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Having an Electronic Health Record system has become a top priority for hospitals across the country. But implementing these systems is a huge and time consuming endeavor that can tax even the most well-oiled IT team. Hospital adoption of comprehensive EHR systems has increased more than eleven-fold in the last five years among U.S. non-federal acute care hospitals.

The implementation and subsequent optimization of EHRs are putting substantial pressure on the hospital IT teams tapped to manage and implement these complex systems, while still maintaining most current systems throughout the process. A focus group at a recent College of Healthcare Information Management Executives (CHIME) meeting found that the #1 concern among hospital CIOs is how to continue to support all ongoing applications during these implementation and subsequent optimization efforts. Yet, when making the huge investment of time, money and effort required to implement and optimize their EHR systems –processes that can take 18 months or more – hospitals often fail to budget for legacy application management.

In some cases this issue doesn’t even get realized until the new project kicks off, forcing the organization to cobble together a piecemeal solution of contract labor, or outside consultants who are pulled in at the last minute to manage a system they have no experience with. Not only does this add cost and time to the EHR project, it creates frustration and risk for the hospital if key information management systems are not being maintained and operated as necessary.

To avoid this risk, hospitals should develop a legacy application back-up plan 90-120 days before their EHR vendor training kicks off. That gives the IT team and their counterparts the time necessary to assess the current state, develop a transition plan, and identify the quantity and quality of staff needed to support the current system while they implement and optimize the new solution.

Once a plan is in place, the IT team must decide who is going to manage those legacy applications. They typically chose between three options:
  1. Hire additional staff to keep the legacy system going. This may seem to be the simplest option but it has a number of challenges, such as hiring qualified IT professionals. Hiring new staff brings less obvious costs like benefits, training, and overhead. This option also leaves organizations with extra personnel to manage once the transition is complete.
  2. Hire EHR consultants for the implementation process. This option allows organizations to keep their IT team focused on the legacy system until the bitter-end, while relying on external consultants to handle most of the new system implementation, training and optimization. This has the benefit of ensuring that experts are handling the new system implementation, but organizations may risk losing the all-important employee buy-in and culture change that comes with having in-house teams leading the IT transformation. Organizations also forfeit the chance to create their own team of in-house EHR experts who are intricately involved in building and managing the new system.
  3. Hire an application management firm. The best and most cost-effective option is to work with an outside firm take over the legacy management while the in-house IT team focuses on the EHR implementation. The benefit of this option is that organizations can harness IT experts with specific experience managing healthcare legacy systems. They understand how to conduct discovery and orientation on the current systems, how to create a transition and knowledge transfer plan, and what support services will be necessary to keep the applications running. Then once the EHR is in place, they will transition any remaining applications back to IT team and be on their way. This model creates less overhead and also allows support and resources to scale to accommodate projects on an as needed basis, and ensures that the core IT people stay focused on the future rather than managing the past.
Regardless of the model organization’s chose, it is critical to make legacy application management part of the project plan. By budgeting for support to keep legacy systems running while a new EHR system is being implemented, hospitals can focus internal resources to accelerate transformational enterprise IT initiatives. Internal expertise can optimize performance of cutting edge new applications, while the transition away from legacy tools is handled by external experts. This ensures that ‘tomorrow’ for healthcare IT will indeed come, delivering on the promise of leveraging clinical data to improve both the quality and cost of care.
Topics in this blog post: Data and Technology, Healthcare, Healthcare Cost