Patient safety is only possible with accurate and comprehensive medical records, and this includes those records available in the active archive. Despite the urgency, one of the biggest challenges in healthcare today is maintaining Longitudinal Records – one record per patient over time, across HIS systems, and among various facilities and treatments. That challenge is made even harder when old records are scattered and inaccessible.
Remember Paper Files?
Twenty years ago, seeing the records department pushing a cart full of paper records was normal on a hospital unit. Requests were made by phone, the records were retrieved and brought to the floor, and then they were picked up later in the day and returned to their filing location. This could take quite a bit of time. Imagine taking hours to look at a patient’s historical record to see what previous visits were about and what treatments were given. Looking through lab values, vital signs, medications, provider notes, or nursing documentation, a clinician had to review each separate visitation folder and take notes on a separate piece of paper to compare them. For new clinicians today, this probably seems ridiculous, but it was reality not long ago. Enter the Active Archive.
It is very unusual to find paper records still being utilized today in the healthcare space. Government mandates were an impetus for change, starting with the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009 to “promote the adoption and meaningful use of health information technology” (Office of Civil Rights (OCR), 2017). As other mandates, including the Health Insurance Portability and Accountability Act (HIPAA) and the Cures Act, all came into play, the need to digitalize records to ensure privacy and confidentiality as well as improve interoperability has forced payors and providers alike to look at data differently.
Data advancements have many use cases, including trending analysis and population health management, all supported by maintaining big data for research and analytics. Clinicians and researchers demand better access to complete files including the associated metadata to improve efficiency and to ensure regulatory and audit compliance. Direct patient care, however, presents the most striking reason to keep data and make it useful and immediately accessible; clinical decisions and medication management rely on the ability of each provider to understand the full patient.
The Impact of Flying Blind on Patient Care
Imagine a cancer patient getting treatment during a facility’s shift to a new HIS system. Part of the record is historical and will move to the archive. Part is current and in the new system. Since patients may face multiple treatments, and chemotherapy medications have a lifetime maximum dose, providers must see what drug therapy worked, what did not, and what dosage has already been given so no drug administration surpasses the maximum lifetime amount. If that history is missing, the practitioner is flying blind. When that patient stays with a facility through a merger, the access to data and the continuum of care could be sacrificed. Only active archived information in a longitudinal record with interoperability serves the various specialists and multiple treatment centers. The systems must connect the current HIS system to the historical data through the active archive, providing the big picture at the point of care.
Format Matters
Imagine the records of the legacy EHR system are not preserved in context or in easily accessible format, but instead must be found in pages of pdfs. The provider’s search for relevant data can have them viewing hundreds of pages looking for that one single lab result, provider note, image, medication administration, or allergy list. This can result in frustration, and the inability to access the accurate historical record in a timely manner is no longer an acceptable risk.
The data life cycle – essentially capture, clean, aggregate and capture again – to create and maintain longitudinal records for a full patient picture that can be found under one roof has become an imperative to patient safety. The challenge is to make the records of a patient’s history across multiple doctors, multiple years and multiple health systems both actively and conveniently accessible and viewable.
The Michigan Health Information Network (2020) stated in its Longitudinal Record Use Case, that aLongitudinal Record, when used for treatment, payment, operations, public health, federal programs, individual authorizations, or permitted or required by law, allows providers and other healthcare professionals to have efficient access to clinical data.
Merging Systems
Unfortunately, hospitals and clinics across the country today are constantly changing their Health Information Systems (HIS), creating huge gaps in the data available from disparate legacy systems. Some organizations create static archives or choose massive pdfs, which means critical data becomes lost in documents and are now unusable, unactionable or inefficient. One of the most common reasons for constant change is the wave of mergers and acquisitions among health systems.
A single merger or acquisition can bring hundreds of new systems to the application portfolio, which means inheriting the increasing costs to support them all. The consolidation of IT systems into a manageable infrastructure not only unifies data into a longitudinal system, but it also reduces the tremendous IT expense of maintaining multiple systems across different parts of the organization and years of operation. At the same time, the multiple access entry points and limited ability to see a patient’s record across all systems increases risk for audit and compliance departments including Health Information Management.
According to WestMonroe (2021), a critical component of consideration during M&A target analysis and due diligence is the Information Technology (IT) supporting the target entity. Maintaining outdated systems may also bring an increase in risk around cyber security and the increasingly common incident of ransomware attacks. Even mergers with up-to-date systems bring extensive costs, as new owners gain responsibility to maintain purchased systems; providing accessibility to that data becomes increasingly complex. This is the point in the deal when archiving considerations should be explored.
Saving valuable patient-care data on a drive and putting it on the shelf is no longer a feasible option. It is almost as outdated as copying paper records and handing them to a patient or retrieving paper records from a warehouse or backroom for providers. The antiquated way of data management really only served organizations well as a data back-up or when used to pull patient information for release of information purposes. Today, the importance of longitudinal records and the complexity of systems has created a strong relationship between providers, IT and credentialed specialists in the Health Information Management (HIM) department. These team members along with other stakeholders of the data determine how and when the data needs to be made available and for how long. This includes determining use cases for which data are needed for an active archived versus inactive or static.
Active Archive Defined
Archiving is a necessity, as healthcare organizations look to ease the financial and operational burden of supporting legacy systems. But not all archiving is the same.
With active archiving, the functionality exists to support various use cases and reduce the overall IT footprint. Perhaps the plan is to work down accounts receivables and collect revenue from the legacy dataset. When it comes to patient care, using an enterprise active archive enables an organization to consolidate all legacy applications into a single platform, using the active features for clinical care. Clinicians can use a single sign-on approach from their new HIS system to launch the patient’s historical longitudinal record in seconds to look across accounts and to provide continuity of care. It also provides user access and activity logging as required by HIPAA.
Summary
The more healthcare organizations realize the benefits of maintaining an active archive, the more their data strategy and plan must include it. Ensuring partnership with a reliable, experienced vendor will help the organization and IT prepare and develop a data life cycle plan, including completing an application inventory, rationalization exercise, cost analysis, and determining data disposition. The effort and planning are worthwhile, not just for the back-office benefits of HIM release of information but for legal holds, audit and compliance support, work-down of AR, research and analytics, record corrections, and the benefits and desire to shut down the expensive legacy systems. Well-planned transitions to enterprise active archiving are key to clinical success and continued patient safety initiatives, providing life-saving data at the point of care and beyond.
About Dr. Kel Pults
Dr. Kel Pults, DHA, MSN, RN-BC, is Chief Clinical Officer at MediQuant and serves on the Board of the Active Archive Alliance. She has worked in many areas of clinical and administrative healthcare, directing both care and technology transitions to make the right decisions at critical phases. She applies her nursing experience to building the most effective health information technology to offer clinical data management solutions.
References
Alexandru, A.G., Radu, I.M., & Bizon, M.L. (2018). Big Data in Healthcare – Opportunities and Challenges. Informatica Economica, 22(2), 43–54. https://doi.org/10.12948/issn14531305/22.2.2018.05
Atherton, J. MD. (2016). History of Medicine. (March 2011). Development of the electronic health record. AMA Journal of Ethics: Virtual Mentor. 2011;13(3):186-189. DOI 10.1001/virtualmentor.2011.13.3.mhst1-1103.
Office for Civil Rights (OCR) (2017). HITECH Act Enforcement Interim Final Rule. Retrieved from https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html
WestMonroe (2021). Reshaping Healthcare M&A: How Competition and Technology are Changing the Game. Retrieved from https://www.westmonroe.com/perspectives/signature-research/reshaping-healthcare-manda-how-competition-and-technology-are-changing-the-game?utm_source=google&utm_medium=cpc&utm_term=healthcare%20acquisitions&utm_content=!acq!v3!122044382041_kwd-304817078316__525729678686_g_c__&utm_campaign=Search%3A+Prospecting%3A+BA%3A+Priority+Content%3A+Gated%3A+Tier+4_BBM&atrkid=V3ADWED098667_122044382041_kwd-304817078316__525729678686_g_c___&gclid=CjwKCAjwn8SLBhAyEiwAHNTJbTul0DaULmaMWItumBEmMOpmMD8T–3_NGZHudB-QlfVCQSRD2kEuRoCdkYQAvD_BwEMichigan Health Information Network (2020). Longitudinal Record Use Case. Retrieved from https://mihin.org/longitudinal-record-use-case/
