The Road to HIT Modernization Runs Through Application Rationalization
is Senior Account Director at Quoris, with over a decade of experience working with health systems through complex technology transitions. She has deep familiarity with EHR environments and the organizational dynamics that determine whether a technology initiative succeeds or stalls. At Quoris, she leads client partnerships from initial engagement through delivery, keeping the work grounded in each organization's operational realities and strategic priorities.
Kaitlin Traft has seen the modernization conversation play out from both sides: the organizations chasing it and the ones quietly doing the harder work of rationalization first. Her argument is simple, and it cuts against a lot of current thinking. You can’t modernize what you haven’t rationalized. Here’s why that order matters.
There’s a conversation happening in healthcare IT right now, and I think we’re using the wrong word.
Modernization and rationalization are not the same thing. Healthcare keeps using “modernization” when the real word (the real need) is rationalization. Modernization is improving existing technology. Rationalization is deciding what keeps or what goes.
And that distinction matters more than most people realize.
You don’t modernize 400 applications. You look at all 400 and you decide: maybe 300 stay, but 100 go. Because sometimes there’s duplicity in those applications. You rationalize to decommission, to get rid of things you no longer need and then you modernize what’s left.
Think about it in the smallest form. You’re modernizing your EHR to put in AI tools. But you don’t necessarily need those other AI tools you have running secondary, because you’re modernizing the EHR itself. You’re getting rid of tools you don’t need in order to do the thing you actually want to do. The goal may be modernization, but you have to look at what’s under the hood first.
That sequencing (rationalize, then modernize) is where a lot of organizations get stuck.
People think, okay, we want to modernize. But they don’t always think about what happens before the modernization. And those who are moving the fastest right now aren’t just implementing new technology. They’re aggressively simplifying the environment underneath it so they can aggressively move forward with AI, or Epic, or whatever that next initiative is. They’re doing both and they understand the order.
This Is a Workforce Problem, Not Just a Technology Problem
Here’s something I don’t think gets said enough: application rationalization is a workforce strategy.
IT teams in healthcare are usually burnt out and it’s because they’re managing or supporting too many systems. You can’t solve that kind of burnout by asking people to maintain 15 years of technical debt that the organization has absorbed over time and can no longer explain. Over time, the reasons get harder to trace. Systems get absorbed, contracts get renewed on autopilot, and the full picture becomes difficult to see from the inside.
And that’s the thing: in order to actually do an app rationalization, you have to align people across the organization first. You have to get everyone in the room and say, okay, this isn’t working. Where can we focus? What does our full tech stack actually look like? Only then can you look at the applications and start making real decisions.
That process starts with inventory, and I mean real inventory. Yes, there’s a spreadsheet. But more importantly, you’re sitting down with stakeholders across the organization: business application teams, HR, clinical leadership, anyone who has oversight into what their department uses and why. You’re interviewing them. You’re asking what they use, how they use it, and what would happen if it went away. That’s where you find the duplicity. Take something simple, like an AI scribes app. One team uses Abridge, another uses Nuance. Functionally, they do the same thing. So, which one is better? What’s the cost? When does the license expire? You work through all of it and then it becomes: which ones do we retire, and why?
The Real Cost Is Never Just the License
One thing I hear constantly is organizations using licensing cost as the primary lens for retirement decisions. And I get it; it’s the number that shows up on the invoice. But the licensing cost is almost always the smallest part of the problem.
The real cost is the infrastructure the license sits on. It’s the interfaces, the upgrades, the analysts, the support tickets, the governance overhead, the downtime risk. There are so many layers beyond that one-line item. And most organizations massively underestimate it.
There are a few other questions I think about when we’re working through retirement prioritization. Does your EHR already do this? If you’re an EHR-first organization, that’s often the first filter. If your EHR can replicate the workflow, then you centralize the data and bring it in. The question stops being “should we keep this application” and starts being “why are we paying for something our EHR can already do?”
Then there’s the clinical workflow piece. If a clinician has to leave the EHR, log into something else, do a thing, and come back… that’s a disconnect. That’s friction at the bedside. A nurse managing 15 patients doesn’t have time to go in and out of systems to get what they need. Does the application simplify their workflow, or does it interrupt it? That answer matters.
And then there’s the forward-looking question: is this application accelerating AI adoption, or is it blocking it? Because if data is siloed, if the outputs are inconsistent, if the application can’t connect to where the organization is going, it’s not worth maintaining. Get rid of it.
The Question I Always Ask
The most important question in any rationalization conversation isn’t “should we keep this?” It’s: what happens if we don’t retire it?
Because doing nothing is the most expensive part. If you don’t look at it, you could have an application running for years (i.e. still paying for it, still staffing it, still managing it) and nobody knows exactly what it’s doing or whether it was ever worth it. That’s technical debt accumulating quietly. That’s operational burden nobody budgeted for. That’s fragmented workflows nobody designed.
Application rationalization isn’t an IT cleanup initiative anymore. It’s a prerequisite for operational efficiency, for AI readiness, for whatever long-term EHR strategy you’re trying to execute. The organizations getting it right aren’t treating it as a side project. They’re treating it as the foundation.
You can’t build on a bloated portfolio. You have to know what you have before you can decide what you’re becoming.
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