Few decisions are as important or as daunting as the one that leads to the implementation of a new EHR. When replacing best-of-breed clinical applications with an integrated EHR, a successful transition involves managing, not just technology but, equally as important, employees across multiple teams. The best and brightest in your organization are asked to focus on this initiative, but this new assignment leaves a gap in the maintenance and management of a healthcare organization’s legacy systems. Many legacy systems will be carried forward, some will remain and continue to need legacy support, and some will be allowed to retire. Whatever their destination, these legacy applications will need support for a certain amount of time.
The care and feeding of legacy applications can cause issues in everyday IT operations. Staff can’t focus on more strategic, forward-moving initiatives when they are still tied up with the old. Maintaining these legacy applications leads to an increasing dependency on the limited number of staff who have such skills. This can increase risk at an operational level due to a potentially lowered skill pool. And as Jonas Knudsen of Health Insights has written, “When IT fails to deliver due to legacy and the lack of agility, the business model, and clinical processes become legacy as well.”
What should be done? One strategy to meet an organization’s’ IT staffing needs is to outsource resources from an external company.
What are the benefits of outsourcing legacy application support?
1. It reduces capital expenditure costs, frees up capital for investment spending and has a positive impact on operating costs. For example, 90% of hospital organizations state that in the third quarter of 2015 they reached or were close to reaching a return on investment within three months of the outset of the IT outsourcing, and 84% of healthcare organizations that outsourced this work reported that the quality of their relationships with service providers met or exceeded their initial expectations.
2. It boosts personnel morale. After all, no one wants to be stuck working on the old technology while everyone else is learning something else. Not only does this isolate them from their colleagues but it denies them the emotional satisfaction to be enjoyed when learning the details of a new and exciting system. When legacy applications are managed by a third party, the staff isn’t distracted by worries that they may not fit into the system in the future. Chuck Podesta, CIO at UC Irvine Health says his meetings with colleagues generate genuine excitement. “They’re not talking about where they fit or what the future looks like. They already know. They get it. We’ve got our best and brightest moving forward very early in the project.”
3. It permits flexibility in staffing. You could hire additional staff to support your organization during the transition, but when the project has been completed, you are liable to face an overflow of employees and difficult decisions to make.
4. It energizes your staff. Instead of facing change with trepidation, instead of pivoting suddenly to adjust to acquisitions or upgrades, instead of adding lines to their already extensive list of to-dos, your colleagues can remain on top of current and evolving demands because they have not been deployed to another job. By outsourcing legacy applications healthcare companies can find the answers to these questions raised by Dr. David Whitehouse, a chief medical officer of UST Global: “How can you create teams for rapid assignment and redeployment? How can you build small teams that are highly experienced in handling the dynamic nature of projects? We have to recognize and accept the fact that static, defined projects are history.”
5. It provides focus. It is critical to have staff concentrate on the task at hand. And it is unproductive to have colleagues conducting two or more jobs, such as the implementation of new initiatives and support for production, in parallel. Outsourcing consultants to support legacy applications allows internal IT professionals to focus on strategic tasks while applying their talents where they are most needed.
6. Its benefits are self-evident. Representative members of the College of Information Management Executives cite the continuing support of all ongoing applications as their number one concern.
7. It eliminates cost variations. Hospitals are required to issue reports and dashboards which demonstrate the quality of the services they are providing when compared with external benchmarks and internal quality improvement guidelines.
They employ incident management systems to track and report application management activities and performance to ensure seamless integration of new EMRs into ongoing operations. A key checkpoint is the help service desk where costs fluctuate based on call volume, application changes, and service-level agreements (SLAs) maintenance. But the biggest unpredictable variable generally occurs in the areas of time-consuming staff turnovers and training. Unpredictable costs are eliminated and consistent SLAs are maintained with outsourcing.
What are the best practices in the management of legacy applications?
The goal must always be kept in mind. When supporting a legacy application, the outsourcing partner is to take complex and time-consuming tasks off the organization’s plate, to focus on more productive, strategic, operations, thus improving and enhancing the patient’s experience.
At engagement kick-off, it is vital to establish clear roles for the HCO and its support partner.
1. Put together detailed standards for change approval, test environments, and factors for prioritization.
2. Determine a common place for storing work-in-progress changes as well as completed documentation.
3. Create a communication plan that outlines who does what; who provides oversight; how information will be provided to specified individuals; and the format and frequency of each communication deliverable, including issue resolution response time depending on the criticality of the situation.
4. Define communication deliverables such as reporting, dashboards, and service metric updates.
5. Track and report application support activities and performance to warrant seamless integration into ongoing operations.
There are several factors to consider in performance tracking and evaluation. These include:
1. Reporting-related problems
2. Maintenance requests to cover all work undertaken
3. On-call production support
4. User requests, special projects, and ad hoc requests.
There should be regularly scheduled status reporting which will cover such areas as
1. Tasks or maintenance requests completed
2. Maintenance requests in process
3. Significant accomplishments
4. Unresolved problems
5. Planned tasks and prioritized maintenance requests
6. Maintenance requests approved and accepted
7. Small Service Request (SSR) status
8. Project status
These regularly planned meetings should be supplemented with quarterly management meetings to discuss potential changes in project scope, report on performance relative to the agreed-upon SLAs, and allow agreement on plans for the next quarter.
This checklist of best practices may seem logical and unnecessarily granular. They’re neither. They are essential to the continued functioning of healthcare organizations.
With today’s healthcare organizations focusing more on quality of care and improving outcomes, hospital leaders must manage their capital and human resources carefully to handle vital business functions. Your application support partner should ensure you and your end users have a superior experience by making the ‘change of staff’ unnoticeable.
This goal is accomplished by investigating current practices and workflows, keeping an open line of communication between organizational leaders, managers and support staff and having a clear understanding of where organizational responsibilities lie, with existing staff or newly created leaders. With the right support partner, hospitals will be free to focus their time and resources on what counts — the patient.
Justin Campbell is the Vice President, Galen Healthcare Solutions, a provider of IT consulting services to specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks.