Practical Guide for Upgrading Legacy Medical Systems
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Healthcare Software Modernization: Practical Guide for Upgrading Outdated Medical Systems

18 min read


In an era where healthcare businesses must navigate the complexities of innovation and rapid market changes, founders and CEOs face the daunting task of modernizing their outdated software systems. With decades of strategic planning and business management behind you, you know just how important it is for the technology you choose to offer visibility, adaptability, and scalability. You also know how important it is to find partners that you can trust to achieve your modernization goals. 

Over our extensive time working in healthcare technology, we’ve learned that developing healthcare applications can pose unique technical and organizational challenges. With regulation, a looming factor, complex functionality and security are critical components of healthcare app development. The goal of this guide is to show how to get healthcare modernization projects done right and demonstrate a real case study of how a clear product vision, the right approach, and a reliable team can bring an outdated product to success.

How to Identify Legacy Software in Healthcare

Legacy software systems are outdated and their core tech stack is no longer maintained or they don’t meet current standards and needs. Electronic health records (EHRs), administrative platforms, and communication networks are some examples of systems that may be powered by legacy software. They may lack compatibility with external systems, mobile access, and the ability to adapt to new regulatory requirements. 

Some signs that the software may be outdated are: 

  • Loss of Support: if the vendor drops support, you’ll miss critical security and feature updates. 
  • Inefficient: if the software has inefficient workflows or compatibilities, it’s likely your business has outgrown it.
  • Vulnerable: legacy software can be more vulnerable to security threats. Since it may not be well maintained, it’s more difficult to provide security patches. 
  • Monolithic and complex: since legacy software often cannot be easily modified or updated, it’s much more difficult to provide the flexibility needed for regulatory changes or new business needs. 

As software gets older, more of the above traits become apparent, especially when the vendor drops official support. Up-to-date systems are faster, more efficient, agile, and better meet the needs of your organization. 

Why Businesses Invest in Modernization

There are a number of reasons why healthcare organizations modernize their software. One of the most important reasons is that businesses see an average ROI of 124% from data initiatives. This is especially important in the face of funding challenges and staffing shortages. 

Teams are also benefiting from innovative technologies not currently supported in legacy software. For example, 43% of healthcare organizations leverage generative AI for data cleaning and 49% utilize the technology for automation. 

According to Statista, over half of companies in a survey listed security and efficiency as the main motivators behind software modernization initiatives, and for the healthcare sector, these factors have an even higher priority.  

What Are the Risks of Delaying Healthcare Software Modernization?

In the face of funding shortages and other pressing issues for your organization, it’s tempting to postpone healthcare software modernization. However, the longer you wait, the more fires you’ll have to put out. Over time, legacy software increases the risk of security vulnerabilities, reduced system performance, and higher maintenance costs. This is especially true once legacy software no longer aligns with current business needs and industry standards. 

However, with 2023 being the worst year ever for the number of reported security breaches and attacks, according to a study done by The HIPAA Journal, it’s crucial to start modernizing your tech infrastructure to protect patient safety and privacy.

Approaches to Healthcare Software Modernization: Maintain or Replace? 

Deciding whether your current healthcare software needs to be replaced is a strategic decision that requires investigating the current state of your systems. 

If the software is sufficient for your business, it may be wiser to maintain it. Legacy healthcare systems are stable and predictable, and your workers are already experienced in how to use them. They are also cost-effective compared to adopting new software.

However, depending on how difficult data is to transfer from legacy storage and how immutable the systems are in the face of regulatory changes, costs can manifest in other ways. Lack of efficiency can lead to increased labor costs, and failure to comply with regulatory standards can result in steep fines. 

Here is a quick overview of the main approaches used in healthcare software modernization:

The best idea is to have experienced software consultants help you choose the approach that’s best for your business. We created a helpful checklist to help you understand each of the approaches that is available to download for free!

Download the full checklist

Follow the link below to download the healthcare modernization approaches chart in PDF


The next part of this guide is written by Alex Vasyilchenko, AI Team Leader and Solution Architect.

Modernizing Healthcare Software with AI

Over the course of my time leading AI projects at MobiDev, I’ve gained significant experience with intelligent document processing (IDP). I’ve also worked in AI data management for four years for a healthcare insurance company. These experiences taught me critical lessons in how to execute healthcare modernization projects, and I want this guide to show you those same lessons so you can succeed too.

Artificial intelligence systems can have a number of benefits that can help you modernize your healthcare software. Some of the best use cases that can help your organization are: 

  • Clinical Decision Support: AI can support doctors, hastening the process of analyzing patient data, medical literature, and best practices to provide insights and recommendations to clinicians.
  • Predictive Analytics: AI models can use historical data to predict the likelihood of disease, complications, readmissions, and other health events. This allows doctors the opportunity to offer advice and respond with preventative care strategies.
  • Medical Imaging Analysis: AI can shorten the time it takes to analyze medical images like X-rays, MRIs, and CT scans. This can improve the efficiency and turnaround time of diagnoses and medical decision-making.
  • Personalized medicine: medical professionals can use AI to better personalize treatment plans for patients based on genetic profiles and other data. 
  • Automated Workflow Optimization: professionals can use AI to automate tedious workflows like administrative tasks, scheduling, and inventory so that staff can focus on more important projects. 
  • Clinical Research & Drug Discovery: scientists can leverage AI to better analyze large datasets and identify patterns when doing medical research. This can lead to faster and safer time-to-market for medicines and treatments. 

AI is an exciting innovation, but it’s important to investigate whether it’s the right approach for your business. AI software consultants can help you make the right decision and figure out the best way to integrate AI into your healthcare organization. 

Auditing Your Existing Software

Before you decide to modernize your healthcare software systems, auditing what you already have is critical to determining if modernization is right for you. Let’s go over each of the steps.

Step 1: Documentation Analysis

It’s important to investigate the documentation for your existing system. How complete is the documentation? How relevant is it to your current business needs and the current functionality of the software? These are questions you can answer by taking a closer look at the documentation. 

Step 2: Source Code Examination

Software consultants should examine the source code (if available) of your legacy software to identify flaws that can compromise code quality and security. 

Step 3: Functional Audit

You should verify that all the features behave properly and find points of concern that you may want to address later. 

Step 4: Security Audit

This is the most crucial step, especially for healthcare. You and software security experts should check the code for vulnerabilities and uncover potential threats that could put your organization and patients at risk.

Challenges and Best Practices of Healthcare System Modernization

Some of the most important challenges that organizations will face when undergoing healthcare system modernization are: 

  • Data migration risks: transferring data to new platforms can be risky because data can be lost, corrupted, or leaked. 
  • Integration: it can be challenging to find the right solution that will integrate with all the tools you need.
  • Regulatory compliance: modernization needs to comply with applicable laws like HIPAA and GDPR.
  • Cost: your budget can constrain the potential of what your modernization plan can achieve. 

When approaching these challenges, it’s important to first engage stakeholders as soon as possible. These may be medical professionals, your IT team, and administrative support teams. These are all stakeholders that can help you identify what your organization needs most since they are the ones who would be using a modernized software system. 

You should also make sure you select a tech partner with proven experience in healthcare system modernization. The right partner can guide you through the process and provide ongoing support. 

MobiDev: Healthcare Software Modernization Success Stories

MobiDev has a proven track record with healthcare software modernization projects. Let’s explore some examples of how real healthcare organizations were able to modernize their software thanks to our assistance. Please note that we cannot provide specific details about many of these projects, such as the company name, because of non-disclosure agreements.

Success Story #1: Online Documentation Platform Refactoring and Troubleshooting Before Expanding to Global Marketplace

The product was an online documentation platform targeted at users in Europe. This project initially was intended to be an extension and update to the existing software, with a business goal to start serving clients globally. However, low code quality was a major conclusion of the initial software audit. With strict deadlines and budgets from the client, we proposed beginning with refactoring key modules to speed up the development process and ensure the stable operation of the application. 

The main tech challenges were:

  • Conduct code refactoring and bug-fixing
  • Optimize database
  • Prepare the product for adding new features
  • Update technical documentation

Step 1: Conduct Code Refactoring & Bug Fixing

Following the audit, the next step of the project was to refactor and bug-fix the application. This was necessary because of system instability and inefficiency. The software required optimizations and other changes to make it more effective. 

To achieve this, our team analyzed the code to find and fix issues. We developed a priority task list to help refactor project modules. We fixed critical bugs,  improved code structure, and efficiency, and turned commonly used bad practices into best practices approaches. This made it easier and faster to add new features and improve the stability of the system. 

Step 2: Database Optimizations

Our next task was to optimize the database with MongoDB by organizing the database and improving its performance. Our team started by removing unused values and fields. We also added validation to all forms on the front end and back end to avoid creating empty entities in the system. 

We also added error handling to queries for easier resolution of application errors. As a result, the system was more stable and easier to maintain. Finally, we prepared migration scripts to easily modify the application’s database schema. 

Step 3: Prepare the Product for Adding New Features

To start with this step, our Node.js engineers updated the libraries to improve the security of the application. The main issue that we faced when trying to add new features was the poorly structured and confusing source code, often referred to as spaghetti code. Systems like this are difficult to understand and maintain, and introducing new features can create new bugs. 

To fix this problem, we implemented the principle of Single Responsibility for every component. This is because initially the business logic was divided between the controller, services, and the repository. We also deleted the unused code and outdated dependencies. This made it possible to improve the structure of the project and reduce its vulnerabilities.

Step 4: Update Technical Documentation

Poor technical documentation slowed down the development process. Our specialists updated the readme file and prepared additional documentation for new product features, including the LICENSE-DEPENDENCIES file and API documentation. 

Low-quality code can be a serious obstacle when developing a product because the system must be up to date in order to add new functionality. Refactoring and optimizing the code allowed us to reduce this risk and significantly improve the stability, maintainability, and security of the application. We’re proud to continue our partnership with our client and we are excited to continue working on their product’s new features.

Nataliia Ponikarovska

JavaScript Developer

Key 5 Business Outcomes:

This modernization project revamped the healthcare software into a more efficient, reliable, and scalable system, significantly enhancing patient care and giving more room for future product development to fit the company’s business goals.

  1. Increased Operational Efficiency: The modernization project significantly enhanced the application’s stability and performance by refactoring critical modules and optimizing the database. This led to faster processing times and more reliable operations, allowing healthcare providers to deliver services more efficiently.
  2. Cost Savings and Reduced Maintenance: By addressing low code quality and system inefficiencies, the project reduced the long-term maintenance burden. Optimized code and a stable database lowered operational expenses and minimized the need for frequent, costly fixes.
  3. Enhanced Scalability and Future-Readiness: Implementing the principle of Single Responsibility and removing outdated dependencies prepared the system for the seamless addition of new features. This scalability ensures the application can grow with the business and adapt to future technological advancements.
  4. Improved Security and Compliance: Updating libraries and implementing robust validation and error handling improved the application’s security. Enhanced technical documentation ensured the system adheres to industry standards and regulatory requirements, reducing the risk of compliance issues.
  5. Global Expansion: The enhanced platform not only achieved its business goal of expanding service to clients globally but also received positive feedback for its reliability and performance. As a result, user adoption in Europe increased, and the platform established a solid foundation for future growth and scalability.

Success Story #2: Refactoring Outdated Application for  a World-renowned Healthcare Provider

This project (the name is strictly under NDA) was inherited by our experts after five years of development by another software engineering company. With outdated versions of Ruby and Ruby on Rails and the code written using many different architecture approaches mixed into a single codebase, the application was convoluted and fragmented. The total absence of project documentation made this project even more challenging. 

The work started from the Tech Consulting stage, which included a Software Audit and Tech Strategy creation.

MobiDev’s Ruby architects ran multiple tests to audit the code and investigated the existing infrastructure. All the approaches used on the platform were thoroughly documented. Then, we proposed a plan for the gradual implementation of new features and updating Ruby and Ruby on Rails

Since the client had no engineers, MobiDev provided a dedicated team to get the job done. As the project required new infrastructure and breaking the monolithic project into a modular approach, DevOps engineers were also involved in the project to transfer the application to Azure.

The main tech challenges to overcome were:

  • Upgrade Ruby and Ruby on Rails versions
  • Define the set of patterns and abstractions to be used during the refactoring stage
  • Make sure the latest version of the code was developed in an extendable way
  • Provide an elevated level of security and personal health information (PHI) protection to comply with HIPAA
  • Set up a performant and easily scalable infrastructure
  • Document the architecture design
  • Develop a new set of features and launch in half a year

Step 1: Upgraded to Ruby 2.7.1 and Ruby on Rails 6.0.1

Our first task was to ensure that upgrades wouldn’t break existing functionality. We developed and refactored 4,488 automated Rspec tests. This covered most of the existing application features. This step made it possible to upgrade RoR to the newest versions safely. Following the upgrade, Rspec tests showed us all the cases where new libraries caused problems, making it much easier for us to fix them. 

Step 2: Built Modular (Component) Monolith Rails Architecture Design

Even though the RoR application had a single repository, the application was made up of many different services. This made it a challenge to develop new features because of the way the services were all mixed together.

The development team brainstormed solutions and settled on using a Modular Monolith design for RoR API. This was chosen because all the services could be decoupled into separate Rails engines (Admin Portal, CMS, Common API, etc.). Following that, it was easy to navigate the project and implement new features. There were also clear and easy-to-follow design guidelines. 

Step 3: Building a New Cloud Infrastructure

Microsoft Azure was our cloud enterprise solution of choice because of its suitable tools for infrastructure setup, account security, scalability, durability, performance, and recoverability. 

End-to-end SSL was implemented to ensure that any phase of communication between services was encrypted, which is especially important for healthcare applications. An Azure Kubernetes service called AKS enabled the required scalability, durability, and performance for our Ruby on Rails API. Finally, the entire setup was performed using the Helm tool and Azure DevOps CI/CD. 

Key 5 Business Outcomes:

  1. Standardized Code Quality: Implementing Rubocop for code formatting ensured that the app codebase adhered to best practices and industry standards. This standardization not only improved code quality but also facilitated easier onboarding of new developers to the project and ensured smooth collaboration within the team.
  2. Cost Reduction: Refactoring the application and moving business logic operations to loosely dependent Service Objects, along with database queries to a repository layer, allowed us to reduce maintenance costs. These changes made the system easier to manage and update, resulting in lower operational expenses for the client.
  3.  Improved Reliability and Quality: Adopting domain-driven design principles and thoroughly covering both new and legacy code with QA testing ensured a robust and reliable system. This reliability translates to fewer disruptions and more consistent service for the app end-users.
  4. Scalability and Flexibility: Despite the initial monolithic architecture, we successfully divided the application into several modules using Rails engines. This modular approach allowed for easier scaling and adaptability to the future business needs of the client and technological advancements.
  5. Enhanced Efficiency and Performance: By upgrading the software and adding new functional modules, we streamlined operations and improved overall performance. This efficiency boost enables the healthcare provider to serve patients more effectively.

Over a 2.5-year period, our team successfully executed the modernization of the critical healthcare application, significantly enhancing its capabilities and performance. This comprehensive upgrade not only improved the software’s functionality but also delivered substantial business benefits.

Serhii Koba

Solution Architect

How to Start Your Healthcare Modernization Journey with MobiDev

MobiDev has been assisting businesses in building, scaling, and modernizing software products since 2009. With extensive expertise in healthcare application development, we’re an excellent partner that can transform your outdated software into an effective and agile system that can meet the ever-changing needs of your business and government regulations. 

Our in-house team of experienced software engineers and consultants can help you determine the best modernization approach that aligns with your strategic objectives. We’ll handle the implementation, allowing you to focus on core business development. Contact us today and let’s talk about how we can meet your needs. 


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