Legacy software continues to be a challenge for hospitals and health systems. Mergers, acquisitions, evolving service standards, software obsolescence, and new technology acquisitions all create outmoded software that must be dealt with.
Beyond the costs to patch and maintain legacy software, there are considerable security risks. A 2021 HIMSS survey of healthcare cybersecurity professionals showed that legacy software was a leading entry point of cyberattacks in 15% of cases, third behind phishing (71%) and human error (19%).
The question becomes what to do with the technology. Data may still be needed by specific departments or users. Likewise, certain data sets must be retained to meet clinical and regulatory reporting requirements.
A strategic data archiving program can be the answer as South Carolina-based Prisma Health discovered following a merger. The health system launched an ambitious archival project that’s saving $14 million annually in maintenance and labor costs. What’s more, the archived data remains readily available for users who need it in their regular workflows, says Rich Rogers, senior vice president and CIO at Prisma. “Patient care is at the center of everything we do at Prisma Health,” added Rogers. “Having a robust patient history for our clinicians is critical to delivering the best care possible.”
Outmoded technology continues to challenge
The HIMSS survey shows that 76% of hospitals and health systems have legacy software footprints that comprise up to one-fifth of their technology assets. Additionally, nearly four in 10 respondents say dealing with legacy software is their biggest security challenge.
Another report shows that 60% of connected medical devices are at the end of their useful lives, which also poses security and integration challenges.
Hospitals face constant change as they search for new, better, and more cost-efficient ways to deliver patient care during a time of continued margin pressures. But implementing new technologies also means that other software likely has outlived its utility.
At first, keeping legacy systems around may not be much of a burden. But as time passes and IT staff turns over, institutional knowledge about the system may become lost. Fewer and fewer staff need to access the technology, and the vendor may either raise the price of the annual renewal or cease supporting the software altogether.
Hospitals that take an enterprise approach to their technology stacks recognize the value of archiving to preserve data while reducing connections to outmoded software that can present security risks. With robust and “active” archival systems, users can access legacy data with the same ease with which they access current data, including the ability for billing staff to work down historic accounts receivable.
Enterprise approach helps inform vendor decision
Prisma Health was formed in 2017 by the merger of Palmetto Health and the Greenville Health System. The health system has 18 acute and specialty hospitals, 2,827 licensed beds, 305 practice sites, and more than 5,200 employed and independent clinicians.
Following the merger, executives decided to standardize the system’s EHR to Epic, which meant a migration project from Cerner. That decision touched off an ambitious archiving project to preserve clinical and financial data. So far, the health system has archived more than 60 IT systems and has about five projects in process at any given time, says Brenda Pickens, Director of Integration.
A critical early decision about what vendor to choose centered on how users would access legacy data. Clinicians want to access historic data in one place, with a single login to multiple systems. Another consideration was whether archiving financial systems allowed users to work down aging receivables in the same workflows as current software.
Other considerations included whether the vendor had experience with similarly sized health systems, had specific software experience, and could help to create strategies regarding the right places to store both discrete and static data.
Pickens says the health system is about half-way through archiving, although she quickly adds that new projects are constantly being identified and more medical practices are joining the health system. Priority for archiving is based on the importance of the system, on when legacy contracts are ending, and on the expected server life for on-premise applications.
Rogers estimates the health system saves about $14 million annually in maintenance costs and labor that were being spent to keep legacy systems online. Prisma Health also retained more than $100,000 in historic accounts receivable that continue to be worked.
Beyond savings, user experience is paramount
Although retiring legacy systems can save hospitals money while reducing their cybersecurity threat footprints, the real value for users should be the ability to access legacy data in their accustomed workflows.
Pickens recalls one vocal physician who was concerned about how he would access legacy clinical data. He asked many questions, and her staff answered every one. They also specifically checked to ensure the data he was concerned with was in the archive. During the go-live period, the physician thanked the staff, saying that accessing the legacy data was easier than it had been with the previous EHR. Since then, the integration team hasn’t heard from this physician, ample evidence that Prisma Health is on the right track with its archival efforts.
Amy Glass
Amy Glass is vice president of marketing and communications at MediQuant.
