In an ideal world, we'd all be budgeting enough money and time to allow ourselves to jettison or redesign legacy systems when they don't perform as advertised. But that's not always feasible — particularly as we face the industry-wide revenue crunch that value-based reimbursements will likely bring with them. When new technology is out of budgetary reach, hospital finance directors have no choice but to find ways to get more value out of current systems. While there may be more and better data collection tools available, the key is to integrate what you have in place and to use what’s being collected.
Many providers rely on jury-rigged interoperability solutions, software patches and low-bid customizations to keep systems up and functioning. Unfortunately, such "unsexy plumbing," as Crunch Network's Jason T. Andrew calls it, usually doesn't work well. And as a result, many providers are beginning to lose confidence in IT ventures.
Moreover, older governmental regulations are still proving to be significant hurdles to the advancement of cross-system interoperability. Even though the federal government and various states are taking steps to cut down on the red tape, there are very real concerns about data security and data privacy that must be addressed before we can assume the full weight of liability that would come with true Meaningful Use.
Given the economic constraints, regulatory issues and consumer protection obligations hanging over our collective heads, what are we to do? How can we get the most from our existing software? And how can hospital finance directors and CIOs work together to realize the returns on investment that we have promised our stakeholders?
Aligning existing systems continues to be the primary challenge to Meaningful Use.
How were we to know, in the 1990s, that Big Data was coming? Or that it would have behooved us to stay ahead of the data entry curve as new health information technologies came onto the market?
As David Loshin noted in an article for TechTarget, "most organizations have data architectures that have evolved organically over time, typically with little guidance from a predefined enterprise data architecture strategy."
"Correspondingly," he wrote, "these same organizations suffer from increased complexity when it comes to enabling access to enterprise data assets in a consistent way."
But how can we align all these legacy systems without resorting to glitch-laden, time-consuming direct coding? Luckily, there are intriguing possibilities that may allow us to avoid all that cross-patching and still meet our data analysts' needs.
Hospitals are increasingly turning to graph database systems to provide a connective node between systems that would otherwise be hard-pressed to communicate with one another. A graph database operates on a NoSQL (Not Only Structured Query Language) basis. In effect, it's an automated translator that speaks a variety of code languages. It takes information from various systems and stores and organizes it in such a way that other systems can read and use it.
By investing in the construction of a graph database, it might be possible to eke out several additional years of operability from your legacy systems, give your organization the time it needs to properly budget for a bigger IT spend and give the development market time to create a more affordable, all-encompassing solution. It could also allow your organization to develop a less complex, one-stop portal for your providers to use in the interim.
Focus on the essentials.
If your hospital or healthcare organization is still operating in a hybrid systems environment, are there efficiencies that could be realized by dropping one system or another and going without?
Let's say, for example, that your hospital is using an automated lab reporting system left over from the early 2000s, prior to widescale adoption of EMRs. It's also using a PACS (picture archiving and communication system) for radiology reporting and archiving.
But your EMR has cross-function capability for importing radiology reads and lab results directly into the patient's chart, via a simple-to-program series of smartphrases. Would it negatively impact care to ask your ER providers and hospitalists to trust the radiologists to read films and report in real time, without viewing the films themselves?
Granted, some providers want to put their own reads into the chart both from a best practice standpoint and to increase reimbursement. But taking time out to go to the PACS portal, search for a film and perform a read that is already being performed elsewhere is a productivity sink.
So, too, is that extraneous lab reporting system. Training lab techs to directly input results, then to scan the report into the medical record, instead of paying to build a custom bridge from your lab system to the EMR seems like a no-brainer.
But often, hospital finance directors have limited insight into these clinic-level inefficiencies; they don't know what to ask because they have little in-clinic experience, and clinicians aren't often trained (or encouraged) to proffer suggestions about potential efficiencies.
Meanwhile, in the time the provider takes to make his or her own read or chase down a lab report, another patient exam could have been started. Net reimbursement thus goes up.
Become best friends with your tech counterpart.
If the finance and technology executives aren't well aligned, IT efficiency will naturally suffer. Knowing when to integrate (and when not to integrate) your hospital's software environment shouldn't be a competency exclusive to the CIO; it's a team effort that should naturally include guidance from finance.
The finance and technology departments should both be able answer these questions for any system in use:
- How much is it costing us to maintain this system this year?
- How much will it cost us to maintain this system next year or 5 years from now?
- Do the projected maintenance costs for this legacy software outweigh the projected investment and implementation cost of a potential replacement system?
- Even if you could afford to maintain a system, what are the chances that its capabilities would be completely obsolete by the time you could have a new system up and running? (If it helps you here, think about how quickly data storage migrated from 3.5" disks, to ZIP drives, to CD-ROMs, to flash memory and external drives, to the cloud — a space of just 20 years, or a full data storage turnover every 4 years.)
- What does this system cost us in terms of provider productivity? Would tearing down the legacy, developing and rolling out a replacement be cheaper than continuing to forego more efficient workflow?
- What systems are our competitors using and losing? Your hospital should strive never to be the last adopter in the marketplace.
- Does maintenance of the legacy system makes sense? Is it the only realistic option available to us? Could we realize savings by outsourcing support?
- Can the software or system be moved off the clinical front lines (in favor of new tech) and into a reserve role without impacting hospital operations or incurring a significant financial hit?