This week I had the unfortunate need to take my car in for service. My car is over five years old and is the family workhouse - it hauls kids, all my stuff (I never travel with less than 4 bags), project materials, the dogs...you get the picture. I cannot be without a car.

Despite the age and warranty status of my vehicle, my dealer provides me with a loaner. I used to think this was some sort of privilege I had earned once I was buying cars from a dealer, but now I realize that it is really just smart marketing.

My dealer puts me in a low mileage, nearly new, PRISTINE vehicle to drive around in for the week KNOWING it will give me the new car bug. They know our history - we have been in the same brand of car (Acura - shameless plug) for over 15 years. We have been through various models, new and used, and now are driving cars 5 to 7 years old. Prime candidates to give in to that new car smell and all the cool gadgets you can get now.

I thought about how that brilliance can be applied to my business. So many organizations are running old applications just to get to the old data. They are relying on those old workhorse machines to keep their data safe and ignoring the risks that decision is creating. Often it is because of an unfamiliarity with the potential solutions out there or that there are even solutions in existence. Once the information gap is closed, most organizations go into analysis paralysis. They get so overwhelmed with defining their archive needs that they spend months or even years shopping for a partner. And maintenance fees keep going up, hardware gets blindly replaced, and risks increase.

I say - "take a test drive". Pick one system and let us archive it for you in our solution set. See how easy it is to implement and use. Work with and get to know our world class staff and methodologies that we are continuously improving. We will even work with you on price to insure your satisfaction with your trial. Get a feel for just how easy it is to unburden your institution of costs, risk, and stress.

Now I'm off to sign the papers on that car...

The number of RFP’s for data archiving projects has increased greatly over the past year. Personally, I don’t think it’s the need that is growing (I think it was always there!); I just think more institutions are finally treating solutions such as ours with the formality they deserve. Archiving requirements vary greatly within and across departments depending on the type of data, the type of system, the age of the data, and what the data is being used for, not to mention the institution’s strategic initiatives around electronic medical record and data retention.

When a large facility is seeking a data archiving partner, there are things that need to be considered:

• RFP requirements need to be considered from the overall solution level in terms of technical integration with existing web services, hardware requirements, SLA’s, project and customer management.

• The primary systems, the main stakeholder department (HIM, PFS, etc.) and their target retirement date needs to be identified and provided as part of the RFP. Include the vendor and any technical information that can be provided.

• Take the time to at least identify at a high level, the functional requirements for each main system being retired. Try to put yourself forward in time to imagine what functions and interfaces you will still be running or that you will require at the date that system retires.

• Consider and include any reporting needs you have, and specifically identify if you will need them running automatically on a schedule or on demand.

• Think about your in-house support model going forward; will you centralize archived systems under one area in IT? How will you manage these from a help desk perspective? Contracting and legal perspective?

• How will you integrate this strategy into your PMO and your new projects? The sooner you have a strategy that can be systematically plugged into current and future project plans and budgets, the sooner you will realize the savings in time and money that an archiving partner provides.

• Check references, hopefully from areas and with applications similar to your stakeholders. Make sure HIM resources talk to HIM resources at the vendor’s reference sites.

Make sure you ask for “like” responses from all vendors. Some questions that will assist with this include:

“Please provide any PER USER or PER LICENSE pricing that your solution requires.”

“For each functional requirement, indicate if the implementation of that requirement is included in the prices quoted or if additional fees would be incurred.”

“For each functional requirement, indicate if a modification is required or if your base solution contains this functionality. If a modification is required, please estimate the additional cost”.

“Please indicate any PER INTERFACE or PER REPORT pricing that your solution requires”.

“Please indicate if your system has standard screens or if screens are customizable. For customizations, please indicate the additional charge and/or support implications.”

“Please cost out a typical Revenue Cycle archiving system cost that includes the following:

1. NN custom reports that will run daily, weekly, monthly

2. N Agency interfaces that include demographics outbound and transactions inbound (posting)

3. UB/837 outbound interface, running daily

4. 100 users.”

Finally, make sure that you allocate enough time for the on-site demos and that all stakeholders are present. Break them up by functional area if necessary to allow all decision makers a chance to thoroughly see the vendor’s solution. Provide a script if possible that the vendors should follow so that the demos are easy to compare each step of the way.

Managing an RFP for an archiving partner can be a complex and difficult task, but the time spent diligently on the selection process will pay off in the long run and provide you with a partner that you can have extreme confidence in far into the future.

I have been doing a lot of reading lately on Accountable Care Organizations, or ACO's.  Yet another acronym in healthcare, as if we needed any more! As a consumer of healthcare, I get it.  No one has any problem paying for good service when it is received.  We take our car to get repaired, and we expect it to be fixed when it is returned.  Prior to taking it, however, we do shop around.  Some of us are looking for the highest quality work at the best price.  Others of us might have to sacrifice quality or make adjustments to our expectations based on what we are able to spend.  ACO's, if implemented correctly, would certainly provide consumers with the information to make such informed decisions when it comes to their healthcare and would compensate providers based on quality outcomes.

There are just a few problems with this model, however.  First of all, human beings are not cars.  While the average person understands that if they cannot afford to get their car fixed, they must make sacrifices or find alternate transportation, those same people tend to feel they have a right to the highest level and quality of healthcare regardless of their ability to pay.  I don't want to get into any sort of debate here about socialized medicine or a person's right to health care, my point is just that people have a different mindset about the quality of their healthcare vs other consumer services.

The other problem with the model also goes back to the fact that human beings are not cars. Healthcare is an art, not a science, so while we are very progressed as far as identifying and curing illnesses, the fact remains that outcomes are not 100% predictable no matter how high the quality of the services performed.

So what, pray tell, does this mean to me, or for that matter FOR me, in terms of my business? It means that the powers-that-be have a lot of work to do to put together a sustainable model for ACO's, and that the main component of that work is going to be (insert sound of trumpets here)…DATA. There is not going to be one simple formula to determine a quality outcome, and there is not going to be one simple dataset that will go into the calculation.  Besides the obvious data that is collected during a episode of care, the data will need to include family history, personal health history, habits, environment, even social and cultural factors, as all of these items can influence a person's health and response to treatment.

It really means that now, more than ever, all types of providers MUST preserve ALL data that they collect, no matter their longterm EHR strategy, no matter their conversion strategy, or what data elements the "experts" have determined are important.  EVEN IF you convert data to a new application, you run the risk of missing that crucial piece of information, that small nuance, that could be impacting outcomes.  Are you willing to take that chance??

Healthcare is transforming like never before, and in all aspects,  from the business structure to the reimbursement structure to how care is monitored and managed. Now, more than ever, the data that you collect across that continuum of delivery must be preserved in its original format, definition and detail.  It is essential that providers have a cost effective, risk mitigating solution that allows this level of data preservation.

One thing about being the last leg of the revenue cycle, we get to live life through the eyes of our customers as they implement and learn to work with their new Patient Accounting systems.  Because we are working with them not only through "go live" and the honeymoon period but also long into the new system's production-status, we experience many of the trials, tribulations, and victories associated with it even while we are just supporting the legacy data.

It makes me realize the wealth of knowledge LDA has built right within these very four walls.  We are often helping our customers not only manage their old data and balances off their legacy system, but also helping them tie the old data with the new and troubleshoot production issues.  The actual combinations of the systems we have touched are mind-boggling - leaving STAR, going CERNER, leaving STAR going HealthQuest, leaving GE going Sorian, leaving HealthQuest going CERNER, leaving Invision going STAR, leaving ANYTHING going EPIC, and yes, even leaving EPIC (but no worries - going to another hospital's EPIC!).

What does this mean to you? It means that we can offer valuable advice and a perspective of what worked and what didn't. We have seen what gets over-emphasized and what does not get enough attention.  We have seen the Revenue Cycle processes that have fallen by the wayside or have become manual, or that had to be completely re-engineered.  We can tell you what to look out for, what you may need help managing, and what others have done in your situation.

We don't just take your legacy data and archive it for safe keeping; we take your hand, and become your partner in your overall revenue cycle, because we have a vested interest in your success.  Don't just take my word for it - talk to any of our customers.  They will tell you about the times we have gone beyond the extra mile for an audit, or a special project, or even for a simple query.  I walk around the office and see the team and what we have built here, and it makes me feel honored to be apart of this intelligent, motivated group of people that make up Legacy Data Access.

It is finally spring.  Seems like this past winter was more brutal than most...lots of snow and ice.  We even had our share here in the Atlanta area. Makes me even more happy to welcome the warm weather, even if it does come with a fine coating of yellow pollen on everything.

The end of winter also brings with it that age-old tradition of spring cleaning.  As I switch out our sweaters for shorts, put the light comforters on the beds and wash the windows,  I also have a list of spring cleaning items for your data center that will keep things running smoothly.

Replace and then wipe and destroy old media. There are probably tapes or CD's, DVD's, or even removable hard drives around your data center that can be wiped and/or destroyed.  Even if your processes are perfect and they dont have PHI on them or they are encrypted, chances are you have media that is aging out.  The last thing you want to do is have a critical backups or files on data that is less than reliable.

Review and update documentation and throw out your paper. I am betting that even if you have all your systems documented properly when they went live, you may not have visited that documentation in a while. It is important to review this information at least yearly, make sure the latest copies are available to your DR plan, and throw out any outdated paper copies that may exist.  Try to go to a paperless repository if you don't already use one, but make sure you can get to the information if your systems are down.  Documentation can be one of those irritating items that, left unchecked, can really bite you in the case of a outage or even a simple audit.

Check the patch levels and release levels of operating systems on your network. There are many tools that will do this for you, but the bottom line is you really need to make sure that all the computers in your network - from system servers to the desktops in doctor's offices - are running the latest OS releases and latest patch levels.    There are government compliance issues to face if they are not - and no one wants to go down that road.

Verify your anti-virus software installations. Along with OS levels, it is always a good idea to make sure all computers in your network are running your standard anti-virus software and that the latest virus definitions are installed.  While your servers may be up to snuff, it is very easy for a user to disable or stop a virus software from updating on their desktop, and before you know it you are dealing with a system-wide problem.

Review your hardware inventory and network maps. These items must be kept up-to-the-minute.  This is getting harder and harder, with laptops, handhelds, iPads, tablets, smart phones and the like.  You must know who has what running within your firewall.

Review your Disaster Recovery plans. Make sure they are up to date and comprehensively on track.  As you implement various systems throughout the year, a task may be to add that system to the plan, but you need to review that plan as a whole to determine any holes, conflicting information, references to systems you are no longer running, or confusing or ambiguous references.

Make sure you are not running systems that are no longer in production or no longer needed. Of course since this is my blog, I am going to reference the need to move retired data to Legacy and clean out your data center, but if  you're here then you pretty much know that drill.   You also need to make sure you are not running old versions of production systems, or old test systems, or even still running those old systems you DID retire with Legacy.

Review your backup processes and make sure the whole backup system is running smoothly. Good return codes on backup jobs are only part of the picture.  Make sure the encrypted files can be decrypted.  Verify that what you think is going off-site truly is being transferred.  Inventory your off-site backup library.  Destroy any old backups that are no longer relevant or that contain data that has been purged from the production system.  Run a small test to make sure that you can get to the backup file you need quickly and easily.  If log files are integral to your backup and recovery process, make sure these are intact, identifiable, and usable as well.

Most of this is common sense, and you are probably doing one or more of these on a regular basis, but it seems like health care IT is moving at double speed lately.  With all of us short on resources and no shortage of projects, some of the above items tend to get overlooked or put off.  Make the time to keep your data center processes tidied up - even if you have to ask your stakeholders to add a couple of weeks to their projects so you can carve out the time.  All they have to understand is how critical these items are to the overall health of your IT systems and they will gladly work with you to get it scheduled.

I ran across an article in Healthcare Finance News regarding bad patient debt and its increase due to the current economy.

Bad Debt is one of those things that is just a part of healthcare finance, for some reason. It has always baffled me how people don't take healthcare debt as seriously as they take their mortgage or credit cards. It seems like the doctors and hospitals are always at the bottom of the list as folks divvy up their paychecks each month.

The article stated what is probably the obvious: layoffs, foreclosures, unemployment, inflation, high cost of fuel - all together are making it harder and harder for providers to collect what is owed to them.

What it did NOT cover, however, is the opportunity that exists to lower the costs to collect these debts. Many hospitals and even physicians offices are continuing to run older legacy systems to collect the outstanding balances and are not really analyzing the cost per dollar to collect those balances. Add to it the fact that more and more of those balances are uncollectable, and you have quite an expensive operation on your hands.

If you visit the Apple App store, you will find ROICalculator. It is an application we put together - it's FREE - that will help you compute the cost of collections. It is built to help you analyze the cost to maintain a system from the IT perspective vs. moving to a solution like ours, but you can easily include your other collection costs in the equations. How many collectors do you have working the legacy system and what is their compensation? Do you have any agencies working the data and taking a cut? Be sure to include those costs.

Once you have identified the monthly costs to maintain your old system, get your last 3 month end reports that show you the total dollars collected from those older systems. Divide that by the cost to maintain the system and look at your cost of collections. Even if you keep the same resource infrastructure around the collection activities once you have migrated the data to LDA, you will see a decrease in the cost to collect.

Additionally, by migrating it to LDA, you have the opportunity to streamline processes, consolidate agencies, and automate some processes that may further reduce the cost of collections. In today's world, every little bit counts!