A Guide to Modernizing Legacy Systems in Healthcare

Imagine a world where your medical records are stored on floppy disks, and your doctor has to use a rotary phone to coordinate your care. Sounds archaic, doesn’t it? Yet, this is close to reality for many healthcare providers, with a startling 73% still relying on legacy software.

The consequences of holding on to these outdated systems are severe. The U.S. federal government spends a staggering $337 million annually to keep ten of its legacy systems operational. But the real cost goes beyond just money.

Legacy systems make it harder for healthcare providers to deliver secure, reliable, and scalable services. This may compromise patient care and risk exposing sensitive data.

Despite these challenges, the global healthcare IT market will become a $728.63 billion entity by 2029. So, modernizing healthcare legacy systems is no longer a luxury; it’s a necessity for providers who want to stay competitive and provide the best possible care.

This comprehensive guide will explain the needs, challenges, approaches, and step-by-step process of modernizing legacy systems in healthcare.

A legacy system in healthcare refers to an outdated software application or technology platform that a healthcare organization continues to use despite its limitations and the availability of newer, more advanced solutions. These systems often have been in place for many years and are deeply integrated into the organization’s workflows and processes.

Although they may still function, legacy systems in healthcare can pose challenges such as limited interoperability with newer technologies, difficulty in maintaining and updating, and potential security vulnerabilities.

Types of legacy healthcare IT systems

Legacy systems come in various forms, each with its own set of challenges and implications for patient care and organizational efficiency. The following are the main types of legacy systems in healthcare settings:

#1. Electronic Health Record (EHR) Systems

Early EHR systems focused on basic patient record keeping and may lack modern functionalities, interoperability, and user interfaces.

#2. Hospital Information Systems (HIS)

Legacy HIS systems that manage administrative, financial, and clinical hospital operations may struggle with interoperability, real-time data access, and reporting capabilities.

#3. Laboratory Information Systems (LIS)

Legacy LIS systems that manage laboratory data and workflows may face issues with data standardization and integration with newer diagnostic technologies.

#4. Picture Archiving and Communication Systems (PACS)

Outdated PACS for medical image storage and retrieval may have limited storage capacity, slow retrieval speeds, and compatibility issues with new imaging modalities.

#5. Radiology Information Systems (RIS)

Older RIS systems that monitor radiology workflows, scheduling, and billing may lack capabilities like automatic appointment scheduling. Legacy RIS may also lack integration with other systems, leading to duplicate data entry, billing errors, and inefficient resource utilization.

#6. Telemedicine Systems

Legacy telemedicine systems in healthcare communications infrastructure may need upgrading to provide secure communication and effective telehealth services.

#7. Claims Processing Systems

Legacy claims processing systems that manage billing and reimbursement between providers and payers may struggle with modern billing rules and regulatory changes

#8. Patient Engagement Systems

Patient engagement systems facilitate communication, education, and self-management tools for patients. When these systems become outdated, they may lack user-friendly interfaces, mobile compatibility, and integration with other healthcare IT systems. This can lead to poor patient engagement, lower adherence rates, and suboptimal health outcomes.

To ensure the delivery of high-quality, efficient healthcare services, organizations must carefully weigh the costs and benefits of maintaining these legacy systems against the potential value of modernization initiatives.

Maintaining vs. modernizing healthcare systems is a crucial decision that requires careful consideration of your organization’s needs and resources. While upgrading may seem like an obvious choice, many organizations choose to maintain legacy systems for various reasons.

Advantages of running existing legacy healthcare systems:

• Cost-effective if current systems function well
• Minimal training and disruption due to staff familiarity
• Better compatibility with existing systems and applications

Advantages of modernizing legacy healthcare systems:

• Improved efficiency through advanced technologies that streamline workflows and enhance interoperability
• Sophisticated security features to protect patient data and ensure compliance
• Future-proofing for compatibility with emerging technologies and organizational growth

The choice between maintaining or modernizing your legacy healthcare system depends on factors like the age and condition of your existing systems, the availability of resources (financial, technical, and human), and your organization’s long-term goals and priorities.

Despite the benefits of maintaining legacy systems, there comes a point when you cannot avoid modernizing them.

As healthcare technologies continue to evolve at an unprecedented pace, it becomes increasingly crucial for organizations to recognize the telltale signs that your legacy systems are no longer serving your needs effectively.

Risks of not modernizing your legacy healthcare systems

When the above signs are clear, not upgrading your IT systems can have far-reaching consequences for your organization’s operations, patient care, and overall competitiveness.

• Compromised patient safety: Outdated systems increase the risk of medical errors, misdiagnoses, and adverse events due to inaccurate or incomplete patient data, ineffective communication, and lack of interoperability between healthcare providers.
• Data breaches and compliance risks: Legacy systems often lack robust security measures and become vulnerable to cyber threats and data breaches. These breaches can lead to hefty fines and legal repercussions for non-compliance with data privacy regulations.
• Inefficient operations and workflow disruptions: Antiquated systems are prone to downtime, slow performance, and compatibility issues, resulting in workflow disruptions, staff frustration, and decreased productivity.
• Inability to leverage advanced technologies: If you hold on to legacy systems, you risk falling behind in leveraging cutting-edge technologies such as artificial intelligence and machine learning. These technologies can significantly enhance patient outcomes, streamline processes, and reduce healthcare costs.
• Competitive disadvantage: Patients expect seamless experiences and advanced services in an increasingly digital healthcare landscape. Failing to meet these expectations can result in losing patients and revenue to more technologically savvy competitors.

When the signs are clear and you are considering upgrading your systems, make sure to understand each modernization approach thoroughly to make an informed decision.

Here are the top approaches for modernizing legacy healthcare systems. Each method offers distinct advantages in upgrading healthcare infrastructure.

The choice of strategy will depend on factors such as the legacy system’s complexity, criticality, and current performance, as well as the organization’s budget, timeline, and risk tolerance.

Now, let’s go through the intricate steps involved in legacy healthcare system modernization.

Modernizing legacy systems is a complex undertaking that requires careful planning, execution, and monitoring to ensure a successful outcome. From initial assessment and planning to implementation, testing, and post-modernization maintenance, here are the essential steps involved in a well-executed healthcare legacy app modernization initiative.

Step 1: Assess the current legacy systems

Begin by conducting a comprehensive IT audit to identify all hardware, software, and systems in use. Analyze their age, performance metrics, compatibility, and security vulnerabilities. We also recommend gathering insights from key stakeholders, including end-users, IT staff, and executive leadership, to understand their needs, concerns, and expectations for the modernized system.

The assessment phase also includes evaluating the total cost of ownership, including software maintenance, support, and downtime costs. This analysis helps organizations understand the financial implications of maintaining legacy systems and the potential long-term benefits of modernization.

Based on the findings, prioritize mission-critical systems that require immediate modernization based on their impact on patient care, operational efficiency, and regulatory compliance. Finally, develop a detailed report outlining the findings, risks, and recommendations for a phased modernization approach.

Step 2: Choose a modernization approach

When modernizing legacy systems in healthcare, consider approaches that prioritize data security, compliance, and seamless integration with existing healthcare workflows.

• Rehosting: Use when you need to quickly migrate the app to the cloud with minimal changes, but it may not address underlying issues or leverage cloud-native features.
• Refactoring: Use when you want to improve the app’s performance and compatibility without significantly altering its architecture.
• Rearchitecting: Use when you need to align the app’s architecture with modern best practices for better modularity and scalability, but it requires more effort and resources compared to rehosting or refactoring.
• Rebuilding: Use when the legacy app is no longer viable, and you want to create a new, modern app, but it comes with higher costs and longer timelines.
• Replacing: Use when the legacy app no longer serves its purpose, and you want to adopt a new solution that better meets requirements, but ensure careful evaluation and data migration planning.

To choose the right modernization approach, assess the feasibility, cost, and timeline for each option, considering the complexity of the legacy healthcare app, its role in patient care delivery, and the potential impact on clinical workflows.

It’s also important to identify the resources and expertise required for the modernization project, such as knowledge of HIPAA regulations, HL7 standards, and clinical data management for successful execution.

Step 3: Choose the right technology stack

Start by evaluating modern healthcare technologies and cloud platforms like AWS, Google Cloud, or Azure, which offer scalability, interoperability, and robust security features. Consider cloud-based EHR systems, such as Cerner or Epic, which can handle large volumes of patient data and ensure seamless integration with other healthcare systems.

Next, prioritize compliance with healthcare industry regulations and standards. Ensure that the chosen technologies provide HIPAA-compliant data storage and secure communication protocols like HL7 FHIR. We also recommend using the blockchain technology for secure data sharing and auditing.

Finally, align your tech stack with the organization’s long-term goals and budget. Select technologies with proven track records in the healthcare industry and strong community support. For example, if developing a mobile health app, consider cross-platform frameworks like React Native or Flutter, which offer a rich ecosystem of healthcare-specific libraries and tools.

Balancing cost with functionality and future-proofing your IT infrastructure ensures a sustainable and effective modernization effort.

Step 4: Specify integration goals

Defining integration goals aligns the healthcare organization’s IT modernization efforts with its overarching strategic objectives.

The following are common integration goals that healthcare organizations should consider:

• Enabling real-time access to patient data across different departments
• Facilitating secure sharing of medical records with external providers
• Ensuring interoperability between clinical systems and emerging technologies like wearables or remote monitoring devices
• Streamlining administrative processes through integrated billing, scheduling, and inventory management systems

To prioritize the most appropriate goals, consider the following steps:

• Start by evaluating the specific challenges your organization faces with current legacy systems. For instance, if data silos are a significant issue, prioritizing interoperability should be high on your list.
• Given the importance of compliance in healthcare, goals related to meeting regulatory standards and ensuring data security must be prioritized.
• Consider the resources available, including budget, technology, and human expertise.
• Prioritize goals that can be achieved within the current resource constraints.
• Conduct a cost-benefit analysis to determine each integration goal’s feasibility and potential impact, ensuring that the invested resources yield tangible benefits.

Step 5: Choose an integration method and conduct the integration of middleware

When choosing an integration method, consider factors like system compatibility, data security, and scalability. Here’s a table outlining common integration methods, their use cases, and examples:

To conduct middleware integration effectively, follow these steps:

• Assess your existing systems and identify integration requirements, considering data formats, security protocols, and performance needs.
• Select the appropriate middleware solution based on your requirements and integration methods.
• Define data mappings and transformations to ensure seamless data exchange between systems.
• Implement security measures, such as encryption and access controls, to protect sensitive healthcare data.
• Test the integration thoroughly, simulating various scenarios and data flows to ensure proper functionality.
• Deploy the middleware solution and monitor its performance, addressing any issues.
• Train end-users and support staff to ensure smooth adoption and ongoing maintenance.
• Continuously evaluate and optimize the integration process, adapting to evolving healthcare IT needs and technologies.

Step 6: Develop and test modern system components

To develop and test modern system components effectively, you should:

• Clearly define the requirements and specifications based on input from healthcare professionals, IT experts, and other stakeholders.
• Next, employ an iterative development approach to build and test the components in small, manageable increments.
• Establish cross-functional teams that include developers, quality assurance specialists, and subject matter experts to foster collaboration and continuous improvement.

As the development progresses, incorporate various testing techniques tailored to the healthcare domain.

• Usability testing ensures the system’s user interface is intuitive and easy to navigate for healthcare professionals.
• Conduct user acceptance testing with real healthcare workers to gather valuable feedback and refine the system accordingly.
• Performance testing is equally important, as healthcare IT systems must be able to handle peak workloads and high volumes of data without compromising responsiveness or functionality.
• Load and stress testing can identify potential bottlenecks and help optimize system performance.
• Security testing is a top priority in healthcare due to the sensitive nature of patient data and strict regulations like HIPAA. Assess the system’s security measures, such as data encryption, access controls, and vulnerability management, to protect confidential information.
• Integration testing is also crucial, as modern healthcare IT systems often need to seamlessly integrate with existing systems, such as laboratory information systems, radiology systems, or third-party applications. Verify that data integrity and smooth information exchange are maintained across different systems and departments.

Step 7: Carry out data migration

To carry out data migration in an effective manner:

• Begin by profiling and cleansing your legacy data, identifying and addressing any inconsistencies, duplicates, or errors.
• Next, define the data models and schemas for the modernized system. This involves understanding the new system’s architecture and designing a schema that aligns with stakeholders’ requirements.
• Once the data models are defined, perform the Extract, Transform, and Load (ETL) process to migrate data from the legacy system to the new system. This may involve writing scripts or using specialized tools to automate migration.
• After the migration, validate and reconcile the migrated data. Conduct thorough testing to ensure data integrity, accuracy, and completeness. Reconcile any discrepancies between the legacy and modernized systems and address the issues.
• Throughout the data migration process, maintain open communication with stakeholders, document any challenges or decisions, and continuously monitor the progress.

Step 8: Enforce monitoring and optimization

Monitoring ensures the smooth operation and optimal performance of modernized healthcare IT systems. It enables healthcare organizations to proactively identify and address potential issues before they escalate, minimizing downtime and ensuring the continuity of critical services.

The process of monitoring healthcare systems involves several key steps:

• Define monitoring objectives: Determine the specific aspects of the system that require monitoring, such as application performance, system resources, security events, and compliance requirements.
• Establish monitoring metrics: Identify the key performance indicators (KPIs) and thresholds that trigger alerts or notifications. These metrics may include response times, resource utilization, error rates, and security events.
• Implement monitoring tools: Deploy the appropriate monitoring tools and configure them to collect and analyze the relevant data from various system components, including servers, databases, networks, and applications.
• Set up alerts and notifications: Configure the monitoring tools to generate alerts and notifications when predefined thresholds are breached or anomalies are detected. These alerts can be sent to designated personnel or integrated with incident management systems.
• Analyze and interpret data: Regularly review and analyze the monitoring data to identify patterns, trends, and potential issues. This analysis can provide insights into system performance, resource utilization, and possible bottlenecks.
• Optimize and fine-tune: Based on the insights gained from monitoring data, implement necessary optimizations to improve system performance, efficiency, and security.

Popular monitoring tools for healthcare systems include:

• Splunk: A powerful data analytics platform that can collect, index, and analyze machine data from various sources, including logs, metrics, and events.
• Nagios: An open-source solution offering comprehensive monitoring capabilities for servers, applications, networks, and services.
• Zabbix: An enterprise-class open-source monitoring solution that supports distributed monitoring of various IT components, including servers, networks, and applications.
• SolarWinds: A comprehensive network and system monitoring tool suite that caters to various IT environments, including healthcare.
• AppDynamics: An application performance monitoring tool that provides deep visibility into application performance, user experience, and business transactions.

Modernizing healthcare IT systems is daunting, but some organizations have successfully navigated this journey.

Let’s look at some real-world examples of healthcare organizations transforming their legacy systems.

#1. NextGen Healthcare reduced cost and accommodated 140x growth of virtual visits by modernizing its legacy IT healthcare system

NextGen Healthcare is a leading provider of innovative healthcare technology solutions, serving doctors’ offices and other healthcare providers.

Challenges

NextGen’s legacy infrastructure was costly to maintain and deploy, and the diverse technology stacks acquired through mergers and acquisitions made change and consolidation difficult, preventing the company from providing consistent product availability. As NextGen dealt with sensitive healthcare information, the company needed to ensure compliance with regulations like HIPAA and the Health Information Technology for Economic and Clinical Health Act. NextGen also needed to modernize its infrastructure to improve its products’ reliability, availability, and security while reducing costs.

Solutions

NextGen went all-in on AWS in 2018 and began migrating its existing solutions and creating new products on the cloud. The company used AWS Control Tower to simplify its AWS experience, establishing a landing zone with built-in governance and compliance guardrails across its 100+ AWS accounts. NextGen also leveraged managed services like Amazon Aurora and Amazon Simple Queue Service (SQS) to reduce operational overhead and improve reliability. For its Virtual Visits telemedicine product, NextGen replatformed the solution into its AWS landing zone, implementing infrastructure as code and automating deployments.

Key Results

• Increased reliability of products for customers
• Improved security and compliance
• Reduced costs
• Accommodated 140x growth of Virtual Visits in 2 months during Covid-19

#2. Tufts Medicine transferred 4M patient records to EHR and migrated 42 apps in 14 months by modernizing its legacy healthcare system

Tufts Medicine, a primary healthcare system in Massachusetts, recognized the need to modernize its outdated healthcare solution and technology infrastructure to serve its patients and providers better. The organization’s portfolio comprised over 800 applications, with duplicative systems and independent IT departments across its hospitals, hindering efficient patient care and operational performance.

Challenges

Tufts Medicine’s legacy on-premises systems created technical debt and limited the organization’s ability to adapt to the evolving digital health landscape. The complex IT environment made it challenging to implement a unified electronic health record (EHR) system and integrate critical third-party applications. The time-consuming hardware procurement and deployment process also delayed the organization’s digital transformation goals.

Solutions

To address these challenges, Tufts Medicine migrated its entire EHR environment, including production systems, disaster recovery, and training, to AWS. Working with AWS Professional Services, Tufts Medicine deployed its new EHR system and migrated 42 business-critical applications to the cloud in 14 months. By leveraging AWS CloudFormation to model and provision resources as code, the organization could spin up environments in less than 6 minutes, significantly accelerating the deployment process. Tufts Medicine also implemented AWS Control Tower to automate security and monitoring and Amazon CloudWatch to collect and visualize real-time data, improving operational efficiency and safety.

Key Results

• Migrated 42 applications in 14 months
• 4 million patient records transferred to initialize EHR in the cloud
• Improved patient experience, system response, and workflow consistency
• Achieved significant cost savings

While healthcare organizations have demonstrated the benefits of modernizing their IT systems, the journey to modernization has its challenges.

Modernizing healthcare systems is a complex undertaking that involves a wide range of stakeholders, including healthcare providers, patients, payers, and government agencies. The process of modernization requires significant changes to existing infrastructure, processes, and mindsets, which can present the following challenges.

#1. Integrating new technologies with existing systems

One of the primary challenges in modernizing legacy systems is the integration of new technologies with existing systems. Legacy systems often rely on outdated architectures and programming languages, making it challenging to integrate them with modern software and hardware solutions seamlessly. This compatibility issue can lead to interoperability problems, data silos, and inefficient workflows, ultimately hindering the desired benefits of modernization.

#2. Data migration and integrity

Healthcare firms possess a wealth of patient data accumulated over years of operation. Migrating this vast amount of data from legacy systems to new platforms poses a significant challenge. Ensuring data accuracy, completeness, and integrity during the migration is crucial, as any errors or data loss could compromise patient care and potentially lead to legal liabilities.

#3. Regulatory compliance and data security

The healthcare industry in the United States is subject to stringent regulations and data privacy laws, such as the HIPAA (Health Insurance Portability and Accountability Act). Modernizing legacy systems necessitates compliance with these regulations, from data migration to system implementation and ongoing maintenance. Failure to adhere to regulatory requirements can result in severe financial penalties and reputational damage.

#4. Change management and user adoption

Introducing new systems and processes requires more support from healthcare professionals accustomed to established workflows. Change management and user adoption are critical challenges that require practical training, communication, and stakeholder engagement. Healthcare organizations must invest in comprehensive training programs and ensure end-users are comfortable and proficient with them.

#5. Cost and resource constraints

Modernizing legacy systems is a resource-intensive endeavor, both in terms of financial investment and human capital. Healthcare organizations often operate under tight budgets and may struggle to allocate sufficient funds for system upgrades, infrastructure improvements, and staff training. Additionally, securing skilled IT professionals with expertise in legacy systems and modern technologies can be challenging, further exacerbating resource constraints.

#6. Business continuity and downtime management

Healthcare operations are time-sensitive and critical, making system downtime a significant risk. During the modernization process, healthcare organizations must ensure business continuity by carefully planning and executing system transitions, minimizing disruptions to patient care, and implementing robust backup and disaster recovery strategies.

#7. Legacy system documentation and knowledge transfer

Legacy systems often lack comprehensive documentation, and the knowledge of their intricacies may reside with a few individuals nearing retirement. Capturing and transferring this institutional knowledge to the modernization teams is a complex challenge that requires proactive knowledge management strategies.

Modernizing legacy healthcare systems is a complex task. It demands expertise to navigate the intricacies of outdated infrastructures, especially with stringent regulations like HIPAA.

As an AWS Healthcare Competency partner and AWS Premier Consulting Partner, Simform becomes your go-to solution for modernizing legacy healthcare systems.

Here’s what Simform’s healthcare IT system modernization comprises:

• Conduct comprehensive assessment of legacy healthcare systems
• Identify critical pain points and inefficiencies
• Develop a tailored cloud migration strategy
• Implement scalable and secure AWS cloud infrastructure
• Integrate advanced healthcare analytics and AI solutions
• Ensure compliance with healthcare regulations
• Migrate legacy data to modern data lakes or warehouses
• Enhance interoperability between disparate systems
• Implement robust disaster recovery and data backup solutions
• Train healthcare staff on new systems and processes
• Continuously monitor and optimize system performance
• Provide ongoing support and maintenance services
• Enable seamless patient data access and exchange
• Implement telehealth and remote patient monitoring capabilities
• Improve patient engagement through mobile apps and portals

Partner with Simform today to embark on your journey towards modernizing your legacy healthcare systems.