Health data management (HDM) software has emerged from infrastructure as hospital “plumbing” to its new position as a primary, clinical application. One of the drivers for this change is the new role of the electronic medical record (EMR) and the fact that hospitals everywhere are struggling to create and maintain a single electronic patient record that allows clinicians to easily access and share data from one definitive source.
Application migration is an issue for healthcare organizations because every five to 10 years hospital departments need to change their software applications to take advantage of new developments and to accommodate the ever changing healthcare environment. The most obvious example is in radiology where the PACS (Picture, Archive and Communication System) is fundamental to the diagnostic process. A radiology department wanting to change from say, Fuji PACS to McKesson PACS or even to a new version of the Fuji PACS itself, must be able to make the existing data in the old system available to the new. This requirement is not unique to radiology; it is replicated across the entire hospital as new departmental applications and facilities come about. With each application change, a hospital department must decide how to make the existing data available not only to the next application but also to the EMR. They are faced with three fundamental choices:
- Do they migrate the data from one application to the next? This works if the data is compatible but what about the next migration?
- Do they continue to run the old and new applications side-by-side? This is frequently an expensive option and does nothing to promote data availability to the new application or the EMR.
- Do they retire the old data into a central repository accessible by both the new application and the EMR?
Increasingly, in many departments, the choice is for the latter. They retire the old application by moving its data into an Independent Clinical Archive where it can be used by the incoming application and shared to authorized systems throughout the Hospital
The average hospital runs between 200 to 300 software applications, and surveys show that 20 percent of these applications are redundant and only exist to make their data accessible.
The cost of maintaining these old applications is proving to be very expensive with some hospitals paying millions of dollars to retain the old applications just for the data.
This cost is measured in a number of ways:
1. The cost to keep staff trained on the old as well as the new application.
2. The cost of licensing fees to maintain the old software.
3. The often large maintenance bills for ageing hardware that the old application runs on.
4. The cost of data that exists in isolation from the new system and all other systems that would want to access it.
Hospitals are now electing to put the data somewhere more cost effective where it can be easily accessed when needed. They are choosing to migrate data to an Independent Clinical Archive and then retire the old applications rather than keeping myriads of applications up and running.
Typically this represents a cost saving as the upkeep cost of the redundant application more than foots the bill for the implementation of such a central repository. Plus the fact the data now becomes accessible to other applications, the EMR and the main hospital patient portal.
Sometimes it is exactly the right thing to do to migrate historic data into the new application or at least ensure that the new application has full and transparent access to the old data. The issue is, that application migration is a complex business, and the movement of historic data is fraught with issues often taking months to achieve. During this time, access to the data is impaired and performance of the new application is frequently reduced. What’s more, you have it all to do again the next time the application is upgraded.
If, however, the data is moved into an Independent Clinical Archive a number of advantages can ensue:
1. During the ingestion, the old data can be cleaned up and stored in a standard form for subsequent use.
2. The performance of the new application is not reduced by the data migration effort.
3. The new application also has a secure place to store and protect its data.
4. The next application upgrade will not require data movement as this data is already in the archive.
Because storage is amortized over three to five years, upgrades to the storage environment are even more frequent and happen more often than application upgrades. What’s more, all storage vendors eventually will cease to support old platforms. The primary issue for hospitals then, is to make sure that when the latest and greatest system comes in, and the data gets migrated at the storage level, the application does not break, and the data is not made unavailable.
If data is stored in an Independent Clinical Archive, the archive becomes responsible for the underlying storage. The application only talks to the archive and not directly to the storage. The archive can manage the storage migration independently of the application without the application missing a beat.
How? The archive will make a new copy of the data to the new hardware while keeping the old copy constantly available to the application. Once the new copy is made it is immediately available to the application without any downtime or inconvenience to the department that relies on that application. The old copy can now be retired.
The storage situation is further exacerbated where the purchase of turnkey systems has resulted in data being locked into the storage of that turnkey system. By putting that data in a more general archive, and the storage under the control of that archive, storage can be utilized across applications, and its usage optimized.
In terms of application migration, the Independent Clinical Archive provides a safe and secure repository for both the old and the new data. While the cost of the initial migration may be similar, the big savings come with each consecutive migration after that.
Those migrations may be application-to-application or storage-to-storage, either way the Independent Clinical Archive provides a layer between the application that protects it from performance reduction and downtime.
The additional value of putting data in a clinical archive is that it also becomes a data store that can fuel other applications, such as data enabling, an EMR, a portal, or an analytics database. Because the data is outside of the application in a place where it can be independently interrogated and used, this secondary data use happens independently of the originating applications.
In summary, the need to migrate data off of an old application and onto a new one can be an inflection point that helps hospitals see both the operational and economic value of creating an Independent Clinical Archive. As they look for ways to achieve a true EMR and to drive more value out of their data, more hospitals are installing an Independent Clinical Archive.
Tony Cotterill has worked in IT for more than 30 years with 25 of those years spent building and managing software businesses in the UK, Netherlands and the U.S..