Learning from the past and living with legacy systems

Over the past eight years that I’ve been in the “real world”, I’ve had opportunities to work at various parts of the health care system from promoting healthy behaviours to children of family violence, preparing a small community hospital implement a new electronic records system, developing a quality improvement program and conducting business process re-engineering projects at a large teaching hospital, to examining national, system-level issues at Health Canada. Through-out my experiences, one thing that I’ve heard over and over is that using new electronic systems is not possible (or at least extremely difficult) because the health care system is saddled with limitations from existing (or legacy) systems. The basic argument is that we need to leverage past investments that have been made (be it in information technology or otherwise), or else we are throwing away precious (and mostly tax-payer funded) resources.

In the past, I’ve never really subscribed to this reasoning, mostly because we see that companies and organizations in other industries (at times) move to another system by gutting their existing system. Yes, these transfers and transitions can prove painful and often disastrous. But, I suspect that if the need was significant, these companies would switch. The health care system response has been that other industries have “more money and expertise” available to them. Okay, on some level I agree.

But, at what point do we say that we need to make a “clean break” from supporting legacy systems and all of the limitations that we may inherit. On some level, this issue is similar to what Microsoft faces when the company works on producing a newer version of its operating system (Vista). The current project is late, millions of dollars over-budget, and much stripped down that originally intended (ouch!). One of the criticisms of Microsoft’s current move is that the company continues to support and utilize many design features elements from past versions of windows (Windows95, Windows98, WindowsNT, and WindowsXP). Previous versions of the operating system were designed, developed, and deployed in a much different “world” than exists today. As such, Microsoft’s developers have had to make concessions to accommodate past decisions and design elements while trying to meet the demands of the present. A hospital, for example, probably has to make a similar decision: at what point does the existing information system hinder our current and future ability to move forward and make progress? I’m sure the decision is not an easy one to make as the ramifications are likely to cost in the millions and affect the organization and partner groups for years to come.

Getting back to my original idea, I was reminded of this exact issue recently, albeit in a much smaller way. For this blog, I’m currently using Google’s Blogger service. I can’t really complain about Blogger as it provides a good package of services. But, as I continue to blog, I realize that there are some additional features that I would like that aren’t available. So, I’ve been checking out WordPress’s services (both free [wordpress.com] and paid [wordpress.org]). There are some features that I really like from WordPress. But, I have concerns about the challenges of migrating this blog to the new service, not to mention the potential broken links for people who have linked to my posts. What I find particularly fascinating is how this particular issue relates to my research. I am interested in evaluation theory and how evaluation may be (or may not be) conducted in health care in regards to ehealth innovations. How do people conduct evaluations? Are they structured? Based on theory? Based on some model? What information is needed? How do we get the information that we need? How do we know that we have collected the right information? Have we asked everyone who needs to be asked? And so forth…

Perhaps I’ve been a bit rash in the past in not believing CIOs and other management types for being hesitant to switch to new systems. As we move increasingly towards more ehealth solutions, what impact with changing systems have on patients and the individual users? Will patients be saddled with deciding which system to maintain a copy of their own health information? Will patients have any say as to what system(s) their health care provider organizations choose? In my particular case, I’m finding that free services available on the Internet are great, but I need just a bit more than what is currently available. But, having my own domain isn’t all that it’s cracked up to be. Yes, I have complete freedom to set-up web services (as available by my hosting package), but I find that being saddled with the technical responsibilities of setting-up, maintaining, and testing new features isn’t all that fun for a non-technical person (as compared with a web developer or site administrator). If I may be so bold, my strength is in creating and synthesizing new content, rather than focusing on the technical aspects of creating a web site. Yes, I don’t mind the odd tinkering with web protocols to learn (that’s my curiosity), but I don’t have the time, patience, or training to set something up at the professional level. Maybe that’s where the real issue is – finding a way of managing the intersection between the technical issues/requirements and the service/content providers.

For now, I’m still collecting information and trying to come to a conclusion about my blog. I’m tempted to try using some of the evaluation theories/models that I’ve come across to see how they stack-up in helping decision makers come to a conclusion on whether to continue to use or to switch. I would be more than happy to entertain any suggestions. Basically, I like WordPress’s capabilities in terms of categorizing and organizing posts and comments, providing (simple) file/picture hosting for posts, as well as providing options on providing permanent links to a post. Blogger has some features that are not available in the free version of WordPress (domain mapping/hosting, modification of your template. More to come…