Why Healthcare IT Leaders Need to Rethink Legacy Systems in 2025

When Legacy Systems Fail: A Healthcare IT Wake-Up Call

At 2:37 AM, a major health system’s electronic health record (EHR) system crashed. The outage lasted for hours, leaving physicians unable to access critical patient histories, delaying medications, and forcing staff to rely on handwritten notes. The culprit? A 15-year-old legacy system running on outdated infrastructure—one that had been flagged for replacement multiple times but remained in use due to budget constraints and transition challenges.

This scenario is not uncommon. Sixty percent of healthcare organizations still rely on legacy systems for critical operations (Deloitte), but these outdated platforms are becoming increasingly difficult to maintain, secure, and integrate with modern technology. With regulatory mandates tightening, cybersecurity risks escalating, and financial pressures mounting, doing nothing is no longer an option.

Why Legacy Systems Are a Growing Liability

Regulatory and Compliance Pressures Are Increasing

CMS and ONC Mandates for Interoperability and AI
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) are pushing for real-time data exchange and AI-driven efficiencies in healthcare IT.
TEFCA (Trusted Exchange Framework and Common Agreement) and the 21st Century Cures Act require hospitals to modernize IT infrastructures to meet new interoperability standards.
HIPAA Security Rule Updates Are Coming
The HIPAA Security Rule is expected to be updated in 2025, requiring stronger protections against legacy system vulnerabilities. Hospitals and health systems relying on outdated security protocols may face increased regulatory scrutiny and potential fines.

Cybersecurity Threats Are Accelerating

Recent Healthcare Cyberattacks Expose Legacy IT Risks
The a major nonprofit health system ransomware attack in 2023 shut down access to patient records across more than 20 hospitals.
The a large multi-state hospital network breach in 2024 disrupted hospital operations nationwide due to vulnerabilities in older IT infrastructure.
The one of the nation’s largest healthcare providers breach exposed over 11 million patient records, reinforcing that legacy system security gaps are a primary target for cybercriminals.
83% of Healthcare Organizations Have Experienced a Breach in the Past Two Years (Ponemon Institute)
Outdated software and unsupported security protocols are among the leading causes.
Many healthcare organizations struggle to meet new cybersecurity standards without dedicated legacy IT support or modernization efforts.

Financial Pressures Are Forcing Hospitals to Reevaluate IT Spending

Maintaining Legacy Systems Consumes Up to 75% of IT Budgets (Gartner)
Rising labor costs, reduced reimbursements, and increasing technology investments are forcing hospitals to optimize IT spending.
Keeping outdated systems running may seem cost-effective short-term but results in higher long-term costs due to inefficiencies, security risks, and compliance fines.
AI and Digital Transformation Are Being Delayed by Outdated IT
AI in healthcare IT spending is expected to grow 40% by 2026 (IDC Health Insights), but many hospitals can’t deploy AI effectively due to legacy system limitations.
CIOs are under pressure to prioritize modernization efforts without disrupting clinical operations.

When Should Healthcare Organizations Consider Outsourcing Legacy IT Support?

As healthcare organizations evaluate how to manage legacy systems, one of the biggest decisions is whether to handle support internally or work with an external partner. There is no one-size-fits-all answer—some organizations have the resources to maintain legacy support in-house, while others may benefit from outsourcing to optimize staffing, security, and cost efficiency.

Outsourcing May Be a Strategic Move If:

Internal IT Teams Are Overextended – If IT staff are already stretched thin managing security, compliance, and new system implementations, outsourcing can relieve the burden of legacy system maintenance.
EHR or Digital Transformation Projects Are in Progress – Organizations migrating to a new EHR or modern IT infrastructure often need to dedicate their internal teams to future-state planning rather than maintaining outdated systems.
Legacy Systems Require Specialized Knowledge – Some older systems require niche expertise that internal staff may no longer have, especially if the original vendor no longer provides support.
Security & Compliance Are Growing Concerns – If legacy systems no longer meet regulatory security requirements, outsourcing may provide faster access to cybersecurity expertise and risk mitigation strategies.
Budget Constraints Make Full-Time Support Cost-Prohibitive – Outsourcing allows for flexible service models, reducing overhead costs while ensuring critical systems remain supported.

Keeping Support In-House Might Be Feasible If:

Internal Teams Have the Bandwidth & Expertise – If an organization has dedicated staff with experience managing legacy systems, keeping support in-house may be a viable option.
There’s a Short-Term Need for Legacy System Support – If a full transition to modern infrastructure is planned within the next 12 to 18 months, it may make sense to maintain internal support temporarily.
The System Is Still Actively Used & Supported by Vendors – If a legacy system is still under vendor support and well-integrated into daily operations, the urgency to outsource may be lower.

The Future of Legacy IT: A Strategic Transition, Not Just Support

Tier 1: Stabilization and Security Hardening

Conduct a risk assessment to identify vulnerabilities in unsupported software
Strengthen cybersecurity protections to meet HIPAA, GDPR, and NIST compliance standards
Optimize application performance to reduce lag and downtime

Tier 2: Workflow Optimization and Cost Reduction

Automate processes to minimize reliance on outdated workflows
Realign IT resources to support modernization initiatives
Implement cloud connectors and API integrations to bridge legacy systems with next-generation solutions

Tier 3: Planned Transition and Future-Proofing

Develop a strategic roadmap for replacing outdated infrastructure without operational disruptions
Establish a knowledge transfer framework to ensure seamless adoption of new technologies
Implement a continuous improvement process to maintain long-term IT sustainability

The Cost of Doing Nothing: What Healthcare CIOs Need to Consider

For organizations still managing legacy systems, the question is no longer if modernization is necessary, but how to do it strategically. Healthcare leaders should ask themselves:

How much of the IT budget is allocated to legacy upkeep instead of innovation?
Are clinicians using manual workarounds due to system limitations?
Are cybersecurity measures strong enough to protect unsupported software?
Is there a structured transition plan aligned with long-term IT goals?

Legacy healthcare IT does not have to be a roadblock—it can be a launchpad for smarter, more strategic technology management. The organizations that proactively manage their transition strategy will not only improve operational efficiency but also position themselves for sustained digital transformation.

References

Deloitte. (2019). The aging healthcare IT infrastructure. Retrieved from deloitte.com
Ponemon Institute. (2020). The state of cybersecurity in healthcare. Retrieved from ponemon.org
HIMSS. (2021). Integration challenges in healthcare IT. Retrieved from himss.org
Gartner. (2022). IT budget allocation for legacy systems. Retrieved from gartner.com
KLAS Research. (2023). Legacy systems in healthcare: A survey report. Retrieved from klasresearch.com

IT Consulting, Healthcare IT