Application Retirement Planning: Compliance, Cost & Access

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1 Application Retirement Planning: Compliance, Cost & Access 4/16/2015 Martin Prince - Vice President - Baylor Scott & White Health Christine Foley Vice President - MediQuant DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Martin Prince Has no real or apparent conflicts of interest to report. Christine Foley Has no real or apparent conflicts of interest to report. HIMSS 2015

3 Learning Objectives 1. Define the composition of the infrastructure (governance) and the elements of a sound plan to retire applications and maintain data retention compliance 2. Illustrate how early adoption of an overall data retention roadmap to achieve data retention and timely application retirement accelerated savings 3. Demonstrate a process to socialize a plan to secure buy-in with business units and overcome fears/objectives 4. Show how the consolidation of legacy data from disparate, retired systems results in added cost savings and efficiencies 5. Identify lessons learned from the creation and implementation of a comprehensive system retirement plan

4 An Introduction to the Benefits Realized for the Value of Health IT

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

6 Retirement Strategy Development 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 or storage of data

7 Data Retention Roadmap Evaluation & Execution Process Phase 1 Phase 2 Phase 3 Legacy Application Analysis & Discovery Design, Detailed Planning & Archival Solution Selection Archive Solution Procurement & Implementation

8 Phase 1 Legacy Application Analysis & Discovery

9 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

10 Phase 2 Design, Detailed Planning & Archive Solution Selection

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

12 Business Engagement/Guidance IS Legal Corporate Compliance Guidance from each of the following areas is needed on an application by application basis, as appropriate: Department Leadership Research and Education

13 Building a Business Case Discovery Work 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

14 Potential Data Archival Options Utility No Source Data Stored Archive with End User GUI Needed Retain Source System Back Up of Raw Data

15 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: Active 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%)

16 Phase 3 Archive Solution Procurement & Implementation

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

18 Charter Steering/Governance Committee Key Responsibilities Ensure compliance requirements and needs of business users are met Set ground rules for organization of the data Prioritize applications for archival Approve project timelines Oversee check points on project progress Participate in key messaging to organization Sponsor end user adoption ownership

19 Build Steering/Governance Committee Membership - Clinical HIM Leader Provider Leader Nursing Leader Compliance Clinical Application Leader IT Legal

20 Baylor Scott & White Case Study

21 Scott & White Healthcare* 12 Hospitals / 65+ Clinics 14,000 Employees 1,000+ Employed Physicians and Scientists $2.4 B in Operating Revenue 215,000+ member health plan *Prior to merging with Baylor Healthcare 21

22 Data Retention Roadmap Planned Phased Approach Phase 1 Phase 2 Phase 3 Legacy Application Analysis & Discovery Design, Detailed Planning & Archival Solution Selection Archive Solution Procurement & Implementation Completed FY12 Completed FY13-14 In Progress FY14-15

23 Phase 1 Legacy Application Analysis & Discovery

24 Application Consolidation Core Methodology Drivers & Considerations Data Base Technology Cache/Mumps Proprietary Databases DB2 Mainframe (VSAM, ISAM, etc.) Oracle SQL MS Access Archive Solution(s) Retention Requirements Regulatory Legal Compliance Research Clinical Needs ACO Data Points Line of Business Data Types Images Discrete data points Marked up text Proprietary Reports 24

25 Business Engagement Round 1 - Gap Analysis - Retention Needs Steps taken: Research and Education IS HIM Formed committees/sub-committees w/leadership representation by functional area Assigned one IS Vice President with primary responsibility for decommissioning legacy applications Providers Corporate Compliance Communicated EHR project objective to reduce overall cost and complexities Revenue Cycle Operations Legal Utilized application portfolio during future state design with committees to identify duplication in function

26 Application Archival Recommendation Total: 263 Applications to be Decommissioned (163) Ancillary, 13% [CATEGO RY NAME]s, [VALUE] Applications To Keep Running (100) [CATEGO RY NAME], [VALUE] Enterprise HIS, 17% Revenue Cycle, 9% Other, 12% [CATEGO RY NAME], [VALUE] Ancillary, 91% *Central Texas Division - Quantities represent a tally of each application (or module) assigned within the specific grouping

27 Phase 2 Design, Detailed Planning & Archive Solution Selection

28 Business Engagement Round 2 Legacy Retirement Planning Discussions Steps taken: Research and Education IS HIM Legacy application specific questionnaire completed for each application by committee participants (data retention & usage) Providers Corporate Compliance RFP conducted for Revenue Cycle & Active A/R processing Revenue Cycle Operations Legal Confirmed data retention periods through Legal, HIM, and Compliance sub-committees Project planning prioritized based upon cost reduction and contractual obligations 28

29 Tactical Archival Plan Function Data Type Purpose Archive Solution Revenue Cycle Revenue Cycle Discrete data Revenue Cycle Images Clinical Dictated Notes Clinical Images (test results) Scanned Images Documents/Reports from legacy clinical systems Active A/R, Billing functionality Legal/risk audits Patient care HIM ROI MediQuant (DataArk) Hosted solution Active interfaces 835, 837, Agency, DSS OnBase Historical Data button added inside Epic that launches the viewer that contains the historical clinical data ERP Data Reporting HR & Payroll data Supply Chain data Inactive AR AP & GL data Non-Clinical Images Business & compliance reporting Oracle Business Intelligence (OBI) Clinical Research Discrete Clinical data preserved in original context Marked-up Text (EMRx) Clinical research Legal/risk audits Historical Data Repository (HDR) TBD

30 Phase 3 Archive Solution Procurement & Implementation

31 Execute Plan Successes Turning off applications (a first for S&W) Repurposing O/S and DB licenses for future expansion Providing legacy data at a lower cost of ownership Challenges Maintaining business engagement throughout the entire project Competing priorities Estimating the work effort Data quality and integrity issues

32 Maintaining Business Engagement Impact on People New Epic Team Legacy Team Original Team

33 Navigating Change Leading Change Focus Group Questions What have you seen help people successfully navigate change? What has prevented successful change? What would help your team? Answers Accountability (staff, managers, leaders) Opportunities for relationship building Fear of change Not proactively addressing problems/barriers Lack of communication and follow up Leadership approach with positive attitude Daily huddle to provide focus Reinforce / encourage positive messages Action items for management Leadership Demonstrate a unified commitment to the new direction Managers actively remove barriers for staff Open door policy and forum to mine for conflict Team Building Encourage team huddles Shared goals to provide clear direction Have a Change Champion to demonstrate what change is about and why it s important to the organization and the individual

34 Learnings

35 Learnings Beware of the Myths Myth #1 Reducing the number of applications will reduce costs. 20% of the applications account for 80% of the costs

36 Learnings Beware of the Myths Myth #2 Reducing the number of applications will reduce complexity. The contribution to system complexity of all of the small applications is much less than the contribution of one large application.

37 Other Learnings Be careful not to under estimate the level and impact of effort Not only a technology project; it can impose significant people change on the organization This is not a part time initiative; it requires a dedicated team You ll need to invest money to save money.

38 A Review of Benefits Realized for the Value of Health IT

39 App Consolidation Expected Cost Savings Central Texas Division FY2014 FY2017 Ancillary, 9% [CATEGORY NAME], Other, [VALUE] Small/Med Hospitals, 6% Legacy EMR, 4% Enterprise HIS, 49% Revenue Cycle, 29%

40 Questions Martin Prince Phone: Christine Foley ext. 232 or