The prevalence of obsolete legacy applications in the NHS

Jamie Clifton of Bridgehead Software discusses the prevalence of legacy applications within the health service and what can be done

Legacy systems are causing problems for NHS trusts

Healthcare organisations are running up to 500 legacy applications behind the scenes, despite their strategy for the Electronic Patient Record (EPR) to be the primary method of accessing clinical content. Although there are significant risks and costs associated with maintaining these legacy applications, worryingly this practice seems to be commonplace across the NHS. Here, Jamie Clifton, vice president of product management and solutions at BridgeHead Software, explores the issue.

It’s not all about cost!

From conversations with our customers, we know that healthcare organisations are running up to 500 legacy applications behind the scenes.

As healthcare leaders set out their Sustainability and Transformation Plans (STPs) to address huge cuts to funding, identifying areas for cost savings while striving to maintain or improve standards in patient care are the primary objectives.

At BridgeHead we believe there’s a great deal more to be gained by retiring legacy applications than how it affects the bottom line.

Preservation of patient data

In order to address the current status quo, we need to first understand what value these obsolete applications have to the various stakeholders within hospitals (finance, IT, CCIOs, clinicians, information managers, compliance/governance officers etc.) and why these systems still persist in a modern hospital.

We believe there’s a great deal more to be gained by retiring legacy applications than how it affects the bottom line

According to our online survey: How Do You Manage Legacy Systems? , 90% of hospitals keep old applications running to preserve data when an application is replaced or retired. In addition, 8% admitted they never migrate data to a new application; and 8% never extract the data into an archive. One respondent admitted that they ‘lose the old data in some cases’.

Because legacy applications are typically run in silos, dispersed across the hospital, they are incredibly difficult to manage. In terms of storing and accessing clinical content, running multiple obsolete applications is inefficient and costly. So why is it accepted practice?

Patient information is the top priority

Our survey highlights that the main reason for not simply discarding old data is because it contains relevant patient information, with 90% of hospitals identifying this as a consideration.

In order to address the current status quo, we need to understand what value these obsolete applications have to the various stakeholders within hospitals and why they still persist in a modern hospital

This was closely followed by regulations and compliance, with 88% of those surveyed citing this as a factor in data retention.

Interestingly, almost a quarter of hospitals admitted to uncertainty or simply ‘playing it safe’ when it came to preserving old data, raising some doubt over their motives and awareness of alternatives.

Generally, the rationale for preserving data and the pain points regarding the current method depend largely upon who you speak to within hospitals.

Legacy applications impact clinicians, finance and IT

Most financial directors would be shocked at the total cost of operating, maintaining and supporting legacy applications, from software licences to power and datacentre floor space.

Often, systems are maintained on a department level, which obscures the true cost of legacy applications.

Even after investing substantial sums of money in a new EPR solution, many hospitals continue to keep their old system running to maintain data that cannot be migrated, typically records over five years old. The costs of running both systems are significant.

And then there are staffing costs to consider. Analysts estimate that healthcare IT professionals spend up to 75% of their time managing legacy applications, which would provide ample justification to explore viable alternatives.

Because legacy applications are typically run in silos, dispersed across the hospital, they are incredibly difficult to manage

In addition to the huge drain on resources, the IT department should be concerned with security risks associated with running legacy applications.

With cyber and ransomware attacks regularly hitting the headlines, prevention has to be a core consideration, alongside a robust and tested disaster recovery strategy.

Given that older technologies, whether hardware or software, are more prone to security loopholes as well as failures, outages and/or corruptions, failing to retire legacy applications unnecessarily compromises the data contained within.

Naturally, clinicians are concerned with ease of access and use of patient data to make more-informed decisions. One respondent to our survey told us that ‘historic data helps in running data analysis algorithms for better decision making…and indicates trends’. Another told us that ‘when used in anonymity (the data) can be helpful in predictive analysis’.

By unlocking data that resides in legacy applications, and making it available as part of the EPR, clinicians gain access to a 360-degree view of current and historic information to improve patient encounters, whether consultation, diagnosis and/or treatment.

Ultimately, improving clinical service and having a positive impact on patient outcomes is the overarching mission of healthcare organisations.

Time to challenge the status quo

The drivers for retiring legacy applications are overwhelming, so why are hospitals seemingly slow or reluctant to act?

Clinicians acknowledge that they can’t rely too heavily on the data presented from legacy applications to be correct, up to date, and integrated. But, it shouldn’t and doesn’t have to be like this in today’s hospitals. We encourage everyone, whatever their role, to challenge the status quo

Many healthcare professionals are simply not making the connection and wrongly believe that there is no easy way to extract data from legacy applications to make it available to those that need it, when they need it.

The costs associated with legacy applications are nothing more than unchallenged line items in the IT budget for the finance department.

Legacy application maintenance is a headache for the IT department, but is seen as part of the job.

Clinicians acknowledge that they can’t rely too heavily on the data presented from legacy applications to be correct, up to date, and integrated. But, it shouldn’t and doesn’t have to be like this in today’s hospitals. We encourage everyone, whatever their role, to challenge the status quo.

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