Legacy System Landscape

• Historically grown IT environments
• Mix of monolithic and modern systems
• Multiple vendors and technologies
• Examples: HIS, lab systems, PACS, specialty clinical systems

Integration Difficulties

• Legacy systems not designed for agile development
• Limited APIs and integration capabilities
• Complex data dependencies
• Vendor-controlled update cycles

Coordination with External Partners

• Standard software vendors often not agile
• Different development cadences
• Dependency on vendor roadmaps
• Limited influence on development priorities

Technical Debt Management

• High technical debt in healthcare systems
• Risk of stability issues with incremental changes
• Security vulnerabilities in legacy components
• Limited documentation of existing integrations

Strategic Approaches

• Use Enabler Epics for legacy modernization
• Implement facade/adapter patterns to isolate legacy systems
• Create clear integration contracts with vendors
• Establish interface teams for external coordination

Technical Solutions

• API management platforms
• Integration layers (e.g., FHIR-based)
• Service mesh architectures
• Automated regression testing
• Feature toggles for safe deployment

"Technical challenges require a combination of strategic architectural thinking and pragmatic incremental improvements to gradually modernize the healthcare IT landscape."