Application Modernization Strategy: A Roadmap to Better Outcomes

Factors Driving Interest in Application Modernization for Healthcare

Brendan Fowkes, global industry technology leader for healthcare at IBM, points to three motivating factors for application modernization:

1. Consumers are demanding more streamlined engagements. These are driven by data that, historically, hasn’t been readily extracted from stand-alone systems.
2. Monolithic clinical, claims and operational systems running on-premises aren’t nimble. Service and maintenance costs only increase over time, and it becomes increasingly difficult to find someone with the experience to fix them.
3. Regulations such as the Centers for Medicare & Medicaid Services Interoperability and Prior Authorization Final Rule demand data-sharing workflows that legacy systems struggle to support.

Organizations are also looking to make applications more adaptable and resilient, Roth says. That’s often difficult with mission-critical EHR and imaging systems that have been highly customized. The intentions may be good, as customization can improve performance and meet specific business needs; however, she says, “the more any system is customized, the harder it is to update, migrate, extend and secure.”

The Key Phases of an Application Modernization Strategy

Generally, there are four steps to application modernization.

Assess applications against modernization goals and develop a roadmap that will help manage expectations of what applications will be updated when — and which may need to be sunsetted. “Any organization can reap the benefits of adopting a modernization roadmap,” says Chuck DeVries, senior vice president and technology officer at Vizient. “Staffing, cost implications, contracting and even security and compliance are made easier by having a roadmap.”

Amid application assessment, Fowkes notes two important considerations. One is the link between modernization and sustainability as applications move to more efficient cloud-based servers. The other is cybersecurity. “You might have an application running software underneath that’s been unsupported for three years. Do you even know where the holes are?” he says.

Migrate applications to the cloud. This includes mission-critical applications, Roth says. Forrester research commissioned by Microsoft indicates that organizations report better security, performance and agility when these applications migrate off-premises. Organizations also find it easier to implement new features when applications run in the cloud, in part because microservices allow engineering teams to build, test and deploy components independently.

Update applications with modern technologies previously unavailable to legacy systems. These may include containers for deploying a single application in multiple environments, machine learning and artificial intelligence (AI) for mining large data stores, and automation to first deploy applications and then monitor them over time.

The question of whether to migrate (rehost) or update (replatform) an application first is common. Rehosting typically results in immediate cost savings and compatibility with on-premises applications, Roth says. Replatforming, on the other hand, tends to speed up time to market.

Optimize applications on an ongoing basis to ensure the overall application modernization strategy meets the organization’s needs. “IT professionals know that as soon something gets to production, it becomes legacy and will need to be updated,” DeVries says.

To that end, he recommends a range of tools, services and best practices to guide the process.

• AI for IT operations (AIOps) can automate monitoring of system performance.
• Software-defined networking can balance network loads, improving performance and application availability.
• Partnerships between software development and IT operations (DevOps) can help organizations build software faster and with fewer errors.
• Infrastructure as Code can automate IT infrastructure management, which makes it easier to configure hardware and deploy software.

Application Modernization and Rationalization in Healthcare

Not surprisingly, the unique nature of healthcare IT means organizations have additional considerations when it comes to application modernization.

It’s not unusual for healthcare applications to run code that’s decades old, whether it’s COBOL for administrative systems or MUMPS for clinical systems. Modernizing these applications is tricky, Fowkes says, as so many other systems depend on them. (That explains why they still run on mainframes.)

That said, there may be a way to apply modern technology such as generative AI to legacy applications. “What if you could tune a large language model on a 30-year-old code base, document what it does in plain English, optimize the code and potentially convert it to Java?” he says. “What cost can that take out, and how would that support the application modernization roadmap?”

In addition, many organizations need to confront the technical debt and application sprawl that stems from growth by mergers and acquisitions. While the situation has improved over the years, Fowkes explains, it’s still common for organizations to leave custom applications running in the background that meet one or two business needs but otherwise do no harm.

This is where application rationalization comes into play. It’s closely related to modernization, and it focuses on identifying inefficient or redundant applications. A cloud-native billing system may do what that custom application does — and it may work on all instances across the organization, not just the version running on a single machine. Or, as many health systems have learned recently, a single platform for virtual visits may do the same job as several implemented in haste in 2020.

“It’s important to understand the capabilities of new solutions and map them to existing software to allow intelligent decisions on what can or can’t be retired,” DeVries says. “Funding for new applications and technology can often be found by redirecting funds from software and solutions that can be retired or evolved.”