Originally published in our Data Management Special Report
Anyone who has ever moved house will have had that awful moment of trying to figure out how on earth to get that wardrobe out of the box room and wondering what it will look like in the new bedroom.
For the IT manager in charge of getting data out of a legacy system and into a new PAS such challenges are very familiar.
Data migration is a major component of any successful switch, as Ben Howison, ICT technical lead for data migration at Barts and The London NHS Trust will testify. He was responsible for delivering migrated data at Newham Healthcare and Homerton University Hospital trusts when they switched to Cerner Millennium a few years ago; he is now taking his current trust through the process and local admiration for him such that has been nominated in the Healthcare ICT Champion category of the BT e-Health Insider Awards.
“The goal is to maintain your business continuity and carry on without losing sight of a single patient and maintaining the visibility of clinical histories,” he says.
“The key principle is to analyse what you’re doing before you start, trying to work out what the old data will look like in the new system and how it will behave,” he says. “It’s a real eye opener when you do it the first time.”
The clinic configuration challenge
One of the hardest parts of data migration in a large hospital is configuring all the clinics. “We have thousands of clinics and perhaps 120,000 forthcoming out-patient appointments. So each appointment has to be built into the system for the right clinic for the right doctor at the right time. That’s hard work,” says Howison.
The other challenge is data cleansing. “Our data is fairly mucky,” he explains. “We have had mergers and splits and so there are duplications. We found one patient on our index 20 times.”
End-to-end he reckons data migration to a new PAS at a large hospital takes six months, with four dummy runs to get the migration right.
Opportunities for improvements
Paul Tempest-Mitchell, product manager for EMC’s public sector division, also emphasises preparation.
“You need to properly analyse both structured and unstructured information,” he says. “Typically a large hospital will have their information systems and their patient systems, but there will also be data sitting in PACS as well as small databases and spreadsheets. Each will need a different methodology.”
Data migration is also the time to look improvements, he stresses. That might be looking at improving your capacity and performance, what you do with your data as well as your security.
Dave Longson, a technical specialist at EMC, cites the use of the clinical data lifecycle management product Centera.
“There are things that need to keep forever but probably do not need instant access to online and so could be stored with access in five minutes or three minutes,” he says. “Centera will help you do that and make significant savings.”
It’s not just moving to a new PAS that presents data migration issues.
Report mining
Olly Bond works for Datawatch Europe and has helped a number of UK hospitals with data migration problems. For example in 2006, he worked with University Hospitals of Coventry and Warwickshire NHS Trust when it decided to outsource storage of electronic patient records to a partner in the private sector, TNT.
The data generated by the hospital’s PAS had to be translated into a format that could be shared with TNT’s systems. Rather than develop its own solution, the trust opted for Monarch’s Data Pump to do the job.
Data Pump uses a report mining methodology, taking data from legacy systems and converting them into a database that could be used not just for transferring data to TNT’s system but also for wider use in the trust.
“It’s much better than a programming approach,” says Nick Elliott, chief technology officer at UHCW. “It makes the system easier to maintain as projects or models can be developed by non-technical staff so the process is not dependent on IT resources.”
Bond says the approach is commonly used in the US where hospitals need to provide information to insurers without giving them access to their database. In business it is increasingly in demand to help convert legacy data into formats that are Microsoft Office Sharepoint Services friendly. This hasn’t hit the NHS yet – but Bond is in talks with a large NHS trust at the moment.
Planning and communication
Data management specialists, Stalis, advise trusts planning a large data migration exercise to take a realistic view of the time they will need to complete the project.
A common problem, says John Wiltshire, Stalis’ sales and marketing director, is that resources and staff commitment are not sought early enough. “Departments working in silos do their bit and don’t realise the impact of their work on other areas.”
When business processes change, working arrangements have to change too. The key, says Wiltshire, is good communication, in particular sharing information with the company contracted to do the data migration.
Stalis’ managing director, Christine Whitehouse, points to the factor driving the need for such good practice: business continuity.
“How many trusts look at issues around managing reporting when moving from one system to another? The assumption is that some reports will be the same.”
Finding that reports are not the same or that vital information cannot be produced can potentially have dire consequences for assessing a hospital’s performance and indeed for getting paid for procedures completed.
The importance of business continuity is starting to gather more recognition, however. Stalis was chosen recently by local service provider, Fujitsu, to supply a business continuity package to trusts receiving new systems under its Connecting for Health contracts.
A trusted ally for primary care
Nor is data migration to new systems purely an acute trust issue – primary care is equally affected with GPs moving onto new systems in droves. Here at least there is help on offer, funded by NHS Connecting for Health.
Helen Atkinson, business development consultant for Primis+ explains. “One key resource in the business change process is the early involvement of a PRIMIS+ information facilitator,’” she says.
They are trained in information management, clinical coding, paper-light working, as well as facilitation skills and change management and can advise the practice and the PCT on data migration and transfer issues.
“They occupy a unique position in that they are a trusted ally to practices and can assist in negotiations with the PCT,” says Atkinson.
Daloni Carlisle and Linda Davidson
Originally published in our Data Management Special Report