Legacy data should not be treated as an afterthought
As many NHS organisations move through the current wave of Electronic Patient Record (EPR) transformations, challenges are arising around data migration and legacy data management. Rather than legacy data being a consideration after a new system goes live, it needs to be treated as a clinical priority.
There are three things that we need to get right: data migration and legacy data management are patient safety issues, data migration and data archiving should be a single, integrated strategy and legacy data has clinical and analytical value.
Data migration is a clinical issue
There are many clinical risks that arise from data migration, and these risks are usually underreported.
One example is a simple error in a patient’s address, which can mean a patient doesn’t receive the right clinical information at the right time, or, in some cases, a third party could open the letter, reading private medical information.
Another example is allergy data not being transferred for the new system and the legacy data is inaccessible. This could give false reassurance of allergy data for clinicians, and it creates a serious clinical risk for the patient’s treatment. If clinicians believe a new EPR contains perfect, validated data following migration, a single error can undermine confidence and trust in the entire system.
These errors linked to data migration are systematically underreported. Complaints are closed quickly, problems are attributed to individual clinical decisions, and there is rarely a mechanism to identify data migration as the cause.
To improve this, errors need to be flagged as data migration issues for organisational learning. If the NHS is serious about patient safety in digital transformation, legacy data needs its own reporting system and it’s not just an IT issue.
Migration and archival should be a single strategy
Data migration and archival should not be treated as separate workstreams. Data migration is often approached as a technical exercise, rather than a clinical and strategic model.
Data migration and archival should be brought together as complementary elements of a single data strategy, a more mature model. The key question should not be how we migrate everything, but what needs to move into the live EPR, and what can be archived and accessed when required. This approach minimises the scope, cost and clinical risk.
For large-scale EPR transformations to work, the migration scope needs to be intentionally reduced.
If the data set does not drive clinical decisions or is not something you’d have to re-enter when you see a patient, there’s no need to the data migration. This data needs to be archived and made accessible from within the EPR in one click.
The strongest model uses the archive as a seamless extension of the live EPR rather than a separate system requiring a different login. Archival solutions need to present data in clinically familiar formats, flow sheets, timeline views and speciality-appropriate layouts so that clinicians can use them safely and confidently.
Legacy data has clinical and analytical value
Well-managed legacy data has value for enabling smarter clinical decision-making and creating actions from population-level analytics.
Legacy data is needed for clinicians accessing patients’ longitudinal history. In almost every clinical encounter, the first question is what has happened to this patient before. Historical data on admissions, medication, pathology, allergies and care episodes can inform safe decision-making.
Legacy data also enables useful predictive and operational insights. For example, it can identify patients who have previously been admitted for long stays in hospital, so they can be treated appropriately. It can predict which patients are not likely to attend appointments, so booking teams can contact patients proactively. It is also useful for population segmentation to help identify patients with long-term conditions.
The approach needs to change
Legacy data is too often treated as an afterthought during EPR transformation, and this needs to change.
As NHS organisations move into a more mature landscape of technology, data migration is becoming routine, but the standards, degrees of success and end data quality still vary.
And, as we reconfigure organisations and shift to more community-based care, data migration will happen more often. When it is handled well, legacy dat is treated as a clinical, strategic priority, with governance prioritised from the outset.
It is no longer good enough to treat legacy data as something to retain, just in case. It needs to be treated as a clinical necessity that reduces patient safety risks.
