application retirement planning: compliance, cost & access€¦ · application retirement...
TRANSCRIPT
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.
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
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
Drivers of Change in Healthcare Market
Healthcare Market Transformations:
o Federal Mandates (ICD-10 and
Meaningful Use)
o Acquisitions and Mergers
o Budgetary Pressures to Consolidate Applications
o Data Driven Healthcare
Data Retention Drivers: o Federal/State Compliance and
Retention Requirements for Clinical Records
o Continued Need for Accessing Clinical Records
o Audits: RAC, Medicare, Medicaid, Commercial Carriers
o Billing Requirements
Legacy Application Challenges
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
Data Retention Roadmap Evaluation & Execution Process
Phase 1
Legacy Application Analysis & Discovery
Phase 2
Design, Detailed Planning & Archival Solution Selection
Phase 3
Archive Solution Procurement & Implementation
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
Analysis of Existing Applications
Dis
cove
ry S
essi
ons
Document Use Cases for Data
Confirm Data Retention Guidelines
Identify Contract Extension/Termination
Options
Option 1
Option 2
Option 3
End Goal = Determine Data Archival Options
Business Engagement/Guidance
IS
Corporate Compliance
Research and
Education Department Leadership
Legal Guidance from each of the following areas is
needed on an application by
application basis, as appropriate:
Building a Business Case Discovery Work
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)
Data Retention Guideline
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
Use Case
Potential Data Archival Options
Utility – No Source Data
Stored
Retain Source System
Back Up of Raw Data
Archive with End User GUI
Needed
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%)
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
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
Build Steering/Governance Committee Membership - Clinical
HIM Leader
Provider Leader
Nursing Leader
Compliance
Clinical Application Leader
IT
Legal
Scott & White Healthcare*
21
*Prior to merging with Baylor 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
Data Retention Roadmap Planned Phased Approach
Phase 1
Legacy Application Analysis & Discovery
Phase 2
Design, Detailed Planning & Archival Solution Selection
Phase 3
Archive Solution Procurement & Implementation
Completed FY12 Completed FY13-14 In Progress FY14-15
Application Consolidation Core Methodology – Drivers & Considerations
24
Data Base Technology
•Cache/Mumps •Proprietary Databases •DB2 •Mainframe (VSAM, ISAM, etc.) •Oracle •SQL •MS Access
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
Archive Solution(s)
Business Engagement Round 1 - Gap Analysis - Retention Needs
IS
HIM
Corporate Compliance
Legal Revenue
Cycle Operations
Providers
Research and
Education
Steps taken: Formed committees/sub-committees
w/leadership representation by functional area Assigned one IS Vice President with primary
responsibility for decommissioning legacy applications
Communicated EHR project objective to reduce
overall cost and complexities
Utilized application portfolio during future state design with committees to identify duplication in function
Application Archival Recommendation
*Central Texas Division - Quantities represent a tally of each application (or module) assigned within the specific grouping
Total: 263
[CATEGORY
NAME]s, [VALUE]
[CATEGORY
NAME], [VALUE]
Other, 12%
Revenue Cycle, 9%
Enterprise HIS, 17%
Ancillary, 13%
Applications to be Decommissioned (163)
Applications To Keep Running (100)
[CATEGORY
NAME], [VALUE]
[CATEGORY
NAME], [VALUE]
Ancillary, 91%
Business Engagement Round 2– Legacy Retirement Planning Discussions
28
IS
HIM
Corporate Compliance
Legal Revenue
Cycle Operations
Providers
Research and
Education
Steps taken: Legacy application specific questionnaire
completed for each application by committee participants (data retention & usage)
RFP conducted for Revenue Cycle & Active A/R processing
Confirmed data retention periods through Legal, HIM, and Compliance sub-committees
Project planning prioritized based upon cost reduction and contractual obligations
Tactical Archival Plan
Function Data Type Purpose Archive Solution
Revenue Cycle • Revenue Cycle Discrete data • Revenue Cycle Images
• Active A/R, Billing functionality
• Legal/risk audits
MediQuant (DataArk) • Hosted solution • Active interfaces – 835,
837, Agency, DSS
Clinical Research • Discrete Clinical data preserved in original context
• Marked-up Text (EMRx)
• Clinical research • Legal/risk audits
Historical Data Repository (HDR) TBD
Clinical • Dictated Notes • Clinical Images (test results) • Scanned Images • Documents/Reports from legacy
clinical systems
• Patient care • HIM ROI
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)
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
Navigating Change Leading Change Focus Group
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
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
Myth #1 Reducing the number of applications will reduce costs.
20% of the applications account for 80% of the costs
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.
Learnings Beware of the Myths
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.
App Consolidation – Expected Cost Savings Central Texas Division
FY2014 FY2017
Enterprise HIS, 49%
Revenue Cycle, 29%
Legacy EMR, 4%
Small/Med Hospitals, 6%
Ancillary, 9% [CATEGORY
NAME], Other, [VALUE]
Questions
Martin Prince Phone: 254-724-6139 [email protected]
Christine Foley 440-746-2300 ext. 232 [email protected] or [email protected]