Mitigating the Risks of Legacy Technology

The increase in demand for health care services can often outpace the ability of a hospital’s infrastructure to grow in response. Actions such as adding new or additional diagnostic equipment and imaging systems to meet patient needs may not always be possible, forcing some hospitals to continue to operate older legacy equipment. This can be amplified by financial, regulatory, and operational constraints, and can be particularly challenging for rural and critical access systems.
 

Many devices, such as MRI machines, CT scanners, and surgical robots are certified with specific systems, and updates can require expensive, time-consuming re-certification. Vendor lock-in adds complexity, as some legacy systems depend on unsupported proprietary technology. If systems still function reliably, hospitals may opt to mitigate risks rather than upgrading. Upgrades also risk operational disruption through downtime, retraining, and integration challenges—especially burdensome for busy or under-resourced facilities. Additionally, limited IT capacity or awareness can prevent smaller hospitals from effectively planning system modernization.
 

Unfortunately, these legacy computer systems can potentially lead to serious challenges to patient safety, cybersecurity, and operational efficiency. A major concern is security—these systems often run outdated, unsupported software like Windows XP or 7, making them highly vulnerable to malware and lacking critical features like encryption and secure authentication. They also often fall short of modern data protection standards like HIPAA, increasing the risk of regulatory penalties and data breaches. Their inability to integrate with newer health IT platforms creates interoperability issues, leading to manual data entry, diagnostic delays, and treatment errors.
 

Maintenance is another issue. As vendor support ends, hospitals must rely on costly third-party services or retain in-house expertise for obsolete hardware and software, which are increasingly difficult and expensive to maintain. Staffing turnover may add complexity. New personnel may lack training in outdated systems, requiring either additional instruction or reliance on legacy-skilled staff. Ultimately, these issues threaten patient care, as system failures and slow performance can hinder timely, accurate medical decisions.
 

Hospitals can address the challenges of legacy computer systems through a mix of short-term fixes and long-term upgrades. A phased modernization approach allows gradual system replacement, reducing disruption and spreading out costs. Using modular, scalable technology ensures easier future upgrades. Improved cybersecurity is also essential. By isolating legacy systems from main networks, using firewalls and intrusion detection, and enforcing strict access controls, hospitals can work to effectively mitigate vulnerabilities. Extended vendor support or third-party service agreements can also help maintain critical systems beyond official end-of-life dates.
 

Data integration tools, such as middleware, allow older systems to communicate with modern platforms, reducing manual data entry and the risk of errors. Regular risk assessments and asset inventories help prioritize upgrades based on urgency and system risk. Training staff to handle legacy systems safely and documenting procedures ensures knowledge is retained as experienced staff leave. Finally, shifting appropriate functions to cloud-based platforms can reduce reliance on outdated infrastructure and enhance scalability and security.
 

Hospital emergency managers, in cooperation with information technology, cybersecurity, and operations personnel, should work to understand the current state of information systems and the level of risk faced by the organization. From there, contingency planning and downtime procedures can be refined in lead up to exercises and training in an effort to boost resiliency and capability to manage issues arising from dated technology.

 

Author: Christopher Chamberlain, MS, RN, CHEP, Vice President, Emergency Management 

Return to Blog main page.