Close encounters with DOS and SCO
Many fail to realize that the state of healthcare IT is firmly entrenched in legacy technology. I’ve encountered this trend in recent travels to healthcare organizations that would rather maintain an old technology until it fails than delve into the effort, expense, and potential risk of implementing a new solution to replace it.
One recent encounter involved a group of CIOs evaluating the purchase of an ESB (Enterprise Service Bus – used for HL7 messaging) for research collaboration. The CIOs questioned why the ESB vendor had only a few customers upgraded to the latest platform. The vendor deferred the question back to one of the CIOs who owned the eight-year-old legacy application; why haven’t you switched to the new platform? The CIO stated that the old application still worked and the upgrade provided a greater potential risk than reward. Despite all of the limitations in features, flexibility, and age of the legacy system, the upgrade required too much of an engineering effort. Simply speaking, the response reflected the phrase: if it ain’t broke, don’t fix it!
A second encounter occurred at a small practice involved in a PQRI initiative to code CPTII codes in billing data. Each practice involved in the initiative had to transmit their billing data to a central quality reporting repository for analysis. I was called in to this particular practice for my knowledge of an ancient technology – DOS! The practice managed billing on an EPM (Electronic Practice Management) application using the same back room white box server since 1989. The machine in question utilized a DOS prompt to access billing data. After a bit of tweaking, we extracted the data to a floppy disk and onto a laptop through a USB floppy drive. At a subsequent meeting, the youngest person in the room asked, what is a floppy drive? The user of the machine, who dutifully processed billing for the practice, remarked that should the system ever completely fail, it would be time for them to retire. That would be an unlikely scenario due to the EPM’s built-in 8-track backup system.
While the DOS box from 1989 wins the record for oldest system I’ve encountered, we have seen plenty of SCO servers from the mid-1990s as well as a host of old platforms operating in the corners and back rooms of physician practices. At this point, I wouldn’t be surprised to find an Atari 2600 running a lab order tracking system or an 8086 storing vital signs for over a million patients.
Nothing legacy is shocking anymore.
As we progress toward the powerful future of PHRs, HIEs, NHINs, and EDWs, DOS is just one example of a legacy system that must communicate with modern applications. There are thousands of DOS machines still spinning disk drives that were built before the college graduates of today were born. Many of these machines serve as the primary source of electronic data that we need to share and analyze. There is a last mile. And healthcare applications don’t die without a fight.
Dan Housman
Managing Director, Analytical Applications
Recombinant Data Corp.
One recent encounter involved a group of CIOs evaluating the purchase of an ESB (Enterprise Service Bus – used for HL7 messaging) for research collaboration. The CIOs questioned why the ESB vendor had only a few customers upgraded to the latest platform. The vendor deferred the question back to one of the CIOs who owned the eight-year-old legacy application; why haven’t you switched to the new platform? The CIO stated that the old application still worked and the upgrade provided a greater potential risk than reward. Despite all of the limitations in features, flexibility, and age of the legacy system, the upgrade required too much of an engineering effort. Simply speaking, the response reflected the phrase: if it ain’t broke, don’t fix it!
A second encounter occurred at a small practice involved in a PQRI initiative to code CPTII codes in billing data. Each practice involved in the initiative had to transmit their billing data to a central quality reporting repository for analysis. I was called in to this particular practice for my knowledge of an ancient technology – DOS! The practice managed billing on an EPM (Electronic Practice Management) application using the same back room white box server since 1989. The machine in question utilized a DOS prompt to access billing data. After a bit of tweaking, we extracted the data to a floppy disk and onto a laptop through a USB floppy drive. At a subsequent meeting, the youngest person in the room asked, what is a floppy drive? The user of the machine, who dutifully processed billing for the practice, remarked that should the system ever completely fail, it would be time for them to retire. That would be an unlikely scenario due to the EPM’s built-in 8-track backup system.
While the DOS box from 1989 wins the record for oldest system I’ve encountered, we have seen plenty of SCO servers from the mid-1990s as well as a host of old platforms operating in the corners and back rooms of physician practices. At this point, I wouldn’t be surprised to find an Atari 2600 running a lab order tracking system or an 8086 storing vital signs for over a million patients.
Nothing legacy is shocking anymore.
As we progress toward the powerful future of PHRs, HIEs, NHINs, and EDWs, DOS is just one example of a legacy system that must communicate with modern applications. There are thousands of DOS machines still spinning disk drives that were built before the college graduates of today were born. Many of these machines serve as the primary source of electronic data that we need to share and analyze. There is a last mile. And healthcare applications don’t die without a fight.
Dan Housman
Managing Director, Analytical Applications
Recombinant Data Corp.
Labels: Clinical Research, Quality Reporting
3 Comments:
Convert And store legacy as discrete or images then Let's Try an enterprise data model with dr and bc built in and reduce interfaces and other one off integrations, we need Clin ancillary fin admin and operations as one it model and include the physicians and amb components as well
Clearly the healthcare IT managers you spoke to have been keeping those legacy machines very healthy, or they would have ended up in the morgue.
The problem with such old systems is that the data must be extracted, usually transformed and loaded into some newer type of architecture in order for it to be useful. I had a project to do just this ETL type of activity on old data that needed to be kept available for a variety of reasons. It became really scary when trying to get drivers for software and database vendors that had long since gone out of business
It is difficult to justify the activity and expense of archiving old data, but if it is needed for a lawsuit, or a regulatory reason, no expense is too much. Archiving must be part of the ongoing operation of the IT department, and a mandatory piece of every application replacement project... and if it is not, extracting it from an old server and making it available may become the highest priority an IT manager ever has to deal with.
What I have noted in payer enviornements is 2 things. Mostly outsources to consultants firms Perot, HP/EDS, CSC, IBM. Second a number of failed attempts to replace legecy systems in payer enviornments by these teams.
I believe part of the reason is what was noted above, part of it is an old story of the claims processing team is usually put in charge of the implmentation. The new system natrually does not do it the way the old systems did so the changes become daunting. In any case it would be an interesting study.
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