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My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week. let's jump right into the episode.

Either have not realized

I'm excited to this opportunity to talk about this. This is one of those things that when you look from the outside it looks easy to do, and it's a little harder once you get into it. Talk a little bit about your organization, how you approach application rationalization.

Sure.

I work for one of the largest non faith based organizations.

Um, We're in 27 states, all across the country.

And only a few applications.

Yeah, and only a few applications. And so we have what is a common problem in healthcare. We are conglomerate of all the mergers and acquisitions that have happened over the last 15, 20 years. And we had acquired a very large IT debt.

So, a decision was made to become an Epic shop. We are implementing a single instance of Epic. over those 27 states and what is the ROI for doing that is archiving and decommissioning the applications that single instance replaced.

So, when people ask me application rationalization, what's the best project you can do?

I'm like an EHR implementation because generally, every hospital you go into, you're retiring at least 100 applications as you go. What's the timeline on the EHR implementation across your system? So,

And so originally we were planning to implement, I think the original was three years. I think it was a little lofty. And so now it's turning into more of five, six years. But from an archiving perspective, that allowed us to slow down and then go forward.

I think a lot of people have the assumption that, oh, you're retiring this, you're bringing in new EHR, you're just going to move all the data over.

But that's not the

case, is it? No, it's not. And so, that's a big opportunity for us still within my organization is determining when it makes sense when there's an ROI for archiving versus when it makes sense to migrate. I think that's still, there's still a lot of work to do in that space because sometimes the return on investment isn't just It's not just the dollars and cents.

It's the end user and the, the access to the data. It's really the business case that it might make more sense to pay a little more to migrate that data. So we're still, that's still an opportunity for us. How does the

end user experience, if you archive versus migrate. So migrate is going to be right in the workflow, right in the system.

But you can still get a pretty close facsimile of that with an archive solution rather than having them go out, log into another system.

We've built an embedded link to the archive right in EPIC. So it's pretty seamless. It doesn't integrate into their chart like the providers would probably like. But it's a link out there and then the patient's data is right there.

Can it be incorporated into the analytics and those kinds of things as well? So we haven't

quite explored that yet. It's still on our future plans. But it's pretty big. So

I sound like your CIO? Hey so we're sitting in the ClearSense booth. You've gone down this path. I think one of the interesting things to me is this whole idea of a platform that you're able to hit from a lot of different ways that's aggregating all this data.

Because we don't get to throw away data, ever, in healthcare. When I went in to St. Joe's and asked, what's our retention policy, they said, 27 years. 27 to life, is what they said. I'm like, no other industry, I think, keeps data that long. And so, you almost just say, okay, we're just not getting rid of any data.

Because 27 years is a long time. And so, you retire these applications. we talked about one way to access it, but some of these applications have 📍 interfaces and things, and it's live data. You still have to act

on it. So the data that we are current state is, the retired data because we're using a new system.

And so, what we did in the beginning was really form a governance on, defining what is a source system. A lot of times you have a lot of applications with the same data. one of our primary goals on the program was not to duplicate data in the archive. We're already duplicating it all. there in the ether in the live production sites, which is going to have a cost eventually.

And so we didn't want to do the same thing in the archive. We wanted to identify those source systems that we were legally and regulatory required to keep that data. And like you said, we have pretty clear retention policies. We worked really closely with our legal team to get that defined ahead of time.

And we're doing this at the enterprise

level. I was going to say, but you're even across states. Like ours was driven we had four states, and we essentially took the highest one. Yeah. And essentially that's what we

did. And we have something similar but what our legal team's approach was is, how much risk are we willing to accept?

And so, we're generally a risk adverse, industry but there is a time when that risk is greater to keep the data than it is to not,

Yeah, I think what people don't recognize is some of that data doesn't get accessed. Like, it goes long periods of time

without ever Yeah, without anyone clicking in it, yep.

So, from a ClearSense standpoint, so you have this platform, and they're not legacy yet, but you have these systems that are going to be legacy systems. They are, so, yep. does ClearSense provide the tools that go in there, like, directly? How do you get the data from one to the

other?

That's very complex. So, it depends on the system, quite honestly. So we have archived and or decommissioned almost 700 applications in the last four years. That has had a return on investment of 50 million for our organization. And when we really went into it we didn't really anticipate much.

The challenges we were going to find to pull that data out of the systems. I mean, some of these systems are frankly dinosaurs. Some of them just, we had the only remaining support person that had this skillset up until we retired this one application. And it was really scary because, there was no longer upgrades being applied to it.

There's all these other things when you're, you have to consider when you're archiving data, not just keeping it, but we've kept things going for so long that we have to. We need to be able to get it out of the system, and that has been a unique challenge. ClearSense has a couple different strategies that help us get them the data.

But what we're finding is the data that is the hardest to get to is data that has to be converted, and we have to get it from the vendor.

Wow. So are you converting cloud systems? Or are they mostly like client server or older? All of the above. All of the above. Yep. Cloud systems I would think would be a different Challenge altogether.

Yes. Yep. And so our program has now started to provide some education on how we might need to adjust our standard contracting to ensure that we're protected, that we're not gonna be charged hundreds of thousands of dollars to get to our data. We're uncovering other opportunities to improve our relationships with our vendors because in the end a lot of the applications we're archiving.

We're separating from those folks. And so, that's been a lesson for the last four years on how to manage that.

So, if I come to you today and say, look, we've got an application we need to retire. Yeah. Talk me through the process. Like, how do you go from the concept of, okay, it's that application we're going to retire, to actually shutting it off.

Because that's where, in healthcare, that's where we get, I remember. That's the scary part. Yeah, there was, we did an EHR thing, And somebody said, hey, we have to keep this on for six months because we have to process the data. so we left it on, and like two years later, it was still on.

And I didn't notice it until I'm looking at, we're doing an audit of our finances. I'm going,

why are we still paying for that? And it's still on. And it's still

on. So, concept to retiring the application.

So, there's two different ways we start the process. One, we started with a list of what applications we thought we're going to go away due to this EHR implementation.

And the other way is now that we're, serving the entire organization, people are finding, the server under the desk. You'd rather us find it than EIS find it. So, we have two kind of funnels on how we start the work. We do a very thorough business intake process to understand where does, where does this application live, who supports it in our organization, how is it used, what is it used for.

And we do So it's a very standardized process to collect all the

information. Yes, to collect all that information. And talk to the stakeholders. And talk to the stakeholders. It is a lot of change management. And so, as we're doing those intake conversations, we're starting to have those beginning. Like, we're going to take this away eventually.

And then after that intake happens, if we deem it's an appropriate application to continue with the archive we will take it through our governance to determine how the application is going to be archived. So, is it clinical data? Are we going to create an end user visualization in the ClearSense platform?

Is it just data that we need to keep for legal and regulatory reasons, like audit data? Who touched what when? And so, it goes through the governance and we make the recommendation on how we archive it and then that team supports, yay or nay. That's the beginning.

That's the beginning. So, you get to the point of governance says go, end user says go, I assume you have to look at the workflow as well and say, okay, has this been replicated in the new build?

Do we have the things? Hopefully you're doing new builds. I, it's but you've done all that work and now you're ready to get going. Is it a situation where you contact ClearSense and say, okay, we've got to go ahead, we're, we want you to get to this data and do it, or does your team, do you have a team that comes in there and looks at the architecture and starts?

So it's a

little bit of both. It's a collaborative approach. Based on the actual application itself. Going through 700 applications, we know what to expect. We've had a plethora of all of them.

Are they starting to fall into buckets? Like, they start to

look the same?

Yeah, they're starting to look the same. But the most important part that we implemented in the beginning was a read only strategy. So like, when that application is supposed to go into read only, when it gets frozen, because the work can't begin until the data's no longer being changed. Right. So we have to have that audit data available

as well.

So do you have to shut down access to the application before you start migrating? No.

So, we leave the production application in its entirety, but it's frozen. End users can still access it, they can print stuff if they need to. Until the archive So the alternative is live? Yeah. Got it. Yeah, the, yep.

Until the archive is completed. And then the application goes through a decommissioning process. Wow,

so

outside of the EHR, how do you identify opportunities for So

we do a lot of M& A work, so mergers and acquisitions. We also are implementing standard platforms across our health system. And so, we are archiving ERP systems.

Basically all the data that our organization has, we're putting on the platform.

So if I come back to your system in five years, the concept is standard platforms across the entire enterprise. A lot fewer applications, which is going to reduce the complexity, reduce the attack vectors, reduce potentially the support costs and all those kinds of things.

And we're

mitigating risk. That's one of our biggest, for me, return on investments. I, we're experiencing very unique challenges when it comes to, what the legal environment is coming and asking for. And we're not prepared quite yet for, the legal technology aspects of all of this and archiving is probably going to help us mitigate risk as the laws continue to change.

So who drives this kind of project? Is it an IT driven project or is it a compliance driven project? It is,

I wish it was like collaboratively driven, but it's been an IT driven project because the costs live in IT. Yep. Yep. And so. In order to continue to, frankly, survive out there in the healthcare industry right now our cost savings is our primary KPI.

So we drive that. Yeah. That's pretty amazing. Well, thank you for your time. Yeah, absolutely. I really appreciate it. Thank you for having me.

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