In 2021, Ireland’s Health Service Executive (HSE) fell victim to a Conti ransomware attack. It began with a phishing email that exploited a known vulnerability in Microsoft Exchange Server. According to The Guardian, the fallout was immediate; IT systems across 54 hospitals went down.
It may have been the first time an entire national healthcare system was taken offline by ransomware. Staff had to return to pen and paper. Outdated software, some machines were still running Windows XP, making recovery slower and more difficult. Modernization is not only a desirable option, but it also safeguards against potential threats that can arise from outdated systems.
Legacy Healthcare Systems
Legacy software or systems in healthcare refer to outdated software or hardware that doesn’t support modern requirements. They may be developed using old programming languages and technologies. Even though they are prone to security vulnerabilities, these software or services continue to be used due to high replacement costs and are deeply integrated into critical processes.
- Built on obsolete platforms with limited vendor support.
- Incompatible with modern platforms and technologies.
- High maintenance cost In healthcare, traditional Electronic Health Record (EHR) systems are examples of legacy systems. They are typically used for scheduling, patient tracking, resource allocation, or even as billing platforms, such as McKesson’s older billing software.
Why Modernizing Healthcare Systems is Crucial
One of the main reasons companies modernize legacy systems is to improve security. In many cases, these systems are expensive to maintain. And because they’re so deeply embedded in the business, replacing them isn’t an easy decision for business owners.
However, legacy systems have a direct impact on security, cost, and the ability to innovate.
According to Gartner, 40 to 80% of the IT budget often goes into maintaining them. Experts also point out that inefficiencies and the growing difficulty of finding specialized talent to maintain these systems are driving up costs.
In healthcare, especially, maintaining data security and compliance is essential. Modernization helps boost operational efficiency and productivity.
Benefits of Modernization
- Better Outcomes: Real-time data access enables faster, more accurate diagnoses.
- Improved Efficiency: Streamlined workflows reduce administrative burdens and staff burnout.
- Regulatory Compliance: Modern systems align with HIPAA, HITECH, and the 21st Century Cures Act.
- Competitive Edge: Advanced systems attract tech-savvy patients and providers.
Common Challenges in Legacy Healthcare Systems
Most businesses link their security gaps to these legacy systems. At the same time, it’s not easy to make them work with modern technologies. And as we mentioned earlier, maintaining them can often be more expensive than adopting new solutions. Let’s take a look at some of the key challenges involved.
1. Security Gaps
Outdated encryption protocols like SSL are no longer considered secure by modern standards. Systems that still rely on them can be potentially vulnerable to cyberattacks. On top of that, maintaining less secure platforms can be more expensive.
When security protocols are outdated, it also becomes more challenging to meet compliance requirements, such as HIPAA or other regulations. This creates roadblocks for innovation and slows down progress.
2. Integration Complexity
Connecting legacy systems with newer cloud technologies and frameworks isn’t straightforward. Many older EHRs, for example, don’t support modern standards like HL7 FHIR. Because of that, their ability to work smoothly with cloud platforms or IoT-based medical devices is limited. It creates friction where there should be flexibility.
3. High Maintenance Costs
Systems running on outdated technologies like COBOL are hard to maintain today, mainly because there are fewer professionals who still work with them. Hiring those specialists often costs more than hiring engineers for modern tech stacks.
“Most of the clients we've worked with on modernization projects came in mainly because of rising maintenance costs of legacy infrastructure,” said the CTO at Brilworks.
4. Limited Performance
Legacy systems often have slow processing speeds and limited scalability, and do not support many concurrent users. To consider an example, an old hospital management system may take several minutes to get and process a patient's history.
When to Maintain vs. When to Modernize
Experts agree that many modernization projects don’t happen simply because business owners feel it’s easier to keep running what already works. And they’re not entirely wrong.
Sometimes, it turns out to be more expensive than sticking with the current system. That’s why it’s important for decision-makers to understand when it actually makes sense to modernize. Let’s look at when modernization might not be the right move and when it is.
Maintain When:
- The system meets current needs with minimal customization.
- Regulatory compliance can be achieved with minor updates.
- Budget constraints prevent immediate modernization.
The system supports critical operations with no viable replacement.
Modernize When:Security vulnerabilities threaten patient data or HIPAA compliance.
Integration with modern technologies (e.g., telehealth, AI analytics) is impossible.
Maintenance costs exceed the cost of modernization over 3-5 years.
Performance issues significantly impact patient care or staff efficiency.
A Framework for Legacy Healthcare Modernization
Modernization can mean anything from minimal updates to doing a complete infrastructure overhaul. There’s no single way to do it; there are several approaches. We’ll quickly go over some of the popular approaches to give you a clear idea of how modernization can look in different situations.
1. Encapsulation
Encapsulation is wrapping legacy systems with modern interfaces without altering the core system. For example, a hospital might use an API layer to connect an old EHR to a new patient portal. This approach is cost-effective but limited by the underlying system’s constraints.
- Use Case: Connecting a legacy EHR to a telehealth platform.
- Benefits: Quick implementation, low cost.
- Limitations: Doesn’t address underlying performance or security issues. 2. Rehosting Rehosting, or "lift and shift," is moving legacy systems, without changing or redeveloping the code, to a modern infrastructure (e.g., cloud).
Rehosting is best when an organization needs immediate scalability without needing to redevelop everything from scratch or figure out its code entanglement. For example, moving the billing system to AWS boosts uptime and helps save on onboarding hardware costs.
- Use Case: Migrating a hospital management system to the cloud.
- Benefits: Scale and reduce infrastructure costs.
- Limitations: This option is not going to redevelop your outdated code or fix integration issues. 3. Refactoring Refactoring is when you change the structure of the existing code base to improve performance without changing functionality. Refactoring is appropriate when an application has good core functionality but is underperforming.
For example, refactoring a legacy EHR to modern APIs to improve interoperability.
- Use Case: Refactoring an EHR to improve speed in data retrieval.
- Benefits: Balances performance gains at a reasonable cost.in
Limitations: High level of development skill required, and may not correct design flaws due to poor architecture.
4. Rearchitecting
Rearchitecting changes the architecture of the system, often by way of microservices or API-first designs. This is appropriate for healthcare systems that need to be scalable and also be interoperable. For example, rearchitecting a billing system into microservices allows more integration with a variety of insurance platforms.Use Case: Redesigning a hospital management system to be cloud-native.
Advantages: Scalability, flexibility, and integration abilities.
Disadvantages: Cost and complexity.
5. Replacing
Replacement includes commercial off-the-shelf (COTS) approaches or systems developed from scratch. This option is best suited for systems that are entirely obsolete. For example, replacing an old EHR with Epic or Cerner will ensure functionality and compliance in a modern manner.Use Case: Replacing an old billing system with a COTS solution.
Pros: Fully comply with modern standards.
Cons: Up-front expenses, and you may need to migrate data.
6. Rebuilding
Rebuilding is defined as redeveloping the system "from the ground up." It is used when you have no other options. An example of this might be a hospital rebuilding a custom clinical decision support system because it wants to include AI analytics within the software application.Use case: building a new patient portal with added functionality.
Benefits: customized function, future-proofing design.
Limitations: a major investment of time and money.
Step-by-Step Plan for an Effective Upgrade
When running a healthcare organization with legacy or legacy-integrated systems, it is critical to take a structured approach to the modernization process to reduce downtime and create a successful path toward modernization.
*1. Understand Your Current Systems *
Identify all of your legacy systems; document dependencies, workflows, and pain points. Define your modernization objectives to ensure they align with the organization's higher priorities (e.g., improving patient outcomes or reducing costs).
2. Identify Requirements
Work with your clinical staff, IT team, administrative staff, and patients to elicit requirements; for example, while clinicians may want to see real-time data, administrators may push for cost savings.
3. Plan for Migration
Understanding where legacy data will go and migrating that data to the new or modernized system in a clean and validated way is key. For example, FHIR compliance mapping for patient records is important for ensuring interoperability. Ensure you maintain data integrity through proper testing and validation.
4. Implement Incrementally
Take an incremental approach to your implementation and deployment schedules to avoid disruption. For example, deploy the new patient portal before you replace the entire EHR. The implementation schedule should reflect goals, priorities, and what is likely to have the best impact.
5. Test and Validate
Plan to incorporate Alpha, Beta, and User Acceptance testing and validation in your project plan. Involve your clinical staff in user acceptance testing to demonstrate that the new system meets their actual needs.
6. Launch and Monitor
Go live at the best time for your organization, i.e., during your slowest volume times. Full personnel training of the new system is critical to reducing subsequent frustration with end-users. Consider running systems in parallel for some time after going live. Measure success by metrics such as uptime, adoption, and patient satisfaction after going live and for the foreseeable future.
Assuring Interoperability and Compliance
Interoperability and compliance are essential components of healthcare IT modernization. The key interoperability standards, as well as the compliance requirements, include the following:
Interoperability Standards:
- HL7: Enables structured exchange of data between health IT systems.
- FHIR: Supports more current industry data sharing using APIs for electronic health records (EHR) and applications.
DICOM: Used for exchanging medical imaging data.
Regulatory Compliance Requirements:HIPAA: Protects patient data privacy and security.
HITECH: Increases enforcement of HIPAA regulations and incentivizes health IT adoption.
21st Century Cures Act: Provides an "interoperability" specification and mandates that patients have access to their data.
Therefore, any modernization effort must incorporate these standards to facilitate interoperability and to comply with regulations.
AI Applications in Healthcare
- Predictive Analytics: Forecasts patient outcomes, reducing readmissions.
- Natural Language Processing (NLP): Automates clinical documentation, saving clinicians time.
- Administrative Automation: Streamlines billing and scheduling, reducing costs.
Speed Up Your Modernization Process
Brilworks, an acclaimed AWS consulting company, specializes in generative AI development and product engineering, allowing healthcare organizations to modernize legacy systems effectively. With plenty of experience in healthcare IT, we are geared towards offering customized solutions based on the needs of the healthcare organization while still being focused on interoperability, compliance, and patient outcomes.
Brilworks works with the popular cloud architecture to ease the transition of a healthcare organization with minimal disruption. If you are interested in starting your modernization process and seeing how Brilworks can support your journey, reach out to our team for a consultation.
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