Case Study: Migrating Indiana's Health Information Exchange

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Case Study: Migrating Indiana's Health Information Exchange

The Need to Upgrade

The country’s largest health information exchange, the Indiana Health Information Exchange (IHIE), connects patient health data from thousands of healthcare providers across the state of Indiana through a data repository and advanced information technology network. Designed to improve patient care, outcomes and population health in the state while improving efficiencies and costs, IHIE serves as a model of health information exchange for the rest of the country.

Cast_Study_IHIE_imageIHIE uses an information management tool called Legacy/INPC/CareWeb that allows providers to submit, search or access a patient’s data and clinical history (such as recent encounters, payor information, medical results and demographics) from the participating facility with a secure login. At the time, all of the CareWeb information was housed on a legacy VAX server in a data center at the Wishard Hospital Campus. With an outdated legacy server that was hard to maintain and a hospital site that would soon be decommissioned due to the hospital’s move to a new location (Eskenazi Hospital), a looming deadline meant IHIE would need to migrate to a new system, or risk losing years of valuable patient data. In addition, IHIE sought to move all of the five major institutions – IU Health, Eskenazi, St.Vincent, Franciscan and Community – onto one data platform (CareWeb14) so they could consolidate and begin to share patient information in a more meaningful way.

IHIE chose CoreTech Revolution to spearhead the project, coordinating resources, managing all of the technical details and serving on the steering committee. To kick off the project, CoreTech developed a basic strategy for the migration and prioritized the timeline for completion of various project phases. Using both internal and external resources, CoreTech Revolution kept the entire team on track – from strategy and communication to hardware and application development, scalability, testing and training.

Infrastructure Needs and Analysis

Knowing the project involved multiple phases, CoreTech initiated a detailed infrastructure analysis of the existing infrastructure to ensure that IHIE made efficient use of existing systems, technologies and resources. With a substantially greater number of users and increased data flow needed for the new system, CoreTech Revolution’s process would help IHIE ensure that moving from the legacy system to the new system would not only be seamless, but that it would also perform up to the same standards as the original system. As part of the analysis, CoreTech Revolution was involved in:

  • Analyzing the infrastructure to determine readiness to handle hundreds of concurrent users
  • Testing the sending/receiving process for medical record data flow
  • Testing the system for scalability to determine how the system handled increased message flow
  • Mapping out a migration process to ensure data and messaging would work during testing as well as after the actual migration

Functional Gap Analysis

In addition to the infrastructure needs, CoreTech Revolution conducted a detailed analysis of IHIE’s existing user interface to determine functional modifications needed to enhance the system. This included processes such as:

  • Reviewing the look and feel of information displayed in the current system, screen by screen, function by function, to determine changes needed within the CareWeb14 application
  • Analyzing the type of information as well as the way the information was processed in the system to determine priorities and important features
  • Developing a plan to correct any issues within the current system that could be modified within the new design

Communication is Key

Once CoreTech Revolution had completed the analysis phase of the process, it began the process of coordinating communication and readiness planning, enlisting the help of internal resources at IHIE, Regenstrief Institute (who owned the original CareWeb), and representatives from five major Indiana health systems – IU Health, Eskenazi, St.Vincent, Franciscan and Community hospital systems. At this time, the largest institutions and regional hospitals around Indiana had little incentive or assistance to begin the process of migration to the new CareWeb data platform. To solve this issue and get the institutions ready for the migration, CoreTech Revolution created a comprehensive communication strategy that would both encourage and guide them throughout the migration process. Some of the activities involved in the communication and readiness timeline included:

  • Notifying institutions about the upcoming timeline and need to migrate to the new system
  • Identifying gaps in technology and resources from each institution needed for the transition
  • Conducting workshops and webinars with institutions to discuss the migration and its benefits
  • Answering questions and following up with institutions
  • Sending institutions reminder emails and documentation needed throughout the process

“I am confident this work would not have been achieved without Michelle’s leadership and diligence. She built phenomenal relationships with all parties, enabling us all to work together.”

-Jane Niederberger, COO Indiana Health Information Exchange

Institution Migrations

During the individual institution migrations, CoreTech Revolution worked with each Indiana health system to determine what data needed to be transferred and where it had to be located in the new CareWeb14 system. Each hospital had to format their own HL7 message based on the needs of the new CareWeb14 application, so it was a very complicated and iterative process to configure the new interface to display properly, while removing old connections. Some of the technical and development efforts required for the IHIE migration project included:

  • Prepare and implement procedures for cross-over to the new platform, including coordinating cut-off times for shutdown and data flow and a back out plan in case of issues
  • Creating a step-by-step plan for conversion for each individual institution
  • Testing the Sending/receiving process for medical record data flow for each institution
  • Correcting inconsistencies and data flaws between old and new platforms
  • Data validation for downstream system testing
  • Individual end user training at each institution
  • Maintaining the institution’s legacy system throughout the migration

The individual system migrations were completed one by one, until all institutions were finally on the new platform. As each institution slowly came online, CoreTech Revolution worked to help them remove old connections and establish new ones, as well as format the patient data in the new system, configuring it to display properly. As application testing ensued, CoreTech Revolution also had to review each institution’s feed (real-time data) to assess potential changes or functionality issues, and then build the system to support that institution’s current operation. This involved everything from hardware to application development to message flow migration and scalability.

“CoreTech coordinated all involved to ensure that the client and the IHIE participants were as prepared as they could be for the migrations. These migrations were not on the top of the clients’ respective priority lists, yet CoreTech kept them engaged and moving forward.”

-Chris Daily, Former VP of Solution Engineering, Indiana Health Information Exchange

Lights On

While working to get all of the facilities migrated, CoreTech Revolution also had to ensure that the current system remained functional while continuing to meet all clients’ needs. The first priority to maintain a seamless transition was to move the servers out of the basement at Wishard, as the Wishard facility and building would soon be decommissioned. To achieve this, the servers had to be emulated in the new environment in order to keep them running and test them throughout the transition. This urgent portion of the project required the assistance of additional outside specialists, and was conducted as a separate project. For more information about the VAX server migration and its importance as part of this project, please see our detailed case study.

Once the servers were migrated, other work remained in order to continue to support active institutions in this environment. IHIE, with the help of CoreTech Revolution, needed to:

  • Apply all appropriate server patches
  • Maintain current and active software and system licensing
  • Provide appropriate application support for new customer interfaces and upgrades
  • Monitor overall system to ensure that all feeds remained active and that the servers performed as expected

CoreTech Revolution worked with each institution individually to support their needs during this transitional period. However, they also looked at the larger group of institutions together to define system freeze dates to support the larger, full system migration efforts. CoreTech Revolution worked to effectively support the migration efforts individually and as a whole until no further changes were required.

A System that Works

After a long process, all of the IHIE member institutions transitioned seamlessly to the new system. IHIE, with the help of CoreTech Revolution, was able to migrate the institutions from the Legacy/INPC/CareWeb onto a new, more intuitive interface in CareWeb14 – a more robust system that could handle the large volume of patient data flowing through it daily. With all of the institutions’ migration to the new CareWeb14 platform, they can now enjoy the availability of real-time patient data all in one place. By providing ongoing leadership and technical expertise to IHIE, CoreTech Revolution helped to make the migration project a success.