As NHS organisations embark on procuring new or upgraded electronic patient record (EPR) systems, whether under their own initiative or as part of the central frontline digitisation programme, they will inevitably create legacy systems, each containing a wealth of valuable patient, clinical, or operational data that has often been accumulated over significant time periods.
This can include anything from medical images and scanned documents to clinical reports or patient correspondence – the list is endless.
The question is, though, how will trusts tackle the challenges of storing, protecting, and accessing this information for the long term?
The volume of legacy applications is a growing and ongoing issue in the NHS.
As technology evolves and over time is replaced with more-innovative solutions, a greater number of legacy applications emerge.
The problem with legacy applications is that they carry a significant financial burden in terms of licensing, maintenance, and resources.
And, as they age, they become an increased security threat – opening up organisations to potential cyber attack.
As technology evolves and over time is replaced with more-innovative solutions, a greater number of legacy applications emerge
The information they contain becomes less secure and increasingly difficult to protect. But, most importantly, the data that is stored in older systems, is increasingly difficult to access, which inhibits the ability for clinicians and support staff to use it when making care decisions.
As an example, EPRs typically undergo updates every 10-15 years; PACS applications are refreshed every 5-10 years; LIMS follow a similar timeline of renewal every 5-10 years; and storage hardware changes every 3-5 years.
Consequently, as new applications are procured and implemented, legacy systems are created by default; and these span across clinical, patient, and administrative systems.
The challenges and risks
It’s not unusual for healthcare organisations to focus on the procurement, implementation, and subsequent management of a new EPR system. But they can, unintentionally, overlook what happens to legacy data held in old applications.
The biggest obstacle with legacy applications is risk.
- Financial risk – running and maintaining duplicate or legacy systems is inefficient, costly, and time intensive
- Operational risk – over time, legacy systems become vulnerable and are often targets for cyber attacks, such as ransomware or malware; that can have a devastating impact on healthcare organisations
- Clinical risk – the data contained in legacy systems often contain a considerable proportion of a patient’s record, especially for those suffering from long-term chronic conditions or multiple morbidities. This information can be critical in the ongoing assessment and treatment of patients. But, because it is generally siloed, it’s difficult, time-consuming, and inefficient to access by clinicians while delivering frontline patient care
It is also a common misconception that all legacy data can be migrated into a new EPR.
This is not the case.
Most new implementations will only allow a restricted amount of data to be migrated from the older system to the new one.
So, what happens to the remaining data?
Some organisations attempt to run an old EPR in parallel with a new EPR, which creates a huge overhead for IT departments that are left to manage both systems.
This is inefficient, time consuming, and expensive.
The cost of licensing, support and maintenance costs, and the resources required to manage the new and legacy systems; can be vast.
Some organisations attempt to run an old EPR in parallel with a new EPR, which creates a huge overhead for IT departments that are left to manage both systems
A further issue of running old and new systems in tandem is that clinicians and support staff are expected to spend time they don’t have logging into and searching both systems for the patient data they need, which is labour-intensive at a time when staff ‘burn out’ is a significant issue.
Times are changing
Historically, managing legacy systems has become ‘business as usual’ in part as there haven’t been cost-effective and operationally-viable solutions to tackle the problem.
As a result, it was not considered a high priority in the grand scheme of things.
For many, the cost of continuing to run legacy applications has been factored into the annual IT budget as a run-rate expense.
However, the landscape has now changed.
With the need to have information more readily available across healthcare organisations (be they multi-site NHS trusts, ICSs, diagnostic networks, and the like) and the security risks associated with managing aging systems and hardware, ‘do nothing’ is no longer an option.
Today, there is an increase in NHS organisations looking to address the decommissioning of their legacy applications while still retaining access to the valuable information they contain.
The idea behind the CDR is to provide a centralised, long-term home for patient, clinical, and administrative information from across multiple sources
And one option starting to gain momentum is the implementation of a clinical data repository (CDR) and registry.
The idea behind the CDR is to provide a centralised, long-term home for patient, clinical, and administrative information from across multiple sources such as, but not limited to, laboratory systems, imaging applications, and other applications scattered across the healthcare economy.
But it is also a perfect solution for managing data from a legacy EPR as well as other replaced, duplicate, or outdated applications.
The CDR should integrate directly with the EPR to offer clinicians and support staff a much-richer patient record – especially as more than 70% of all healthcare information lives outside of the EPR.
This is a winning combination when it comes to harnessing data, particularly when making patient information available outside the walls of a hospital, such as in community healthcare, mental health, tertiary care, or more broadly at the ICS or diagnostic network level.
A new £150m National Framework for Legacy Information Integration and Management, led by the Countess of Chester Hospital NHS Foundation Trust, has recently been launched.
This is a huge boost for NHS trusts and will help tackle the escalating issue around legacy systems.
HealthStore, BridgeHead’s award-winning clinical data repository, has been granted approved supplier status on this framework in a bid to help healthcare organisations by providing a legacy information and management solution and associated services.
The best solutions will enable real-time access to the valuable patient, clinical, and administrative data which those duplicate, replaced, or outdated applications contain
Ultimately, NHS organisations should carefully evaluate the solutions available that have the ability to retire legacy systems from a myriad of sources, across multiple sites, cost effectively and securely, to reduce financial, security, operational, and clinical risk.
The best solutions will enable real-time access to the valuable patient, clinical, and administrative data which those duplicate, replaced, or outdated applications contain.
Remember to also partner with experts in data management with the requisite knowledge, experience, and proven track record in healthcare.