Tabitha Lieberman serves as President, EHR and Healthcare Applications at Brightwork Health IT.

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A recent survey by MuleSoft and Deloitte revealed businesses use an average of 976 individual software applications. That’s a whole lot of technology—unless you’re in healthcare. In this business, it’s not uncommon to accumulate thousands of bright, shiny applications, only to toss them into their tool kit without considering the long-term viability.

While all sectors struggle with keeping an organized tool kit, healthcare faces a host of unique challenges when it comes to architecting and maintaining the right tech stack. That’s why leaning into application rationalization is so critical and so often overlooked.

What is application rationalization?

Imagine you start a new handyman business. You buy the necessary tools: a couple of screwdrivers, a hammer, a drill, a tape measure and a level. In healthcare IT terms, the equivalent would be having a solid electronic health record (EHR) system with an integrated lab, pharmacy and billing system. With your new tools, business is humming, and it’s time to expand. You add a new service that requires a miter saw. Or, in health IT terms, a cardiology system. As business continues to grow, everything in your tool kit has a clear purpose and meets a defined need. But six months later, you see a next-generation drill at a home show, and you have to have it.

You now face your first rationalization decision. Can you transfer batteries between your old drill and the new one? Is your tool kit big enough for another? Should you sunset the first drill or maintain two for specific purposes?

These scenarios play out frequently in healthcare organizations for the implementation and utilization of technology. Unfortunately, stakeholders often overlook key questions, leaving organizations with a crowded mix of tools that don’t play so well in the proverbial sandbox.

Building an IT rationalization program is key.

As healthcare organizations struggle to control costs and technology continues its rapid advance, the imbalance between fiscal responsibility and innovation grows. They spend millions maintaining outdated applications, failing to realize that alternative solutions are readily available in their tool kit. This model needs to change, and an application rationalization program is a great place to start.

Building a healthcare rationalization program is not easy, but the results are well worth it. Here are some tips to get started:

1. Engage beyond your core IT team. Changing systems in healthcare can have ripple effects that surpass core tool use. Clinical governance, clinician use of tools, regulatory environments, patient safety and capital funds all factor into the process. Moving from one brand of hammer to another has minimal cognitive overhead, but a new fetal monitoring, oncology or patient monitoring system has a significant learning curve and systemwide considerations, meaning you should include clinical and operational leaders in the discussion.

2. Set goals. You must clearly understand what you want the rationalization program to accomplish. If you are one of the organizations with thousands of applications, expect an arduous, time-consuming and complex process. Be strategic about your outcomes, and keep the application portfolio process focused on your ultimate goals. Consider the technology standards you want to adhere to and what long-term funding might look like.

3. Thoroughly analyze your technology portfolio. Just because an application is in your tool kit doesn’t necessarily mean it should stay there. Do the applications play nicely or fit well with each other? Are they worth the product investment? Are there redundancies? By prioritizing the applications that you absolutely need, you can begin to assess others with similar functionality to eliminate.

4. Clear out old technology. Plan application upgrades or replacements in advance to avoid scrambling or falling behind. Vendors often rework their technologies and shift to modern platforms. Older applications are more prone to errors and security issues and often become unsupported. Closely monitor the efficacy of your tools and clear out those broken hammers and dull saws.

5. Evaluate vendors wisely. Choose vendors with the best products and simple integration. Beware of on-off products that have very limited use. Streamline your purchases by modernizing legacy tools and consolidating redundancies. Ten reliable vendors will serve your organization far better than 1,000 bad ones. Run through a risk-management scenario with your vendors and ensure they are up to date on compliance.

6. Centralize your data. Data is a critical tool in healthcare. Data that’s mixed, mangled and spread across the enterprise in different siloes makes it cumbersome to use. How frustrating would it be to get to a job site only to realize you left your tool kit at the shop? So, why do so with one of your organization's most valuable assets?

7. Become a master architect. The handyman should constantly monitor the safety and security of their work, and you should assess the viability and efficacy of your application portfolio architecture. Consider the big picture by having a good handle on your hardware and software workstreams. Create a chart of your various applications in an architecture framework, consolidating and optimizing where possible.

Application rationalization requires eternal vigilance.

Even if your organization does not have thousands of applications or sensitive patient information like EHRs, application rationalization makes sense, especially if you have never done so before. The process can be daunting, but your IT environment will often achieve financial goals and run more efficiently, safeguarding your organization from potential security breaches. Whether your IT department is conducting the rationalization in-house or externally with a vendor, you should continue this process regularly.

You’re still not done after you’ve completed the hard work by cleaning out your tool kit and rearranging everything to easily swap extra tools for new ones. Even if you have an efficiently running organization and hit your ROI, rationalization must be a core component of your governance model. By creating a clear structure with a holistic lens, you will avoid the mistakes made by many other healthcare systems.

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