Legacy Systems in Healthcare: Maintain or Replace

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This article explores the pros and cons of both healthcare legacy system modernization approaches for medical organizations so that you can make an informed decision.

The COVID-19 pandemic highlighted the inefficiencies in multiple healthcare systems and approaches. With the rising need for telemedicine, remote care, and contactless patient/staff interactions, many healthcare providers face the need to replace or rearchitect the legacy healthcare software they use with modern cloud-based solutions.

If you work at an organization like this, you know what we’re talking about. You need to ensure HIPAA/HITECH and/or GDPR compliance, especially regarding cybersecurity.

Updating the legacy healthcare system should help meet the ICD-11 and government requirements. On top of that, patient expectations are growing in terms of remote care via mobile apps. You also have to deal with the increased overall workload and constrained resources due to the pandemic.

Finally, you need to ensure system interoperability with new data formats — all the while guaranteeing the security of patient data storage and payments.

Now, how can you tell if you’re running a legacy healthcare solution? Look for the following clues:

• Lots of processes must be done manually
• The number of data formats your system works with is very small
• Some processes take very long to complete due to the poor integration of various system modules
• If it works, it works; if it doesn’t, you can’t tell why
• There are no error handling procedures
• You cannot guarantee the security of your patients’ and organization’s data
• Your system can’t run big data analytics
• Your IT department is a money sink in constant need of hardware replacements

Most importantly, if your EHR or other medical software is decades old, you definitely have (or soon will) a hard time keeping it running. All due to the lack of experts that know how to maintain a legacy healthcare solution, the increasingly growing costs of hardware upkeep and replacement, and the system’s inability to cope with increased workloads.

Given all that, there are only two realistic scenarios — you can either go for a healthcare IT legacy system support or rearchitect the software infrastructure.

Rebuilding vs. maintaining a healthcare legacy system

The success of running a healthcare organization depends on ensuring smooth interaction between multiple moving parts: people, hardware, and software. Obviously, any software gets old with time, and you must either replace the outdated healthcare software or try to keep it running at all costs. There are some obvious benefits and downsides stemming from both decisions.

There are some advantages to the continued use of healthcare legacy systems:

• Your staff is used to running it, so they know how to perform their daily tasks with the tools at their disposal.
• The software was developed for some purpose and gets the job done.
• Using this system will not cost you a thing (hardware replacements aside), as it was paid for in full long ago.

As an alternative, you might decide to rebuild the legacy medical software from scratch. This brings the following benefits:

• You can select the most appropriate tech stack to future-proof your hospital software and ensure it’s easy to update in the years to come.
• You can benefit from the security and scalability of the cloud, ensuring your organization’s and patient’s data is safely backed up.
• You can provide your patients with the level of services they expect and easily add new functionality on request.

It seems like legacy hospital software replacement is a better way to go: it future-proofs your business, gets rid of liability in the form of outdated technology, and cuts your expenses. But every coin has two sides.

Challenges of healthcare legacy systems replacement

As any system-wide endeavor, the decision to replace outdated healthcare software requires thoughtful planning and comes with certain challenges:

• You need to halt (or at least disrupt) your usual operations while a technology provider helps you migrate from legacy healthcare systems to new software.
• Your staff will have to learn to use new tools, which will take some time.
• There is a possibility of bugs that will have to be ironed out with time.

While these disadvantages do seem concerning, they can be minimized with proper planning and careful implementation. They are completely dwarfed by the benefits you get, though: the ability to implement a centralized Electronic Health Records (EHR) system, consolidate your patient data and enable its smooth interchange with other medical facilities, ensure a positive patient experience and optimize your costs.

Besides, the alternative is much more costly.

Challenges of healthcare legacy systems support

You definitely know the shortcomings of your existing system and understand the headaches you’ll keep getting if you decide to maintain and support your legacy healthcare solution:

• Different parts of the system were designed by different teams and, while they are still mission-critical, maintaining them is close to impossible.
• You have to maintain an in-house data center or rely on an external dedicated server provider to store and process your data. You also have to pay for idling backup resources.
• Adding new functions, services, and features is never easy, as the technology stack used in your system might not support them. This requires lots of custom code, which is hard to keep running smoothly, let alone the problem with finding developers.

Most importantly, this will never be the final decision, as you will have to rebuild the legacy healthcare system at some point in the future anyway, even despite the challenges it will bring.

Let’s say you’re ready to replace your outdated healthcare software already. How should you go about it?

Read also: How to update legacy software the right way.

Healthcare legacy system modernization approaches

Naturally, there is no one-size-fits-all solution when updating a legacy healthcare system. But there are four main approaches to doing it: replacement, rebuilding, refactoring, and rehosting. Let’s take a closer look at each of them.

Replace

There are lots of SaaS products built for healthcare providers. You might happen to find a solution that will satisfy the core needs of your organization. And if some features are not there, the vendor can develop them for you or provide plugins and addons to deliver this functionality. The biggest challenge here is migrating the data to the new system, as there might be data format compatibility issues.

Rebuild

Sometimes, there simply isn’t anything to salvage if your mission-critical systems run on incredibly old code like COBOL or FORTRAN. In that case, you can only list the useful functions and features your system provides and order them rebuilt from scratch using a modern programming language. This is the best way to future-proof your software.

Read also: Your guide to software reengineering.

Rehost

Also known as “lift-and-shift,” this is often the initial phase of cloud migration, often followed by refactoring. Sometimes the core of your system is too complex and fragile to be quickly replaced or rebuilt but is too resource-demanding to ensure the needed scalability and operational resilience. In that case, your systems are moved to the cloud Infrastructure-as-a-Service or IaaS solutions, where they continue to run on virtual machines and in Docker containers instead of rackmount servers.

This way, the code remains unchanged and the functionality is not affected while the system gains additional security and scalability. The problem here is that it’s only a temporary solution, as all the structural inefficiencies of the old system are dragged along to the cloud. So, rehosting should be followed by rearchitecting the software.

Read also: How to build a Healthcare SaaS.

Refactor & rearchitect

Sometimes, the system you run is built using a programming language still in use, but it’s quite an archaic version, which limits its backend business logic and makes further updates impossible. This can apply to many languages but is especially true for PHP, where 3.x and 7.x versions have completely different syntax and logic. If there are lots of custom modules built specifically for your system in outdated language versions, updating them might not always be possible.

In that case, your selected technology provider must refactor the code, which means reimplementing the existing functionality using the latest stable versions of an appropriate programming language, databases, frameworks, and libraries. This can be quite expensive but enables you to get rid of liabilities like an outdated database, custom modules, potential cybersecurity breaches through open-source dependencies, etc. The same goes for rearchitecting the infrastructure to ensure maximum cost-efficiency.

As you can see, there are multiple approaches to updating a legacy healthcare system, so your organization can select the one that fits your business strategy and budget best.

Read also: How to migrate your software to a Cloud.

Healthcare legacy system modernization cases

While most healthcare-related modernization cases are NDA-protected, we did find an example to showcase the benefits of replacing legacy healthcare software with cloud-based tools.

A US-based healthcare payment solutions provider that connects insurers, patients, and clinics had its platform built with Visual Basic. After Obamacare was enacted, lots of people were able to afford medical insurance, and the company’s customer base started growing exponentially. However, the existing solution lacked the scalability needed to meet this growing demand.

Its technology partner offered to go the rearchitecture way, which included moving the infrastructure to a new virtual environment run on Cisco UCS, VMware, and SRM (Site Recovery Manager). The old HP rackmount servers were then repurposed, upgraded to the latest VMware version, and moved to the provider’s headquarters to run as a failover solution and data storage, with SRM running in parallel for both environments.

This helped guarantee system scalability, remove performance bottlenecks, ensure HIPAA compliance, and implement a disaster recovery plan to warrant the safety of sensitive data.

Read also: How to use cloud computing in healthcare.

Our solutions for healthcare legacy system replacement

Acropolium has 11+ years of experience in delivering healthcare software development services building new apps from scratch and upgrading existing solutions.

We helped one of the market-leading virtual healthcare providers in the US save their project, refactor the code, and develop a HIPAA compliant app for monitoring sexual health, scheduling testing, and sharing results with a partner securely.

In another case, we helped develop an enterprise-grade system for remote SaaS biotech device control and quality assurance. The product enables real-time remote audit of any biotech precision tool and simple management of records, streamlining the ongoing audit of medical toolkits in healthcare facilities.

There are lots of other projects in our portfolio that prove we are an established technology partner with ample expertise in healthcare software development.

We will be glad to assist you in updating your legacy healthcare system and selecting the most cost-efficient approach to meet your business goals. If you have any questions or want to discuss your project, get in touch with Acropolium, and let’s talk business!