Readers Write: From “Make It Work” to “It Actually Works”: App Rationalization as a Bridge to the Technologies of Tomorrow

From “Make It Work” to “It Actually Works”: App Rationalization as a Bridge to the Technologies of Tomorrow
By  Wes Gattis, RN

Wes Gattis, RN is director of health informatics solutions at Cordea Consulting.

Healthcare IT has long been a patchwork of legacy systems, quick fixes, and digital duct tape. Over time, hospitals and health systems accumulate an overwhelming number of applications, each added with the best intentions but rarely assessed holistically. The result? Bloated tech stacks, hidden security risks, and skyrocketing maintenance costs.

App rationalization isn’t just a cleanup exercise. It’s a strategic approach to aligning IT investments with healthcare organizations’ business and clinical goals. By evaluating, consolidating, and modernizing applications, CIOs can unlock efficiencies, enhance security, and redirect budgets toward innovation.

Why App Rationalization Matters in Healthcare

Hospitals and health systems often inherit an unwieldy IT environment through years of incremental purchases, mergers, and regulatory shifts. This creates significant challenges:

•  Excessive IT costs. Licensing, maintenance, and support costs add up quickly when hospitals run redundant or outdated applications.
• Cybersecurity risks. Legacy systems often lack modern security protocols, making them prime targets for ransomware and data breaches.
• Operational inefficiencies. Poorly integrated applications lead to fragmented workflows, duplicated efforts, and user frustration.
• Lack of interoperability. When systems can’t communicate, it hinders data sharing and coordinated patient care.
• Regulatory compliance risks. Outdated applications may not comply with evolving HIPAA, CMS, and ONC requirements.

App rationalization addresses these pain points by eliminating redundancy, improving system performance, and ensuring that T investments align with clinical and operational priorities.

Key Benefits of App Rationalization

Hospitals and health systems can realize several critical advantages through a five-step structured app rationalization effort:

• Cost savings. Reducing redundant applications lowers licensing fees, support costs, and infrastructure expenses.
• Improved performance. Optimized IT environments improve response times, uptime, and overall system reliability.
• Stronger security and compliance. Eliminating obsolete applications minimizes vulnerabilities and enhances regulatory adherence.
• Better user experience. Clinicians and administrative staff benefit from streamlined workflows, reducing frustration and inefficiencies.
• Scalability and innovation. Freeing up budget and IT resources allows organizations to invest in forward-looking initiatives such as AI, cloud computing, and population health analytics.

A Step-by-Step Guide to App Rationalization

A successful app rationalization effort follows a structured approach:

1. Inventory and categorize applications. Start by creating a comprehensive inventory of all applications used across the organization. Document key details such as application owner, user base, licensing costs, usage frequency, and integration dependencies.
2. Assess business and clinical value. Evaluate each application based on its contribution to clinical workflows, operational efficiency, and alignment with organizational goals. Rank applications using a simple framework. Keep high-value applications that are essential to operations. Replace outdated but necessary applications requiring upgrades. Consolidate redundant applications that can be merged. Retire obsolete applications that no longer provide value.
3. Analyze costs and security risks. Perform a total cost of ownership (TCO) analysis, factoring in licensing, maintenance, and infrastructure costs. Assess security risks that are associated with legacy applications, especially those that are no longer receiving vendor support.
4. Develop a future state architecture. Map out a streamlined IT environment that eliminates redundancies, enhances interoperability, and aligns with strategic objectives. Establish technology standards, cloud strategies, and integration frameworks.
5. Implement and optimize. Execute the rationalization plan in phases to minimize disruption. Prioritize applications that pose the highest security risks or yield the greatest cost savings. Continuously monitor system performance and user satisfaction.

Best Practices for App Rationalization Success

App rationalization best practices include:

• Engage key stakeholders early. Seek input from clinicians, administrators, and IT leaders to ensure that rationalization efforts support real-world workflows.
• Leverage data-driven decision-making. Use analytics to assess application utilization, costs, and user feedback.
• Prioritize interoperability. Ensure that remaining applications integrate seamlessly to support coordinated care and data exchange.
• Review regularly. Reassess the IT environment at least annually to prevent future system bloat and inefficiencies.

A Special Note About Organizational Change Management

Organizational change management (OCM) is often overlooked in an application rationalization effort, but its impact on the effort’s success can’t be overstated. A well-planned OCM strategy ensures that key stakeholders, from IT teams to clinicians and administrative staff, are engaged from the outset, understand the rationale behind changes, and receive necessary support throughout the transition.

Resistance to change is a major hurdle in any IT initiative, and proactive communication, training, and leadership alignment are essential to overcoming it. By embedding OCM practices early in the process, organizations can increase adoption, minimize disruptions, and maximize the benefits of their rationalization efforts.

Moving Forward: Beyond “Make It Work”

Healthcare IT can no longer afford to operate under the “just make it work” mentality. The shift toward value-based care, digital transformation, and patient-centric models requires IT environments that are lean, secure, and adaptable.

Through application rationalization, hospitals and health systems can shed unnecessary complexity, enhance security, and redirect valuable resources toward technologies that drive better patient outcomes. It’s time to build IT ecosystems that actually work.