Legacy Data Stewardship and Patient Safety: A Lesson from High Reliability Organizations


Many healthcare systems are adopting the principles of High Reliability Organizations (HROs), in which safety-driven policies lead the organization. Here we examine how HRO principles are applied to legacy healthcare data management.

High Quality

A major goal in healthcare today is to prevent all incidents of harm to patients. To promote patient safety and quality care, many healthcare systems are adopting the principles of High Reliability Organizations (HRO). Incidents of harm are costly and threaten the delivery of quality care. Legacy Data Stewardship1 can play a vital role in the quest for patient safety.

What is an HRO?

An HRO is an organization where safety and reliability matters.  Examples of HROs are air traffic control, nuclear power, aerospace and theme parks. Safety-driven policies and processes lead the organization and are the focus of continual improvement.

The five general traits of an HRO adapted for healthcare are as follows2:

  1. Sensitivity to operations. Have constant awareness of the systems and processes that affect patient care. This awareness is key to noting risks and preventing them.
  2. Reluctance to simplify. Avoid assuming simple explanations of failure to identify reasons patients are at risk.
  3. Preoccupation with failure. Identify near-misses as areas where the systems and processes should be improved to reduce potential harm to patients.
  4. Deference to expertise. Listen and respond to the insights of people who know how processes really work and the risks patients face.  Create a culture in which high reliability is possible.
  5. Resilience. Be prepared to know how to respond when system failures occur.

For a more thorough look at HROs and how to implement these principles in your healthcare organization, check out this article.

Applying HRO principles to legacy data   

Using a best-practice HRO tool from the military called SBAR (Situation, Background, Assessment and Recommendations), let us examine how your electronic health record storage, specifically the storage of legacy data, promotes patient safety and quality care.

“How reliable is your historical patient record management for achieving patient safety and delivering quality care?”


Converting and migrating historical data from a legacy system to a go-forward system can be costly.  To minimize cost and complexity, comprehensive historical patient narratives are often left behind in legacy systems in read-only mode.  These legacy systems are at risk: running on outdated servers and platforms, oftentimes unpatched and non-compliant with security protocols.


Healthcare record retention laws and guidelines seek to:

  1. Preserve the full patient narrative and improve patient outcomes with better-informed clinical decision-making.
  2. Streamline the legal and compliance eDiscovery process.
  3. Simplify the release of information workflow for health information management professionals.
  4. Give healthcare providers a full patient story to offer the best care and reduce the risk to patient safety.

Patients often assume their doctor has access to their complete history.  Without the important historical information to provide a more complete medical record, safety and quality are at risk of being compromised. Cost and rapidly-changing technology can create a barrier to accessing the patient record—the opposite of the initial endeavor to provide high quality care through an EHR.

Finally, with an increase in cyber-attacks, there is a security risk that the patient’s record could be breached leading to costly HIPAA violations resulting in heavy fines and putting a patient’s identity at risk.


Key points for reliable patient data

  • The patient is at risk when clinical historical information is omitted in the go-forward EHR.
  • Patient safety is at risk when there is a loss of access to vital and valuable historical information to provide reliable and timely care.
  • Allowing historical data to remain in disparate legacy systems can further compromise safety and corrupt the integrity of useful patient data.


  • Be a good steward of technology by applying High Reliability Principles to develop a strategy for legacy data.
  • Preserve legacy data to meet record retention requirements.
  • Establish a diverse data governance team to provide easy access to a comprehensive patient record that prevents vital information from being missed.
  • Enhance patient safety and reduce medical errors by allowing clinicians easy access to the full patient narrative.
  • Consolidate and secure legacy data that is maintained on outdated servers and at risk for breach.
  • Lower medical errors by providing comprehensive access to the patient’s complete historical record.
  • Lower the risk of losing the legacy data by preserving records using a long-term solution such as the HealthData Archiver®.
  • Ensure patient records and other employee, administrative or operational data is preserved and accessible within a system-neutral archive that is easy to operate and provides data where and when it is needed via single sign-on from go-forward systems and other interoperable solutions.

Safety as a Science

When we think about safety as a science2 and the quality of patient centered care, applying HRO principles to healthcare technology can enhance patient centered care by arming frontline providers with necessary information and tools for providing care.  A comprehensive approach to patient safety must include access to historical information that is essential to delivering safe and effective care.  Healthcare organizations aiming for a comprehensive understanding of their patient population should include a data stewardship plan for their legacy data.  Legacy Data Stewardship is essential for safe and effective care that leads to highly reliable care.

Is your legacy data stewardship plan up to the task?

Safety as a science is the future of healthcare.  Have you begun to address your legacy system inventory to consolidate and secure disparate data stores, making them accessible to users when, where and how it’s needed to ensure high reliability?

Harmony Healthcare IT, the makers of HealthData Archiver® can help.


1 “Technology stewards are people with enough experience of the workings of the community to understand its technology needs, and enough experience with technology to take leadership in addressing those needs.  Stewardship typically includes selecting and configuring technology, as well as supporting its use in the practice of the community.”  DIGITAL HABITATS: Stewarding Technology for Communities.  Wenger, White and Smith, 2007

2 https://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/hroadvice/hroadviceape.pdf

3 Agency for Healthcare Research and Quality, Advancing Excellence Health Care 

Guest Blog submitted by Jeff Liddell

Jeff is a High Reliability Organization coach and a Licensed Clinical Social Worker who has worked in emergency psychiatric services for the past 21 years.  He received his MSW from Portland State University and his Master of Divinity from The University of Notre Dame.  His Master of Divinity Thesis titled, “Healthcare of the Poor” has kept him attuned to ethical issues in the healthcare arena.  He has been consulting for Harmony Healthcare IT and continues to provide psychiatric services.

Mar 16 2018

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