Out with the old and in with the new? 5 thoughts on health IT legacy systems

Each day in health IT brings new technology. With such rapid change, when does technology become outdated and become a legacy system?

Vess Bakalov, co-founder and CTO of Boston-based digital infrastructure management company SevOne, offers five thoughts on the state of legacy systems in health IT.

Question: How would you define the term "legacy system?"

Vess Bakalov: "Legacy system" means a lot of things to different people. Generally speaking, it means outdated. Twenty years ago many health IT systems were built for individual customers, but these became hard and expensive to maintain. These systems are also difficult to integrate with any others. There is no economy of scale.

Q: Why do healthcare providers often rely on these older systems?

VB: These types of systems are custom-built. They fit particular workflows really well. Switching away from something you have sunk so much capital and training into is a big deal. Hospitals and health systems have staffs of thousands, and you have to retain them. The cost could be $1,000 per person in addition to the software switch. There are also productivity costs. An upgrade could cost less than swallowing the bitter pill of making the switch.

Q: How does the continued use of a legacy system affect a hospital's business operations?

VB: At the end of the day, it means additional planning. In this day and age, regulations and new workflows come up. For example, pharmacy has to be digitally managed in many cases. With a legacy system, you would have to make a custom module and plug it in. It costs more in the long run.

Q: Why does digital infrastructure matter more today than five or 10 years ago?

VB: Digital infrastructure is now the nerve center of healthcare. Thirteen years ago, I was working as an intern making one of the first digital X-ray systems. It seemed like science fiction then. The film was developed in a second. That was a big deal then. Hospitals had to upgrade their networks to make sure digital images would work.

Things continue to be driven this way as we go to a paperless environment. There are hardly any paper records. We are relying on electronic records for everything we do. Waiting even a second grinds down productivity. We have to make sure systems are not just up, but running quickly.

Q: How can healthcare providers evaluate their digital infrastructure to determine whether updates need to be made?

VB: I think of the quote "Physician, heal thyself." We need to know what health IT we have and have a frank discussion of its performance and the current system's baseline. You need to know where systems are performing today to know what to improve. We need to know every aspect of digital infrastructure, data centers, servers, etc., to know enough and be open enough to integrate a new method.

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