How one medical center overcame legacy EHR systems

The challenges of legacy EHR systems

Although not ideal, maintaining the old EHRs worked for a while. But the situation became unsustainable several years ago, when one of the systems went down well after the service agreement with the EHR vendor had run out, Hruby said. Parkview had to pay a staggering $75,000 to the vendor to fix the system so that physicians could gain access to needed patient data.

At the same time, Hruby said he and his team realized they could face similar situations with any of their other legacy EHR systems -- or lose service all together as vendors stopped supporting older systems or went out of business altogether.

Hruby said Parkview also recognized that as caregivers accessed those old EHRs less frequently, and as the vendors offered dwindling support, the medical center risked losing the knowledge needed to use those systems, which added an additional layer of risk around maintaining those legacy EHR technologies.

A common and onerous issue

Many healthcare organizations are facing similar challenges, particularly as mergers and consolidations bring together multiple medical practices and their varying legacy EHR systems under one entity, said Ryan Oliver, a researcher with KLAS, a healthcare IT research firm. 

Yet, moving data from one EHR into another remains exceptionally difficult, Oliver said. The vendors don't build systems that easily enable such movement, while the multiple data formats contained in medical records further complicate the task.

"A lot of these systems have different data formats and the way the data is structured, so it's not easily converted. There's a lot of work in doing that," Oliver said, noting that storing unlimited amounts of old records in modern EHRs is also very costly.

As a result, healthcare organizations typically end up migrating only recent patient data from legacy EHR systems into their new systems. They then keep those old systems up and running to enable access to the old data and to meet regulatory data-retention regulations. It's a scenario that strains IT department resources in multiple ways.

However, Oliver said the data archiving market has matured in response to this common scenario, allowing healthcare institutions like Parkview to more easily move its data onto a modern platform, so they can fully retire their legacy systems.

Finding an offering that would work

Although Parkview officials knew they had to tackle their legacy issue, Hruby said they also knew that they couldn't simply migrate the data in the legacy EHR systems into the current system used by Parkview -- it simply wasn't going to work.

Hruby said he wanted a single modern system that enabled access when physicians needed it and that his own IT team could learn to use moving forward so doctors would always have support.

Moreover, he needed a system that could intake huge volumes of data in varying formats without requiring huge conversion efforts with related big-ticket costs. And Parkview preferred to keep the data on premises, which eliminated cloud-based options.

"We wanted a solution that would allow us to keep and manage it on our own servers. We also wanted something that was easy to use and able to receive information in a lot of different formats," Hruby said, explaining that some information contained in the legacy EHR systems were in discreet fields -- but the EHRs also contained PDFs, JPEGs and Microsoft Word files that needed to be migrated as well.

Additionally, the new system had to be financially sustainable, which eliminated several potential offerings that would have cost Parkview $500,000 to $1 million in annual maintenance fees.

"If this were a large healthcare system or a large corporation, cost would not have been as big of a problem, but we couldn't afford that," Hruby said.

Parkview ultimately settled on HealthShare, a healthcare informatics platform from InterSystems.

Hruby said that in addition to being affordable, he opted for the platform because it was expandable and was able to scale if needed. HealthShare could also intake into its database discreet data elements common in medical records, such as birthdays, height and weight, but could also hold the additional files including the PDFs and Word documents.

"That's what made it so appealing -- it pulled in all that information," Hruby said, adding that the feature enables Parkview providers to access the full range of patient data that had been locked away in the old EHR systems.

Implementation challenges

There were challenges that Parkview's IT team had to face when implementing HealthShare.

Hruby said he first selected an implementation partner tasked with helping to migrate the data from the legacy EHR systems to the new platform, but quickly learned that he had picked a partner that didn't understand the challenges of that job.

Hruby acknowledged that he should have done more due diligence himself so that he could have selected a partner that understood his own organization's needs and the complexity of the data elements, as well as how those would impact the migration.

His second pick was a much better match, putting Parkview on target to have all the data moved out of the old EHRs and onto HealthShare by mid-2020.

His experience isn't uncommon, experts said.

Healthcare institutions won't find data archiving platforms that are plug-and-play, Oliver said. In fact, KLAS says in its 2019 report on the topic that the "first step of the data-archiving process -- extracting and migrating the data -- can be onerous."

However, Oliver said healthcare institutions generally find that they can more easily convert the data in legacy EHR systems into formats for intake by the data archiving platforms that are still discreet and searchable, as well as cheaper to store.

"There's still a lot of legwork and audits that need to be done. But it's not all manual," he added.