Sharing One Record Should Not Mean Replacing Every System. Here Is the Benchmark We Would Set.

The hospital wants to do one thing: send a discharge summary to the patient’s own doctor, electronically, on the day the patient goes home.

Two proposals come back. Both say the same. The old record system cannot do this, and the answer is to replace it. One runs to forty pages. The other has a three-year plan.

The medical director wanted to send a summary. The finance head is looking at the largest technology purchase the hospital has ever considered. The idea is put aside.

What We Found

We looked at what the public record says about replacing a whole record system in order to exchange records, and at what a smaller path would need to show.

Full replacement is what leaders picture, and the picture is daunting. The US Department of Veterans Affairs set out to replace the record system it relies on, which, in its auditor’s words, “does not optimally support VA’s need to electronically exchange health records with other organizations”. In April 2023, after deploying to five medical centres, it paused further deployments. Before the pause it had identified “14 critical patient safety issues requiring development or enhancement work”.

The money is on the same scale. From fiscal 2018 to mid-2024 the department committed about 12.71 billion dollars to the programme. The contract ceiling has risen from roughly 10 billion dollars to roughly 27 billion dollars.

The programme continues. The department has deployed the system to 11 sites in 2026. A full replacement can be the right decision; it is rarely a small one.

The need to share is usually narrower than the system. An old record system is a set of parts: registration, orders, results, the discharge summary. A request to send one record touches one or two of them. This is our reasoning from how such systems are built, not a finding of the record.

What Rebuilding One Part Opens Up

A proposal to replace everything is usually judged on whether the hospital can afford it. Our reading is that the smaller path frees more than the budget.

• The need is met sooner. The discharge summary does not wait for year three of a programme. It waits for the stage that rebuilds the part that produces it.
• Everything that works keeps working. Registration, orders and results stay as they are. Clinicians keep the screens they know.
• Each stage leaves a record behind. A written account of how one part works makes the next connection easier to plan and to price.
• The board can see progress. “Replacement deferred again” reports a position. A list of records that now move, longer at every review, reports a direction.

This is our reading. It is not a measured market figure.

Three Ways to Share One Record, Weighed

Option	When it fits	What it risks
Build a connection around the old system, leaving it untouched	The old system can already produce the record as a file or report, and is sound otherwise	The connection depends on a system nobody can change. When the old system changes, the connection needs attention. Someone must look after it
Replace the whole record system	The old system is failing in many places, and a long programme is affordable and wanted	Every department changes. The need to share waits for the whole programme. The scale of the risk grows with the scale of the system
Write down the old system, then rebuild the parts that must exchange, one module at a time, most needed first	The system is old, undocumented and used every day, and particular records must move first	Several stages, with two systems side by side for a time. The rest of the old system stays, with its age and its other limits

Where You Are Now, and Where You Should Be

This is the benchmark we would set before the first module moves, and fill in as each module is accepted.

Measure	Typical starting point	Where it should be	How it is checked
Hand-offs done by people	Not counted	Each listed, with what is carried, from which system to which, by whom and how often	The list, confirmed by the desks that do the work
Connections partners have asked for, and their status	Deferred until a replacement is approved	Each one with a stage against it and a status: waiting, in progress, live	Reported at every review
Records re-keyed between systems	The same details typed at several desks	Fewer after every accepted module	Reported at every review
Modules able to exchange their records	None	Each module that must exchange rebuilt and accepted, in the agreed order	Signed acceptance for each module
What moved and how it was checked	Not recorded	Each old function linked to its replacement, with how it was checked	The traceability matrix
The order of work	Whichever request is loudest	Ranked by what each record is needed for, who is waiting and how often it is carried by hand	The ranking, agreed with your clinical and operations heads

The starting points above are what we expect to find. In an engagement they are replaced by your own position, taken in the first review. The targets are what we would work towards with you. They are not results we have already achieved for a healthcare organisation.

A small part of the finished list might look like this.

Record that must move	Stage that rebuilds it	Status
Discharge summary, to the patient’s own doctor	Stage 1: discharge summary module	Live when the module was accepted; the printed copy stopped
Laboratory results, into the main record	Stage 2: results module	In progress; still typed in by the ward
Claims, to the insurer	Stage 3: billing module	Waiting; still prepared by hand

The rows above are an illustration, not taken from a real system.

How We Work With You, and What You Are Left With

1. We listen: a free Reliability Review. A first conversation about the record you need to share, who is asking for it and what you have been quoted. You leave with a short written note of what we found. You can start with a conversation about the system; we ask for read-only code access only when the assessment begins.
2. We research. We research your sector, the regulator’s position and what the public record says about firms in your situation.
3. We read the system and propose: the Legacy System Specification Assessment. It produces a written specification of what the system does, a risk register, a cost comparison between keeping and replacing the system, and a staged plan with a fixed quote. AI does a first pass, our senior engineers review it and trace it to the code, and your own experts confirm it. Code access is read-only and logged, never used for training, and deleted within 30 days of the evaluation ending unless we engage.
4. If you approve, we build. We replace a system one module at a time while the old one keeps running, starting with the module whose records must move first. We never do a single cutover. A traceability matrix links every old function to its replacement. The work is billed by milestone, each milestone tied to a module you accept, and you can pause after any accepted module. Where a module touches clinical work, accepting it is your clinicians’ decision.
5. We review against the benchmark. Before work starts we set the benchmark above. As each module is accepted we show you where each measure stands, and the filled-in benchmark is yours at the end.

The Review is free. Every paid step is fixed price, agreed at scoping. Stop after any step. The findings are yours. The assessment fee is credited in full against the first build stage if it starts within 90 days of the report.

This has a price. The old system remains, with its age and its other limits, and we do not maintain it; your own team or vendor does. Some old systems are in such a state that the honest advice is to replace them, and our assessment may say so. We do not change a product that belongs to another supplier, and we give no advice on the rules for sharing patient records. Staff will go on carrying the records whose modules have not yet been rebuilt.

At the end you hold three things: the specification, the traceability matrix, and a list of the records that now move, with the date each one went live.

What changes for the business:

Role	What they gain
CEO	New services and partnerships no longer wait for the whole system to be replaced.
CTO or CIO	One part is rebuilt to share its records while the rest keeps running, and each later connection is easier to plan.
CFO	Money goes on the part that must share, not on replacing everything to send one record.
COO	Only the desk that needs the change is touched. Every other department carries on as before.
Medical head	Clinicians keep the system they know, and gain the records they were missing.

The cases in this article, and what IOanyT does about that kind of problem:

The case	What IOanyT does
The US Department of Veterans Affairs paused the roll-out of its new record system after five sites, with about 12.71 billion dollars committed by mid-2024.	Our part is far smaller than this case, and we do not work on record systems of that kind. For an organisation’s own applications, we assess before we price and rebuild the parts that must exchange one module at a time, with the old system still running.

IOanyT is a consultancy with its own engineering team: we study the problem, recommend, and prove it by building only what you approve. The next time a partner asks for a record, the answer is a stage on a plan, not a new building.

Book a free Reliability Review →

Get a fixed quote →

See the Legacy System Specification Assessment →