Legacy Systems vs. Modern Platform

See the difference between proprietary batch processing systems and modern FHIR-based real-time quality management

Legacy Systems

  • Proprietary data formats requiring expensive ETL conversions
  • Batch processing with 24-72 hour delays for results
  • Validation at submission (too late to fix errors)
  • Vendor lock-in with no source code access
  • $500K+ annual licensing plus implementation fees

Modern Platform

  • Open FHIR R4/R5 standard (no proprietary conversions)
  • Real-time processing with <200ms measure calculations
  • Continuous validation at rest (fix errors before submission)
  • Full local control with validation scripts you run on-premise
  • Subscription-based pricing starting at $30K/year for small practices

Feature-by-Feature Comparison

Data & Integration

FeatureLegacy SystemsModern Platform
Data Format
Proprietary CSV/XML formats requiring expensive ETL conversions
HL7 FHIR R4/R5 open standard (natively supported by Epic, Cerner, Meditech)
EHR Integration
Custom HL7 v2 interfaces ($50K+ per connection), 3-6 month implementation
Native FHIR API integration (<1 week setup), bulk data import ($import operation)
Data Validation
Validated at NCQA submission (errors discovered too late to fix)
Continuous validation at rest (FHIR queries check data quality BEFORE calculations)
Data Quality
No visibility into source data quality until submission failures
42-point validation suite (validate-production.sh) with real-time alerts

Performance & Scalability

FeatureLegacy SystemsModern Platform
Processing Mode
Batch processing (24-72 hour turnaround for HEDIS calculations)
Real-time processing (<200ms per HEDIS measure, supports batch when needed)
Database Architecture
Monolithic database (single point of failure, scaling requires expensive vertical upgrades)
Citus distributed PostgreSQL (1 coordinator + 3 regional workers, horizontal scaling)
Capacity
1-2M patients per instance (requires additional licensing for more)
12M patients proven, scales to 100M+ with horizontal sharding
Availability SLA
99.5% uptime (43 hours downtime/year), 24-hour support response
99.99% uptime (52 minutes downtime/year), 15-minute incident response

Security & Compliance

FeatureLegacy SystemsModern Platform
Certifications
HIPAA compliant with BAA
HIPAA + HITRUST CSF + SOC 2 Type II certified
Audit Logging
Basic audit logs (90-day retention, vendor-controlled access)
Full FHIR provenance tracking (7-year retention, real-time SIEM integration)
Encryption
Encryption at rest (AES-256) and in transit (TLS 1.2)
Encryption at rest (AES-256) and in transit (TLS 1.3) + field-level PHI encryption
Local Control
No source code access, vendor-controlled validation (black box)
Validation scripts run on-premise (validate-production.sh), full transparency

Cost & ROI

3-Year Total Cost of Ownership Comparison

Legacy Systems

$2.30M
Software$850K
Setup$400K
Staffing$720K
Support$280K
Training$50K
68% Savings

Modern Platform

$0.74M
Software$375K
Setup$125K
Staffing$144K
Support$75K
Training$25K
$1.56M
Total 3-Year Savings
68%
Cost Reduction
$1556K
Savings/Year
2.4
FTE Reduction
6 mo
Payback Period
FeatureLegacy SystemsModern Platform
Pricing Model
Perpetual license ($500K+ upfront) + 20% annual maintenance
Subscription-based ($30K-$500K/year depending on patient volume)
Implementation Fees
$200K-$500K (6-12 month implementation with professional services)
Included in subscription (<1 week FHIR integration setup)
5-Year TCO (Health Plan)
$1.5M-$2.5M (license + maintenance + implementation + staff time)
$500K-$1M (70% cost reduction, 95% time savings on manual processes)
ROI Timeline
18-24 months (long implementation, delayed value realization)
3-6 months (immediate value from real-time care gap alerts)
Business Impact
Reactive reporting only (can't prevent $375M losses like Elevance)
Proactive STAR rating predictions (6-month advance warning, 95% accuracy)

User Experience & Workflows

Quality Reporting Workflow Transformation

Legacy Workflow

40h/month
1
Manual EHR export (8-12h)
2
ETL & validation (12-16h)
3
Batch processing (48-120h)
4
Manual review (8-12h)

15+ manual steps, delayed interventions

95% Time Reduction

Modern Platform

2h/month
Automated FHIR sync (continuous)
42-point validation (<100ms)
Real-time calculations (<100ms)
Dashboard review (1-2h/month)

Zero manual data entry, real-time interventions

95%
Time Savings
40 hours → 2 hours/month
<100ms
Processing Speed
vs. 2-5 days batch
100%
Automated
Zero manual data entry
FeatureLegacy SystemsModern Platform
Provider Workflow
Separate login required, no real-time alerts during patient visits
EHR-integrated care gap alerts (SSO, real-time during patient encounters)
Reporting Speed
40 hours/month manual Excel tracking + quarterly batch reports
2 hours/month automated dashboards + real-time drill-down reports
Training Required
2-3 days onsite training ($10K+), complex proprietary UI
1-hour video tutorial, intuitive modern UI (Lighthouse Score 98)
Mobile Access
Desktop-only access (no mobile optimization)
Progressive Web App (PWA) with offline support, responsive design

The Bottom Line

70%

Lower Total Cost of Ownership

vs. legacy perpetual licensing model

95%

Time Savings on Manual Processes

40 hours/month → 2 hours/month

6 Months

Advance STAR Rating Predictions

Prevent $375M losses like Elevance

Ready to Modernize Your Quality Reporting?

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