Real-time Legacy Data: A Real Game Changer

by Dr. Dave Levin

Some days, the job of Chief Medical Information Officer (CMIO) feels like shuttle diplomacy. The actively engaged CMIO often finds herself in the middle of debates and conflicts between clinical, operational and IT colleagues. It’s a natural outcome of a role that combines knowledge and responsibility across diverse areas. The CMIO is in the crosshairs because she’s sitting in the crossroads! Great CMIO’s leverage this to help lead their organizations. And, they look for technical solutions that reduce the conflict and create win-win scenarios for all stakeholders. 

A great example of these conflicting agendas and the way better technology can break the deadlock is management of legacy EMR data.  

When an organization implements a new EMR, they face some very tough decisions regarding how much legacy data should migrate from the old EMR to the new one. Ready access to this data is vital for continuity of high-quality patient care. There are also regulatory and other requirements to be met for maintaining old records. Traditional approaches like extracts or CCD’s do not provide an easy way to move data from old to new or to simply just view legacy data in the old EMR. As you might imagine, this sets up significant conflicts between clinicians, IT professionals, and operational leaders.  

Legacy data decisions come down to two basic questions: What should be migrated and what can be safely left behind? Most organizations can quickly get to consensus on the basics like medications, allergies, medical problems, recent lab results and the like. Pretty much everyone will agree these items should be moved. After that, the discussion gets much harder.  

As in many things in life, where you stand depends on where you sit. 

Most clinicians will tell you it is impossible to predict what they might need in the future. While the probability of needing any given item may be low it is not zero. The clinician rightly claims that they could need almost anything at any time in the future. They will also tell you that while it may be rarely needed, when it is needed it will likely be critical and time sensitive – they need it and they need it now.  

For example, are the changes on the EKG of this patient with chest pain new indicating a possible heart attack? The ED MD has 30 minutes to decide and get the patient to the cath lab for an emergency procedure. Has that spot on the chest xray been there for 10 years or is does it foreshadow a new lung cancer? If the primary care physician can access the old x-ray and report that’s great. If not, then that patient is going to get a more extensive workup because that old information was lost in the EMR migration. 

The other stakeholders, IT professionals and operational leaders like the CIO and CFO, understand this clinical dilemma. They also must take into account other practical issues such as cost, project timelines, and accuracy. Traditional approaches are expensive, complex, tedious and time consuming so these non-clinicians will lobby for moving the least amount of data. They will also seek to provide ways to look up old data either in the legacy EMR or in a paper record.  

Unfortunately, looking stuff up is usually so cumbersome and time consuming that it doesn’t happen. In this case, the lost data has a negative impact on clinical decision making, duplicate testing, overall costs and both patient and provider satisfaction. Historically we have reluctantly accepted these outcomes while quietly acknowledging that patients will suffer (and costs will be higher) because that old EKG, chest x-ray or blood test wasn’t readily available. 

This legacy data dilemma is a symptom of a technology gap. Lacking a simple, powerful way to view legacy data in real time forces everyone into tough choices about what is worth moving versus what can be left behind – with tacit acceptance that “left behind” will often mean “never to be seen again.” 

Fortunately, we now have a next generation solution that delivers superior results at a fraction of the cost and effort when compared with traditional methods. This solution leverages Application Programming Interfaces (APIs) – the same technology that powers data exchange throughout the digital economy. Deploying APIs makes it possible for all legacy data to be conveniently available in real-time. API’s eliminate the legacy data dilemma by changing “left behind” to “readily available.” They also require very little maintenance or support demonstrating another important aspect of an API-based approach: high-reliability and low operating costs. 

And it’s not just a theory.  When the University of South Florida (USF) Health medical group, which provides over 500 medical specialty staff to Tampa General Hospital (TGH) decided to retire their Allscripts EMR and migrate to TGH’s Epic EMR they faced the legacy data dilemma. They were unwilling to accept the less than ideal results of traditional approaches. Instead, they opted to implement Sansoro’s legacy data solution which combines Emissary APIs with an embedded Chart Viewer to deliver real-time searchable views and browsing of all legacy data. TGH migrated key data from the old EMR to the new one and provided a convenient method of accessing everything else. Now, busy clinicians can quickly search for legacy data in real-time from within their current EMR. 

With no HL7 interface development required and the knowledge that legacy data would be readily available to clinicians, implementation happened in days rather than months resulting in substantial cost savings. Additional savings will accrue over time from reductions in the cost of maintaining interfaces and the opportunity to reduce the number of legacy EHR licenses. Clinical leaders at both USF Health and TGH report a high degree of satisfaction among a wide range of users including primary and specialty care physicians, nurses, and ancillary staff. They also believe this has impacted patient satisfaction and confidence which makes perfect sense to me.  

It’s also been fascinating to see how, and how often, clinicians take advantage of the system which has been in place at TGH since December 2015. As the graph below illustrates, there is sustained use by physicians, residents and fellows to retrieve a wide variety of information – testimony to the ongoing value of convenient access to diverse legacy data.  

It turns out that when it comes to on-demand legacy data, if you build it, they will indeed come.