The long and short of it is this: Old code deteriorates over time. It begs to be transported to new platforms. With that, though, comes challenges.
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For payers, probably the most important part of their computer systems are thousands of coded business rules that determine whether or not a particular claim is payable.
With the government now mandating that, when organizations take their systems offline for maintenance, they need to extract business rules and modernize, doing this efficiently and cost-effectively is a big deal.
This is where people like Miten Marfatia of Santa Clara, Calif.-based Evolveware step in. The company develops tools to automate and update IT infrastructure, working with payers to extract rules and integrate them into modernized software.
How important is code modernization? For healthcare payers, it's actually more of a challenge than in other industries. For one thing, this is because regulations change so often, code is perpetually being altered and tweaked to reflect policies in healthcare, which "change so dramatically and so frequently," says Marfatia.
A lot of money and functionality can be on the line too. Marfatia says that "when you're spending 70 percent of IT budget on maintaining old code," an IT department doesn't have much time or money to work on developing new apps or tools.
And many people who even understand older code are disappearing. "The talent pool is shrinking," says Marfatia. "It's becoming more difficult to understand what is being done."
One way to address this is to bring in subject area experts, he says. These are people from within the organization who have an understanding of the rules and who can train the coders on the ins and outs of the business logic of their particular company.
It's an important strategy, because "the tool does the extraction, information is shown in its raw form," after being extracted says Marfatia. Having experts involved in contextualizing the information means the "readability of that logic increases dramatically," and that the payer has a very direct hand in the modernization process.
So is this a one-size-fits-all process? Not exactly, says Marfatia. While the extraction step is pretty consistent, his firm has found that, moreso than in any other industry "the need to make sure that you have the process being used completely ... is very important."
Skipping a step in the process might fly in another industry, but in one with business rules as complex as healthcare means, not following the process to the letter means that "the understanding can sometimes be skewed," he says.
An organization that's looking to modernize their code needs to do a few things, says Marfatia. The first should be a no-brainer: Get together an inventory of all of the code they need to modernize.
Next, they need to figure out how they want the extracted rules delivered back to them. This step suggests an IT department should have an idea of what kind of environment they anticipate operating in moving forward, he says, so that the modernization results can fit into the correct new framework.
Finally, and "most importantly," says Marfatia, "the client will need to allocate the time of their subject matter experts who understand the software application from which rules have to be extracted. This is critical."
