Legacy Systems in Healthcare: Main Steps & Challenges

Eugene Makieiev, BDM
Legacy Systems in Healthcare: Main Steps & Challenges

Legacy healthcare systems pose a range of challenges to medical organizations and their patients. For example, outdated technology hampers compatibility, limited interoperability hinders efficient information exchange, and operational inefficiencies impact productivity. At the same time, security vulnerabilities risk patient data, leading to longer lengths of stay, higher mortality rates, and delays in procedures and tests. High maintenance costs strain budgets, requiring skilled professionals and specialized hardware.

We understand that you may be wary of radical system updates. However, with a competent approach, modernizing healthcare systems brings many benefits. You can expect advanced productivity with streamlined workflows and enhanced security measures. That means you will protect patient data from cyber threats and ensure compliance with evolving standards. Additionally, the upfront investment leads to long-term cost savings through reduced maintenance expenses and optimized resource utilization.

Today, we will discuss the main types of outdated medical IT systems and potential challenges. You will also learn about modernization strategies and the stages of their implementation.

Why Do Healthcare Organizations Avoid Upgrading Legacy Systems?

Here are some key reasons why healthcare organizations may avoid upgrading their legacy systems:

  • Healthcare is an industry where patient safety and data security are paramount. Any disruption caused by system upgrades can impact patient care. Organizations may be reluctant to take on the risks, especially if the existing platforms are stable and secure.

  • Many healthcare organizations need more resources, both in terms of finances and skilled personnel. Upgrading a medical legacy system often requires a significant investment of time, money, and expertise. Small to mid-sized healthcare facilities do not have the required expertise or budget to undertake complex software improvements.

  • Legacy systems are often deeply integrated into the existing healthcare infrastructure. Upgrading these systems may require addressing interoperability challenges with other systems like electronic health records (EHR) or hospital information systems (HIS).

  • Healthcare organizations must adhere to strict regulatory standards and compliance requirements. Upgrading software necessitates ensuring that the new technology aligns with these regulations.

  • Over time, healthcare organizations may have customized their legacy systems to suit their specific needs and workflows. Specialists may fear losing such configuration during an upgrade, along with the potential for the new system not meeting specialized requirements.

  • Healthcare professionals are accustomed to using specific systems in their daily routines. Resistance to change among the staff can be a serious barrier.

  • Some systems are closely tied to medical devices with long lifecycles. Their upgrading may also require replacing compatible medical devices, which could be costly and logistically challenging.

  • If a legacy medical system is still stable, performs its core functions effectively, and has been reliable over the years, organizations may see no reason to invest in an upgrade. The "if it's not broken, don't fix it" mindset prevails in such cases.

Addressing these challenges requires a careful balance between innovation and the necessity to maintain continuity and stability in healthcare operations.

How Widespread is the Issue of Legacy Software in Medical Practices?

The consistent utilization of inefficient or flawed legacy health systems poses a remarkably urgent issue within medical organizations.

For example, 40% of NHS hospitals in England use outdated clinical equipment, with some over a decade old items. Based on freedom of information requests to 69 NHS trusts, the study revealed that 541 medical devices, including X-ray and radiotherapy machines and CT and MRI scanners, were more than ten years old. Among the trusts, 41 had X-ray machines over 20 years old, with the oldest being 37 years old.

The NHS Confederation's CEO, Matthew Taylor, requested increased government funding to address the £10.2 billion maintenance backlog. Over the past three years, the NHS spent nearly £20 million maintaining old equipment.

When it comes to legacy software systems in healthcare, remember this: not modernizing them can cause more problems than benefits. It's smarter to go for a long-term strategy to upgrade them and stick to a maintenance schedule for healthcare apps and IT environments.

It is pleasing that more and more companies are turning to modern healthcare solutions. As a result, the healthcare IT market, valued at $200 billion in 2022, is projected to reach $1,069 billion by 2032, with an anticipated CAGR of 18.30%.

Main Types of Healthcare IT Systems

Healthcare IT systems encompass various software solutions used to support different functions. Some common types include:

1. Electronic Health Record (EHR) Systems

EHR systems store patients' complete health records, including medical history, diagnoses, medications, treatment plans, immunizations, allergies, radiology images, and lab test results.

Early EHR systems focused on basic patient records, lacking advanced functionalities like decision support and patient portals, and convenient interfaces. Modern EHRs integrate advanced features, ensure interoperability for seamless data exchange, and provide user-friendly interfaces.

Examples: Epic Systems, Oracle Cerner, Meditech

2. Hospital Information Systems (HIS)

HIS is an integrated information management system that handles administrative, financial, and clinical aspects of hospital operations. It encompasses patient data, resource management, billing, and other critical functions.

Legacy HIS may face challenges in interoperability and real-time data access. Upgraded HIS solutions address these issues and incorporate modern reporting functionalities.

Examples: Orion Health, MyNapier, Meierhofer

3. Laboratory Information Systems (LIS)

LIS manages and organizes laboratory data, including sample tracking, workflow automation, and test result documentation. It ensures efficiency in laboratory operations and data management.

By handling laboratory data, legacy LIS encounters issues with its standardization and integration with modern diagnostic technology. Modern LIS systems deal with these complications, enhancing workflow efficiency.

Examples: CGM LabDaq, LigoLab, Dendi

4. Picture Archiving and Communication Systems (PACS)

PACS is a medical imaging technology that stores, retrieves, manages, and presents images produced by various medical imaging modalities. It facilitates their digital storage and distribution.

Older PACS systems may struggle with compatibility and integration with modern imaging technologies. Upgraded PACS ensure improved integration capabilities and efficient storage/retrieval.

Examples: Paxera Health, Intelerad, INFINITT

5. Radiology Information Systems (RIS)

RIS is a specialized software system used in radiology departments to manage related imaging workflows, appointment scheduling, billing, and reporting.

Legacy RIS monitors radiological workflows but may lack features like automatic scheduling and face integration issues. New RIS includes such capabilities, ensuring scalability and improving overall outcomes.

Examples: Magentus, Centricity, eRAD

6. Claims Processing Systems

Claims processing systems manage the billing and reimbursement procedures between healthcare providers and payers, ensuring accurate and timely claim processing.

Complexities arise from modern billing rules and regulatory landscapes that outdated systems can't handle. Upgraded claims processing systems adapt to the latest rules, ensure compliance with regulatory changes, and streamline billing procedures.

Examples: HEALTHsuite Advantage, TriZetto Facets, Optum360

7. Patient Engagement Systems

Patient engagement systems include interactive platforms, educational resources, and communication channels to enhance patient participation and collaboration in health management.

Early systems may lack good UI/UX and interactive tools. Enhanced platforms focus on convenient, user-friendly interfaces, enhanced features, and improved patient engagement. They often utilize artificial intelligence and machine learning algorithms to personalize interactions, provide tailored health information, and adapt to individual patient needs and preferences.

Examples: MyChart, NexHealth, SONIFI Health

6 Challenges of Legacy Systems in Healthcare

Healthcare frequently grapples with challenges posed by legacy systems, hindering their optimal functioning and adaptability. We've prepared a list of common issues and strategic solutions to resolve them.

1. Outdated Tech Stack

To initiate transformative changes, developers need to understand the specific tech frameworks on which the existing solutions have been originally constructed. However, newer generations of coders are more versed in contemporary tools and languages. This creates a shortage of professionals with expertise in older tech stacks.

To overcome this challenge, prioritize training programs for developers to bridge the knowledge gap between legacy and modern technologies. Encourage collaboration and mentorship, invest in documentation, and plan migration on more modern stacks.

2. Interoperability

One major challenge faced by outdated healthcare systems is interoperability, the seamless exchange of data between different systems and applications. Its absence impacts the efficiency of healthcare operations and patient care.

To tackle this, you can use standardized data formats like FHIR, providing a common vocabulary for consistent communication between disparate systems. Middleware solutions bridge software applications, enhancing legacy systems' communication with modern technologies and fostering a fluid data flow. Resolving interoperability issues establishes a networked healthcare environment, improving collaboration, patient care, and workflows.

3. Outdated User Interface

Many healthcare user interfaces lack modern design and functionality. It inhibits the overall user experience and hinders operational effectiveness within healthcare settings.

Introducing user-friendly interfaces becomes imperative for improving how healthcare workers (and patients) navigate and interact with the system. At the same time, medicians need to be proficient in utilizing and navigating the new interfaces. Consider training initiatives to ensure a seamless transition to updated interfaces — and healthcare experts will adapt quickly and work more productively.

4. Security Concerns

According to Check Point Research, in 2022, healthcare organizations globally faced an average of 1,463 cyberattacks per week, up 74% compared to 2021. The vulnerability of outdated systems necessitates a proactive approach to safeguard sensitive information from unauthorized access and potential cyber threats.

Key components of a comprehensive cybersecurity strategy include intrusion detection systems, routine audits, and encryption. A strategic option to mitigate security concerns is transitioning to more contemporary platforms equipped with advanced safety features.

5. Patient Engagement

Legacy systems often impose limitations on patient engagement, hindering proactive involvement in their healthcare journey. Overcoming these limitations requires a modernization strategy that integrates advanced technologies.

Proactive legacy system modernization in healthcare involves implementing integrated patient portals, mobile applications, and communication tools. These enhancements provide diversified options for patient interaction, facilitating a more accessible and involved patient community. Additionally, personalized health records are crucial in increasing patient participation by delivering easily accessible and customized health information.

6. Data Silos

Common in older healthcare systems, data silos present a challenge to achieving a comprehensive and integrated patient care strategy. These silos hinder a unified view of patient information, impeding seamless collaboration and decision-making across different healthcare entities.

By integrating systems, you can dismantle information silos, offering a uniform and cohesive view of patient data. Adherence to interoperability standards and the adoption of data exchange protocols are essential steps in breaking down silos and fostering collaboration among all parties.

Key Healthcare Legacy System Modernization Strategies in 2024

Each modernization strategy has its own considerations, advantages, and challenges. Let's overview them in detail:


This strategy entails isolating and encapsulating deeper application components like medical databases. Then, you wrap these parts with newer interfaces and functionalities through APIs and other software engineering methods.

Encapsulation enables seamless integration of older and newer system components. It allows for preserving critical functionalities while modernizing the user interface and interoperability. However, the strategy can lead to increased intricacy in system architecture and maintenance.


Rehosting involves redeploying a legacy healthcare application to another platform or infrastructure without significantly revising its code sources, features, and capabilities. This can include moving to physical hardware, virtual settings, or cloud technology.

Rehosting offers a relatively quick and cost-effective solution, especially when maintaining the existing functionality is a priority. However, it may not address underlying issues in the legacy system's code or architecture, potentially limiting long-term scalability and optimization opportunities.


Refactoring is all about enhancing and optimizing the current code of a legacy system to eliminate technical issues, loopholes, and inefficiencies. It is often applied to open-source or custom software solutions and can be performed by the original vendors or third-party dedicated developers.

Refactoring improves the efficiency and maintainability of the software, making it more adaptable to current technologies. However, its success relies on the availability of proper software documentation.


Rebuilding involves rewriting the sources of a legacy application from scratch while preserving the product scope and key specifications. This often includes implementing newer programming languages, faster processing engines, and more flexible platforms.

Rebuilding allows for leveraging modern technologies and platforms while retaining the essential features and functionality of the legacy software. At the same time, it leads to extended development timelines and costs.


This strategy retires obsolete healthcare applications entirely and replaces them with newer software. This can involve either full-cycle development of a new application or adopting a ready-made solution.

It provides an opportunity for a fresh start with the latest technologies so organizations can choose solutions that better align with current needs and industry trends. However, replacing requires careful consideration in selecting an appropriate alternative and ensuring a smooth data migration process.

The 9 Major Steps to Upgrade Healthcare Legacy System

Upgrading healthcare legacy systems involves several strategic steps to ensure a smooth transition and alignment with current industry standards:

1. Evaluation and Record-Keeping

In this initial stage, healthcare organizations comprehensively evaluate their legacy systems, examining reliability, functionality, and data structures. The goal is to create a detailed record of the legacy systems' current state, taking into account specifications and integration objectives. Also, it's crucial to emphasize security and scalability considerations.

2. Specify Integration Goals

Articulate precise integration goals, whether it's to enhance data flow, introduce new functionalities, or ensure compliance with cutting-edge technologies. This stage involves aligning integration objectives with broader organizational goals within the healthcare sector. This way, you ensure that the modernization strategy contributes effectively to overall business success.

3. Choose an Integration Method

After evaluating requirements and existing infrastructure, it’s important to select an integration strategy. This may involve data migration, API implementation, middleware adoption, or a strategic combination of these methods. The focus is on choosing an approach that ensures long-term sustainability and scalability, aligning with the company's evolving needs.

4. Integration of Middleware

When middleware is part of the chosen strategy, focus on configuring it to facilitate seamless communication between contemporary and legacy healthcare applications. The goal is to ensure smooth data transport and interoperability, laying the foundation for effective integration across different medical system components.

5. API Integration

In this stage, specialists implement APIs compatible with both contemporary and legacy applications. Establish robust authorization and authentication procedures to safeguard data during the integration process. API integration enhances interoperability, allowing efficient communication and data exchange within the incorporated healthcare system.

6. Data Migration

The data migration involves meticulous planning and execution, ensuring a smooth transition from old legacy systems to the upgraded healthcare environment. Organizations verify the consistency and accuracy of the migrated data, addressing any potential challenges to ensure a successful consolidation process.

7. Testing

Thorough testing validates the functionality of the integrated healthcare systems. This includes user acceptability, integration, and unit testing to identify and rectify any bugs or glitches. Ensure that the integrated systems perform as intended, providing a reliable and efficient platform for healthcare operations.

8. Implementation

Here, healthcare organizations adopt a phased and gradual approach to integration to minimize disruptions to routine operations. Continuous monitoring of the process allows for promptly resolving any challenges that may arise. This ensures a smooth and successful implementation of the upgraded healthcare system.

9. Monitoring and Optimization

After implementation, you should employ monitoring tools to track user feedback and system performance. Prioritize continuous optimization of the integrated platforms to adapt to changing business requirements and enhance user experiences.

Upgrade You Legacy Healthcare System with Integrio

Healthcare applications can significantly enhance patient care, but their effectiveness relies on how well they integrate with the foundational legacy systems in healthcare. Despite challenges, modernizing these legacy IT systems brings numerous advantages. The future of healthcare demands a balance between legacy systems and modern apps to improve patient outcomes and overall system effectiveness.

Integrio has extensive experience in the development and upgrading of healthcare solutions. We use artificial intelligence and other advanced technologies to unlock new opportunities. Our modernization solutions focus on smoothly integrating advanced technologies with legacy systems. This results in improved data accessibility, faster processes, increased patient interaction, and strengthened compliance and security measures.

Through our healthcare software development services, we pave the way for a future-ready medical ecosystem powered by artificial intelligence and machine learning. Here, legacy systems seamlessly connect with cutting-edge applications, fostering continuous improvement in patient care and operational excellence.

Ready to upgrade your legacy medical systems? Contact our experts


Healthcare continues to use legacy systems due to the industry's conservative nature, where reliability often takes precedence over experimentation with new technologies. Limited IT resources and the deep integration of legacy systems within organizational workflows make the transition to modern solutions complex and potentially disruptive. Additionally, certain medical functionalities, such as patient data management, do not require frequent updates. As a result, healthcare organizations prioritize stability over the immediate adoption of top-notch technologies.

Before moving forward with legacy systems, it is crucial to assess the system's reliability, functionality, and integration within existing workflows. Consider the potential impact on critical medical functionalities, ensuring the transition does not compromise patient care. Additionally, evaluate the availability of skilled IT professionals for managing the upgrade and assessing the cost implications. If you lack such experts, contact Integrio for assistance.

The cost of upgrading an outdated healthcare system can vary significantly based on the scale of the system, the extent of modernization needed, and the chosen modernization strategy. Small-scale or incremental improvements may cost less than a comprehensive overhaul or replacement of the entire system. Contact Integrio to discuss your specific requirements and the complexities of the upgrade process — and we will provide you with accurate calculations.

A modernized healthcare legacy system offers enhanced interoperability, allowing seamless data exchange between different components of the medical ecosystem. Improved user interfaces and experiences contribute to better operational efficiency and engagement from healthcare professionals. Furthermore, modernized systems often provide robust security features, safeguarding patient data against potential cyber threats and ensuring compliance with evolving regulatory standards.


Legacy Systems in Healthcare: Main Steps & ChallengesWhy Do Healthcare Organizations Avoid Upgrading Legacy Systems?How Widespread is the Issue of Legacy Software in Medical Practices?Main Types of Healthcare IT Systems6 Challenges of Legacy Systems in HealthcareKey Healthcare Legacy System Modernization Strategies in 2024The 9 Major Steps to Upgrade Healthcare Legacy SystemUpgrade You Legacy Healthcare System with IntegrioFAQ

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