsylvania 6 years Mississippi: 10 years for adults, up to 28 years for Children Pediatric Care: up to 28 years (age 21 plus 7 years)

10 Data to Archive Workflow & User Access No workflow, no GUI Replicate legacy look, feel and workflow 0% 100% Retain essential workflow

11 Systems to retire 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 for storage of data

12 Typical use cases Patient Accounting Sustain cash flow with extensive, robust active patient accounting functionality. Continue to post payments, submit claims, add notes, and manage interfaces. Clinical Patient centric longitudinal view of clinical records compiled from multiple legacy systems HIM Easy to respond to Release of Information (ROI) requests ERP Human Resources, Payroll, General Ledger, etc.

13 Building a Business Case Data Retention Guideline 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) Use Case 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 ERP ERP 10 years EOE audits HR, Payroll/pension inquiries

14 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: 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%)

15 Build the team: Steering Committee IS Legal, Compliance Clinical Other Dept. heads HIM Rev Cycle Research and Education Guidance from each of the following areas is needed on an application by application basis, as appropriate

16 Conduct 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

17 Discovery Sessions Conduct Analysis of Existing Applications Document Use Cases for Data Confirm Data Retention Guidelines Option 3 Option 1 Identify Contract Extension/Termination Options Option 2 End Goal = Determine Data Archival Options

18 Using an Active Archive Not a typical archive Includes workflow functionality Billing accounts for active A/R (2+ years after last DOS) Release of Information Interoperability Allows for real-time, end user access Reporting Discrete data elements and document images Secondary use of data

19 Execute Plan Charter steering committee for overall initiative Identify project specific resources needed Develop project plan/timeline Migrate data as appropriate Decommission legacy application

20 Legacy Retirement & Data Retention Program Results 1)$ millions saved per organization 2)Legacy systems decommissioned (a few to 100+, depending on organizational initiative) 3)Data retained and consolidated 4)Workflow retained: billing, ROI, clinical, reporting, other; 5)IT landscape simplified

21 Lessons Learned Start early ideally at the same time as selection of new HIS or during merger Include the business unit stakeholders: Revenue Cycle, Clinicians, HIM, Finance/HR Manage expectations: time, budget & archive functionality Engage in data retention road mapping Ensure a successful program with your own internal project manager/coordinator Ensure validation beyond a simple record count

22 Questions? Tony Paparella, President