Let’s start with a QnA.

Q: When would you consider modernizing a legacy software platform?

A: a). When my system does not scale up or is not agile enough to support modern technology, such as multitenancy support on the cloud

b). When regulatory compliance requires data to be shared over APIs

c). When customers request for the latest features

d). When the technology vendor finally stops supporting the platform, exposing it to security vulnerabilities

I am sure most of you are nodding your heads at one or all of these answers.

The reason behind the reactive approach is not lack of will. The cost and risks associated with modernization have kept many healthcare software vendors running legacy applications for long periods. Not to mention the worries about whether profit margins will adequately compensate for modernization costs.

Legacy software components could be jobs, transactions, programs, or procedures within existing application systems. These systems are usually running on outdated technology and are often complicated and challenging to manage. These are a few of my pet peeves with legacy healthcare software systems:

Cost of maintenance

The cost of maintenance here could mean the cost to support an outdated technology. If these are commercial-off-the-shelf (COTS), then the vendor would charge a premium to keep supporting an outdated technology. Alternatively, if these are in-house systems, then you need to find talent and skills willing to support such systems. Who from the new generation would want to work on Power builder and PHP?  The cost of maintenance of legacy applications far outdoes any benefits that may be accrued by avoiding modernization.

The risk of the data breach

Legacy technologies may have multiple vulnerabilities that expose them to today’s sophisticated cyber-attackers. According to this IBM Report, healthcare companies continued to incur the highest average breach costs at $7.13 million — an over 10% increase compared to the 2019 study. Keeping the providers’ and patients’ best interests in mind, healthcare vendors need to ensure the best data security practices.

Fragmented systems

Many of the legacy platforms are closed systems with little to no provision for integrations. The demands of the modern business require close integration between various subsystems for seamless coordination of workflows. For e.g., the integration of a patient portal to the EHR is a mandatory compliance requirement today and yet we find vendors using roundabout ways to manage such integrations. Thus, legacy systems tend to be poorly integrated and do not support the 360-degree view.

No room for innovation

The rapid adoption of mobility has made it possible for patients to become active participants in their care. Hence, EHR vendors must elevate themselves from being transactional to transformative. As John Glaser wrote in Harvard Business Review, integrating EHR systems to population health management systems, health information exchanges, health management apps, and big data analytics systems will pave the way for a new kind of EHR redesign. This redesign will enable EHRs to fuse seamlessly with complementary systems, capabilities, and technologies.

Preparing for change

These challenges do not mean that healthcare IT vendors have to reconcile with a painful “rip and replace” approach, which is expensive and complex to undertake. Instead, after carefully weighing the pros and cons, a systematic approach will help make life easier. The piecemeal approach is best for those who feel the need to change certain aspects of the system that are no longer serving them and retain the rest. It’s essential to work with a seasoned technology partner who understands the technology landscape and has expertise in legacy modernization to guide you through the process.

In the next blog in the series, I will discuss the importance of reusing vs. reengineering legacy systems based on our experience and the techniques involved in legacy modernization.

Please write to itservices@healthasyst.com with your queries on legacy modernization.

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  • The HealthAsyst Blogging Community comprises key thought leaders with decades of experience in the Healthcare IT Services industry. Their expertise ranges from product engineering, implementation, healthcare regulation, managed services to applications of data science and analytics in healthcare.

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