“Active” Record Retention and Legacy1 Yr. Total $200,000 Legacy Cost for 7 years $1,400,000 Example: Archive cost: Data extract & migration (vendor) $80,000 Project management,

“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

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!

Presented to NMHIMA, 4/20/17 Copyright, MediQuant

… and there was celebration and great merriment across

the organization after a successful implementation….


…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


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


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


The Lifecycle of Data

Database Archiving for Long-Term Data Retention

http://www.tdan.com/view-articles/4591, accessed January 2010

Healthcare adds “post

production workflow”

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)

How Long to Keep data?

Data to Archive

No workflow,

no GUI

Replicate legacy

look, feel and

workflow

0% 100%

Retain essential

workflow

Workflow & User Access


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


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.

Typical use cases

Building a Business Case

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

ERP

• 10 years

ERP

• EOE audits

• HR, Payroll/pension inquiries


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%)


Build the team: Steering Committee

IS

HIM

Research and Education

Clinical

Legal, Compliance Guidance from each

of the following

areas is needed on

an application by

application basis, as

appropriate


Rev Cycle

Other Dept. heads

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


Conduct Analysis of Existing Applications

Dis

covery

Sess

ions

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


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



Execute Plan

Charter steering committee for overall initiative

Identify project specific resources needed

Develop project plan/timeline

Migrate data as appropriate

Decommission legacy application

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

Legacy Retirement & Data Retention Program Results


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

Lessons Learned


Questions?

Tony Paparella, President

Documents

“Active” Record Retention and Legacy1 Yr. Total $200,000 Legacy Cost for 7 years $1,400,000 Example: Archive cost: Data extract & migration (vendor) $80,000 Project management,