One health system's data archiving strategy for migrating to Epic
AltaMed, a 35-location health system in Southern California, recently moved from its NextGen electronic health record to an Epic EHR, which left patient records in multiple systems.
The health system wanted to turn off NextGen so it could reduce the cost and complexity of having multiple systems up and running, but it needed to keep those legacy records easily accessible to clinicians and the healthcare information management team. AltaMed also needed to comply with record retention requirements.
Migrating all of the data to Epic was not feasible or affordable, so staff considered their options and turned to archiving. They went out to bid and chose a vendor.
"We started down the road of archiving our two NextGen data sources, which included ambulatory, dental and revenue cycle records," recalled Emmet Jacobs, director of enterprise applications at AltaMed. "Unfortunately, the project did not go smoothly. During implementation, we found many errors in the archived data."
It also became clear the vendor could not handle the complexity of the dental records that required extraction and migration. AltaMed had odontogram dental images to archive, which represented about 27 terabytes of unique data with special formatting that needed to be preserved to ensure the color in the images was retained. This detail is important for the dentist to see.
"If your organization has a growth plan in place, a solid archiving strategy can provide a foundation for future consolidation of legacy patient records and help simplify the EHR portfolio, making it easier for both IT and the patient-facing teams."
Emmet Jacobs, AltaMed
"As the vendor was not able to deliver the scope of work, we were forced to halt the project mid-stream," Jacobs said. "Our support agreement with NextGen was ending soon, which drove an aggressive time line to find a better solution. It was critical that we didn't experience a gap in accessibility to the patient records for our clinical and HIM teams."
AltaMed staff met with the team from vendor Harmony Healthcare IT and talked through the challenges they faced.
"They had a lot of experience with archiving NextGen, but had not dealt with odontograms before," Jacobs noted. "After a bit of investigation, they said they were confident they could deliver on the project. Harmony Healthcare IT worked through the unique image management from the services side and then customized their archive to store the complex dental components that were important to this project."
The health system evaluated the Harmony product HealthData Archiver, which is the user interface for accessing the consolidated legacy data. It met the needs of the clinical and HIM teams to easily access the historic patient records, so AltaMed moved forward with the vendor.
"The simplicity and intuitive nature of the HealthData Archiver interface really wowed our team and gave us the confidence we needed to move forward," Jacobs said. "We knew we needed a tool that was easy to use while also meeting all of the complexities that came with the unique dental imagery. This solution gave us all of that and then some."
MEETING THE CHALLENGE
The first challenge was to get all the needed records from NextGen into the archive so they were securely stored and accessible. Harmony's team of experts played a pivotal role in accomplishing the collection in a manner that was efficient and effective, Jacobs said.
"They knew we didn't have time to waste," he said. "The day-to-day use of HeathData Archiver lies mainly with the clinical and HIM teams. It offers features like clinical views, search/sort/filter and audit reports. There are workflows for Release of Information, addenda and record purging. The feedback from the user evaluations was positive."
The health system opted to do a single-sign-on integration from Epic.
"This seamlessly connects our clinical users to a patient's historical medical record in HealthData Archiver from within the same patient's current medical record in Epic," Jacobs explained. "With just a click, the SSO standard recognizes and matches the user identity behind the scenes. The users save time as they don't have to login to another system and search for the patient again in the legacy data. The clinicians really like this feature as it lets them focus more on patient care."
Overall, the Harmony Healthcare IT solution has saved the AltaMed team a lot of headaches by getting them back on track when the previous vendor could not meet their needs, he added.
"Harmony's team was skilled and well-staffed to manage the implementation," he noted. "They met all of our data requirements, helped us cut costs, and fortified cybersecurity defenses by consolidating information silos into one HITRUST-secured platform. This saved our team a great deal of frustration and allowed us to focus efforts back on our No. 1 priority: our patients."
"Cost savings is a big one," Jacobs stated. "We were able to decommission our old EHR and quit paying the monthly maintenance fees. Over time the archive saves cost. The accuracy of the data is obviously critical, and we underwent a robust validation process on both sides to verify that the patient data was accurate in the system.
"There was a training and implementation period to make sure the rollout of HealthData Archiver to end users went smoothly," he continued. "Clinicians commented how simple and intuitive the user interface was to use. In fact, some stated it was easier to use than our previous EHR."
Additionally, the clinical and HIM teams appreciate the single-sign-on feature from Epic. The historical record is accessible right within Epic and it saves them time.
"As a director of IT, I find that the ongoing satisfaction of the users of a new technology can often be measured by what I don't hear about. So far, so good," Jacobs said. "We have other legacy systems in our portfolio to archive, so this is a longer-term strategy for us."
ADVICE FOR OTHERS
There is complexity any time one is extracting or migrating data to and from EHRs. When looking to simplify an EHR portfolio by archiving legacy data, have a full understanding of the data one is working with, and make sure any archiving vendors have the right expertise to handle that data, Jacobs advised.
"Make sure the proposal includes the full scope of work and that deliverables are clearly defined," he said. "You don't want any surprises once you've started the project. Sometimes the cheapest option can cost you in the long run.
"Second," he continued, "make sure you involve end user subject matter experts in the project. Ask them to evaluate the user interface and participate in validation. Take the step to implement a single-sign-on integration from the main EHR to make it easier on them."
Finally, assess the vendor from a security standpoint and make sure it has the proper measures and resources in place, he advised. "We all see the healthcare cyberattack headlines in the news, so you'll want to be certain your data is protected," he said.
"If your organization has a growth plan in place, a solid archiving strategy can provide a foundation for future consolidation of legacy patient records and help simplify the EHR portfolio, making it easier for both IT and the patient-facing teams," he concluded.