AWS Institute

Independent think-tank, Reform, facilitated a session in March to focus on the legacy IT challenges facing the English National Health Service. Attendees identified three policy challenges associated with legacy transformation: management of risk, supporting people (skills and ways of working), and ensuring value for money.

Managing risks
Attendees agreed there could be issues with expressing the risks associated with using technology, both in terms of remaining on legacy technology and of migrating to newer technology. Articulating these risks in non-technical terms, referring to the impact on patients wherever possible, would help address those issues. Real case studies, anonymized, of what not to do - and of failure - are needed, as well as relevant guidance and resources to help organizations migrate well.
“The more a legacy migration program is delayed, the further the impact on patient and healthcare practitioners in terms of missed benefits of digital transformation,” - Reform
Mapping legacy IT, which has generally “grown organically, creating a jigsaw of systems within organizations, and the interdependencies between these systems are poorly understood,” would also help healthcare leaders understand their IT risk better, including those without an IT background. Systems such as Wardley Mapping, a technique that the AWS Institute Government Executive Education program covers in depth, would be an example.
Attendees acknowledged that healthcare organizations might have concerns about the risk involved with transitioning from one IT system to another. The group believed migration should be incremental to help mitigate this risk: “Organizations need to think about [legacy migration] in terms of the broader organizational transformation, and not simply do a lift and shift of old structures.”
An important success factor would be to express IT risk in the same terms as clinical risk, and giving it a monetary value, to help non-IT board executives truly appreciate the potential cost of failing to manage legacy IT.

Supporting people, skills development, and ways of working
The report noted that there can be challenges in the public sector with recruiting and retaining enough people with the right skills, including those required specifically for managing legacy IT. Attendees suggested a range of solutions, including creating in-house training for staff at all levels to increase digital literacy, which in turn could improve decision-making.

Ensuring value for money
NHS organizations could develop case studies and cost-benefit analyses to help their teams make the business case for legacy migration projects, attendees suggested. For example, identifying business problems that could be solved through legacy migration creates a clear rationale and could increase board-level buy-in, as could articulating the return on investment of a legacy migration project.
Public sector IT, including in the healthcare sector, historically has been funded from capital budgets (capex), leading to a tendency towards longer projects and lock-in of more traditional IT, instead of more incremental transformation through Software as a Service products, which are funded from operational budgets (opex).
The report concluded that healthcare organizations could become “more informed buyers”. This means asking suppliers for discounts and for practical support to transition legacy IT; asking for break clauses; inspecting existing contracts for ‘terminate for convenience’ clauses; and planning incremental improvements with iterative funding. Read the Reform paper.

These were some of the views that a panel of experts discussed as they considered Peru’s Digital Transformation Journey, hosted by the AWS Institute and AmCham Perú in March 2021. Modernizers could address challenges such as government bureaucracy by drawing on external support (such as GovTechs and CivicTechs, startups that serve governments and nonprofits), as the OECD’s Head of Digital Government and Data Unit, Barbara Ubaldi, suggested. However, as IT procurement regulations designed in the 1990s continue to block transformation, these need to be reformed. One solution could be to follow other governments who use contracting vehicles for cloud technology, suggested Andrés Calderón, author of Digital Peru: the Road to Transformation.

Looking ahead, digital transformation will enable governments to improve policy decisions because significant amounts of data will enable better insight. Digital government will become smart government, said Carlos Santiso, Corporate Director of the Comisión Andina de Fomento’s Digital Innovation in Government team. The analysis behind the public discussion and paper also produced recommendations for accelerating transformation.