Healthcare for Native Americans will be improved through IT modernization, says Indian Health Service CIO Mitchell Thornbrugh.

Feb 21 2020

How Agencies Can Leave Legacy IT Systems

Decades-old tech still runs in some agencies, including Indian Health Service and Education, but modernization plans are underway.

In 1969, the Indian Health Service’s new electronic health record system was considered cutting-edge. Although that system has evolved over the years, much of its underlying software code is still decades old, in desperate need of an upgrade.

The latest iteration, ­co-developed with the Veterans Affairs Department, manages clinical, administrative and financial operations. Although it has the amenities of a modern EHR, such as seamless electronic workflow, information sharing and patient portal access, they’re not adequate. It’s also not very user friendly.

“In 2004, we added a graphical user interface, but some modules still have a command prompt, DOS-like green screen,” says IHS CIO Mitchell Thornbrugh, whose agency has embarked on a multiyear modernization effort.

The federal government operates with a good amount of legacy technology, and agencies are attempting to modernize the antiquated IT to improve performance, security and operational efficiency as well as reduce costs.

A 2019 Government Accountability Office report details the 10 most critical legacy IT systems in the federal government — all of them between about 10 and 50 years old. Some systems operate with known security vulnerabilities, run on obsolete hardware and/or unsupported ­software, or are written in outdated ­programming languages.

These older systems are more expensive to maintain, put data at greater risk and are less effective than technology available today, the report says.

“The public sector is finding that the talent they have to support those older systems is retiring, and that those legacy systems are limiting their ability to innovate and deliver better user experiences,” says Thomas Ortiz, a partner at Information Services Group, a technology research and advisory firm.

Agencies have several ways to upgrade their systems, including rewriting applications and replacing legacy code with modern programming languages, buying commercial software or moving applications to the cloud.

In doing so, they can streamline ­business processes, automate manual tasks, bolster security and reduce ­support costs, while ­providing users with a more accessible user interface and improved customer service, the GAO report says. 

IHS Modernizes Its Software to Improve Healthcare 

IHS, a component of the Department of Health and Human Services that provides healthcare to 1.6 million Native Americans and Alaska Natives, is in the early stages of modernizing its Resource Patient Management System, a software suite for managing clinical, administrative and financial operations at its 150 sites.

RPMS is based largely on VA’s VistA EHR application built in the mid-1980s, but it still has its roots in IHS’ original 1969 EHR system. In fact, the GAO report considers RPMS to be five decades old, though it’s unclear how much of the 1969 software code remains.

When VA in 2018 announced it would retire VistA and replace it with an off-the-shelf EHR solution, that prompted IHS to explore its own modernization. “We rely on the VA for a significant portion of the support when it comes to some modules like pharmacy and radiology labs,” says Thornbrugh.

$337 million

The annual cost of operating and maintaining the federal government’s 10 most critical legacy systems

Source: Government Accountability Office, “Agencies Need to Develop Modernization Plans for Critical Legacy Systems,” June 2019

While RPMS still works, it’s time to upgrade, he adds. For example, while it does have a module for electronic prescriptions, RPMS does not offer integrated workflow and seamless data exchange within IHS’ medical facilities or with outside care providers. “If patients get referrals to see specialists in another health system, you expect their records to transfer,” Thornbrugh says. “That’s at the heart of us needing to modernize our health IT infrastructure, to enable that communication and coordination of care.”

RPMS implementations are also not uniform and have resulted in siloed systems in IHS locations throughout the country. In some cases, different locations implemented different features, making software support difficult.

“The loudest thing we heard was that the user interface was a challenge. They need training, but when we have hundreds of ­systems and enhancements varying from site to site, it’s challenging,” says Maia Z. Laing, a senior ­business consultant within the HHS Office of the CTO.

Mitchell Thornbrugh, CIO, Indian Health Service
That’s at the heart of us needing to modernize our health IT infrastructure — to enable that communication and coordination of care.”

Mitchell Thornbrugh CIO, Indian Health Service

In 2018, HHS took the first step toward modernization by assessing RPMS, with input from 450 staffers across IHS’ 12 regional areas. It produced a modernization roadmap in late 2019.

Thornbrugh says the agency wants to build a centralized, state-of-the-art, ­easier-to-use EHR system that meets key federal priorities. Among them: The new system must be cloud-based, secure and interoperable, and meet the challenges of ­delivering healthcare in rural areas with modern capabilities such as telehealth and patient portal technology.

IHS plans to purchase a new system by 2021 and go live with the first site by the end of the 2022 fiscal year. It will take seven to 10 years to deploy the new software agencywide, Thornbrugh says. In the meantime, IHS will continue to support RPMS.

“We can’t abandon our efforts with RPMS. In fact, we may need to redouble our efforts to keep the system viable until everyone gets converted,” he says. 

IRS Rolls Out Major IT Modernization Plan

Last April, the IRS announced a six-year, $2.3 billion to $2.7 billion plan to modernize its IT systems with innovative technologies and processes, including cloud, agile and DevOps methodologies, modern programming languages, robotic process automation and next-generation infrastructure.

The effort will improve services, beef up security and allow the agency to decommission legacy IT applications, including a 50-year-old, COBOL-based system that contains taxpayer data and helps process more than 150 million tax returns a year. 

Once complete, the new system will automate manual processes, improve analytics and reporting, and better meet taxpayers’ and employees’ needs.

“The integrity of our nation’s tax system depends on modernizing IRS operations and the supporting technical pieces,” IRS Commissioner Charles Rettig stated last April.

Education Department Updates Its Full IT Stack

The Education Department is also busy modernizing legacy systems, including plans to replace a federal student aid system built in 1973. 

The COBOL-based system processes more than 20 million student loan applications annually. It runs on a mainframe, requires 18 contractors to maintain it, and costs about $43.9 million per year to operate, including $2 million in labor. 

Upgrading the system will not only reduce costs, boost security and reduce complexity, it will also provide better application integration and allow the department to operate more efficiently.

While the student aid system is more than 40 years old, the infrastructure it runs on is up to date, says Education Department CIO Jason Gray.

He can’t discuss specific plans for the system because the department is in the midst of an active acquisition, but he says it’s part of the Federal Student Aid office’s planned Next Generation Financial Services Environment.

Education Department CIO Jason Gray

Education Department CIO Jason Gray says IT modernization has led to cost savings and avoidance, better performance and higher productivity. Photography by Brad Howell

The department has multiple ways it can upgrade its legacy applications, Gray says. In 2018, for example, the IT team replaced a decade-old financial management system that was running on an operating system that was no longer going to be supported.

The department upgraded to an entirely new application, and in turn, provided users with new features, including automation of manual processes, says Walter McDonald, director of IT program services.

Besides replacing an entire legacy app, the department can also simply update the apps by adding functionality on top of it, Gray says. For example, if legacy software requires manual processes, the department can invest in RPA to automate tasks.

The Education Department also spent early 2019 updating its office technology and IT infrastructure, from new computers and printers to network equipment and a new cloud provider for its data center needs.

Gray and his team replaced a long-term contract that provided all IT serv­ices with contracts for individual technologies. The result is cost savings and avoidance, better performance and higher productivity, he says.

The department replaced 5,000 laptops running Windows 7 and Office 2010, providing new notebooks running Windows 10 and Office 365. By moving to a new cloud provider, the department reduced cloud storage costs from $1.43 per gigabyte to 12 cents — a $1.5 billion savings.

“As technology improves, things get more efficient and faster, and we want to make sure we are an efficiently run and operated organization from an effectiveness standpoint,” Gray says.

Photography By Jonathan Timmes