To maintain peak efficiency, health systems and hospitals need to clear out underperforming, duplicate and legacy apps and platforms. That's not an easy task.
Hospitals sit atop an IT infrastructure that keeps the EHR and all other tech platforms functioning smoothly. But what happens during an upgrade, a change of vendors, or when an app needs to be removed?
Mike Prokic, FACHE, VP and Chief IT Strategy Officer at Trinity Health, says there's a lot that goes on behind the scenes that clinicians and patients don't notice. And that's intentional. If the system is buggy, care can be compromised.
Trinity recently partnered with Clearsense to clean up those back-office operations. That partnership helped Trinity decommission more than 740 redundant apps and platforms, saving the health system $68 million in annual costs.
"It worries me that not enough people know about how big of a differentiator this is," he says. "It's the least attractive thing in IT and yet it has so much potential and cost savings and can help offset the financial burden every organization is inevitably facing right now."
Setting the Stage
The project took place alongside a wide-scale Epic implementation and the end of a three-year renewal cycle of a major vendor contract.
"That was hundreds, if not thousands, of applications for us," Prokic says. "That was the catalyst for the investment."
Prokic says leadership first sat down and mapped out all the applications to be affected, then looked for redundancies and legacy tools.
"If you have three apps in the portfolio that offer similar capabilities, well then, you just run it on the production line, rationalize which one meets your business needs at a lower unit cost, etc., and then move it on to decommissioning and archival," he says.
This includes making sure legal/privacy, clinical and financial leaders are aware of the process for archiving and decommissioning a legacy tech app. That might include creating a committee or coalition of key decision-makers to make sure everyone's on the same page when an app or platform is set for removal.
"It's been years since there's been a really contentious discussion about it because the coalition has been built," Prokic says. "They all support it and the return on investment."
Where Are All These Apps Coming From?
Along the way, Prokic says he was surprised at how many apps originate in places other than the EHR.
"What we found over the last six years is that if you look at the proportion of applications that have been rationalized and decommissioned, only 60% have come by way of the EHR," he says. "The other 40% is made-up of other common platform deployments, [like] ERP, Workday, PeopleSoft, things like that, and the other proportion is [through] mergers and acquisitions."
As a result, he said, Trinity has three parallel production lines, one monitoring the EHR, a second overseeing other common platform deployments and ERP applications, and a third keeping an eye on M&A.
Dealing With Vendors
Another sticky point is vendor relations.
"The hardest part of this process is the breakup," Prokic says. Healthcare leadership has to have a game plan for renewals and terminations and a full understanding of what contracts say about each process. If you're breaking up with a vendor, you often have just 90 days to make sure all relevant data is archived.
That may not be enough time.
"At that point you've lost your leverage," Prokic points out. "That's happened, and [it] gets to be a very difficult discussion. {You're] going back to a vendor that you've broken up with [and] saying, ‘I need more time.' Well, that time comes at a higher unit cost than you were paying for originally. It's not budgeted, and everybody's anticipating that data being available in the archive, and it's not."
In addition, he says, vendors may put data into a proprietary format prior to a contract being terminated, forcing health systems and hospitals to negotiate to extra and archive their data.
Prokic says he's talked to other health systems and suspects "quite a few" aren't aware of how difficult a process this can be.
"Everyone's dealing with these very same problems right now," he says. "There's a lot of integration activity going on." And archiving is "the least sexy thing on IT right now, and no one's thinking about velocity as a differentiator in your M&A approach."
Eric Wicklund is the Associate Content Manager and Senior Editor for Innovation and Technology at HealthLeaders.
KEY TAKEAWAYS
Healthcare organizations need to be sure their IT infrastructure isn't slowed down or adversely affected by inefficient technology, which could affect not only operations but patient care.
Tech executives and IT leaders need to map out their tech infrastructure and create protocols for removing apps and platforms without disrupting normal operations.
The process may get tricky when working with vendors whose contracts are being terminated.