How and Why to Maintain and Support Medical Applications?

19 May · 12 min read

How and Why to Maintain and Support Medical Applications?

The healthcare industry is increasingly becoming digital, and patient-centered applications have gained huge popularity over the past years. So, medical software is in demand among clinics and healthcare startups. But, solutions released for this niche require constant support and maintenance to be both useful to customers and regulations-compliant. 

The adverse effects of neglecting regular maintenance procedures are software errors, data breaches, and violations of healthcare standards. Still, the need for everyday support of your application doesn’t mean you should have an in-house software development team.  

A remote intervention from DevOps or an engineer can be enough for software diagnostics and medical system management. This person can also perform necessary security checks, fix bugs, implement updates, and address feedback from users.

What Support and Maintenance Mean for App Development

Support and Maintenance are sets of procedures carried out by software developers to ensure IT ecosystems’ high performance. Support is urgent assistance that is delivered by request to resolve destructive issues. Maintenance is a scheduled work needed to fix non-urgent issues. The combination of both is the key to an app’s continuous performance. 

Most medical software hosts sensitive patient data. They must comply with standards and regulations that protect this data. An example is the American Health Insurance Portability and Accountability Act (HIPAA) which sets security and privacy rules for software that in any way interacts with protected health information (PHI). Support and maintenance are required by HIPAA’s Security Rule, for instance, because of the necessity to process and analyze audit trails of in-software interactions with PHI. 

Healthcare also uses a lot of software — Hospital Management Systems (HMS), Patient Management Systems (PMS), Electronic Health Records system (EHRs), and so on. These are frequently designed as stand-alone software and are an integral part of any clinic’s operation. In case one or both malfunction, medical staff will have difficulty delivering the care or reimbursing their services. The probability of medical or administrative errors occurring will also rise. These issues have to be addressed as well — and it’s partially done via maintenance and support.  

Types of App Maintenance

Two main maintenance strategies with different timetables and goals exist:  

  • Long-term maintenance. This type of project focuses on ongoing software improvements. It can last from twelve months to however many years the software exists. The main goal here is to enter “non-stop improvement” mode and adapt an application to a continuously changing healthcare environment.
  • Reactionary maintenance. It is rather a one-time project intended to deliver particular improvement efforts: to debug, troubleshoot, do quality assurance updates, and so on. Reactionary maintenance can last up to six months if the reported issue is found on a large scale.

Besides, there are four concepts for executing app maintenance and support: 

  • Corrective maintenance. This approach is often applied after the release of software or an update. It helps to address unanticipated malfunctions as soon as they occur and release a patch or an update that fixes them.
  • Preventive maintenance. It is an approach for accessing potential risks, anticipating malfunctions, and installing detection and mitigation controls for them before they occur. That approach covers threat detection safeguards for preserving data integrity.
  • Adaptive maintenance. This is the release of modifications or adjustments for the software because of changing business needs or technological trends. For instance, when Windows 7 stopped being supported by Microsoft, all software companies that create apps for healthcare had to, ideally, update their apps not to support this OS.
  • Evolutionary or perfective maintenance. It is all about integrating new features into healthcare software, optimizing its performance, and so on. This approach does not solve a particular issue but aims to improve user experience overall.

Combining different forms of maintenance enhances software usability and value.  

Why Maintenance and Support Are Necessary for Healthcare Software

In the digital age, delivering high-quality care requires software — especially after two years of the pandemic. Consequently, the health and well-being of patients majorly depend on how medical apps function. 

Here are the details of why it’s vital to run support and maintenance procedures regularly: 

  • Prevent technological stagnation. Healthcare facilities must take advantage of the latest technologies with the potential to improve the treatment success rate. Timely maintenance and release of updates or adoption of new software can enhance care services with, for example, new monitoring devices for the detection of anomalies in patients’ vital signs.
  • Upgrade the legacy system. Healthcare professionals often use outdated software and hardware — for instance, a lot of them still run their computers on Windows 7, which, apart from being old, is a huge security liability. Legacy systems are also often fractured, disconnected, and not compatible with the new technologies. So, they also are to be improved.
  • Resolve technical issues. It’s not possible to build software that will continuously work perfectly. Reactive maintenance is a solution to fixing errors, bugs, and UX flaws that might impact the usability of the software and trump the value it’s supposed to bring to healthcare operations.
  • Improve business performance. Streamlining a medical facility’s performance and increasing business capabilities sets new requirements for software healthcare uses. So, continuous optimization of applications and integration of additional features are due.
  • Adapt to new market rules. The healthcare industry, especially its private sector, is highly competitive. For a business to stay in the market, it should keep up with its rivals — upgrade the software to maintain the competitive edge of its services.

Healthcare software plays an essential role in the industry, so investing in its support and maintenance is a cost-effective decision that allows to both improve patient and doctors’ satisfaction with the care process and reduce costs of mistakes, rework, and so on. 

What Maintenance and Support Services Are There?

Let’s talk about support and maintenance types and services they include. 

Security Management Support

Meeting strict security requirements is necessary for healthcare apps. Recurrent maintenance and support prevent data breaches and protect sensitive patient information. Also, continuous monitoring risk management-related maintenance often lowers the probability of software shutdowns because of cyberattacks. 

Here are the three security management concepts that are relevant for digital health:

  • Information security management focuses on mitigating threats to data.
  • Network security management includes implementing network segmentation, integrating network defense systems, and monitoring connected devices.
  • Cybersecurity management protects all aspects of IT ecosystems, including cloud infrastructure, applications, APIs, and Internet of Things (IoT) devices.

Combining these approaches is a key to achieving a superior security level.

Implementation of New Features

Maintenance of healthcare applications naturally includes releasing updates and introducing new functionality in the software. 

  • Health tracking features (wearable-based trackers and self-reporting tools)
  • Cloud integration
  • Symptoms checkers (chatbots, surveys)
  • Video chats
  • AI and ML algorithms in diagnostics tools
  • Blockchain technology for payments

Each of these features and technologies requires developers’ attention and continuous testing and improvement of its capabilities.  

Compliance with HIPAA Guidelines and Regulations

Many data breaches still happen because of inadequate security policies adopted by healthcare system institutions and vendors who provide solutions for them. So, HIPAA provisions regarding privacy and security in healthcare are updated regularly to keep up with new environments in which patients’ health info needs to be protected.  

Meeting the changing requirements is a headache. But violations of HIPAA may lead to irreversible damage to patients’ well-being — in particular because PHI records often contain financial information. Those who don’t comply with HIPAA receive penalties and even prison sentences. Since the Omnibus Rule’s introduction in 2013, Business Associates (BAs) — organizations that don’t provide healthcare services but interact with patient data in any way (host it in the cloud, for instance) — are obligated to follow HIPAA as well. 

So, requesting a digital health software development agency to audit your software, make it HIPAA-compliant, and conduct support and maintenance procedures is a good way to avoid harming your users, paying fees, and becoming a victim of cyberattacks. 

Bugs or Technical Issues Fixes

Bugs in the usual apps we use day to day are annoying and cost companies a lot. However, the price of medical software malfunctioning is much higher. For example, if a symptoms checker feature or a continuous monitoring tool provides an inaccurate report, a patient might receive the wrong treatment. In a best-case scenario, they would just have an unnecessary and costly doctor visit — in the worst-case scenario, machine learning (ML) algorithms that are supposed to alert doctors when something in patients’ vitals goes wrong don’t activate. 

Dev agencies that offer comprehensive support and maintenance services run software audits and tests to detect errors. They also fix bugs ASAP. Apart from that, support and maintenance operations related to the implementation of ML as a diagnostic tool or digital therapeutic, would require tuning the predictive models and achieving better accuracy.

Upgrades for Outdated Software

Outdated applications are prone to data breaches and frequent system failures. They also may have inadequate performance overall. Releasing updates that improve software’s performance and patch up its vulnerability is the way to extend its life cycle.

One of the approaches to upgrading software is re-engineering: developers examine an existing system and reconstruct it around the main concept, with new technologies at an affordable cost. 

Plus, the software may start malfunctioning after the release of a new OS version. It’s customary to release a corresponding update to prevent errors in that case — that’s a part of support and maintenance, too. 

Continuous Healthcare Software Maintenance

As previously detailed, long-term maintenance is beneficial because it ensures that customers receive a superior user experience via reactive and proactive updates, patches, and improvements. 

Continuous software maintenance includes:

  • Constant software auditing
  • Analyzing users' feedback
  • Scheduling maintenance procedures
  • Panning the release of updates

Regular maintenance ensures that your healthcare application works well at all times, and that’s already a significant competitive advantage. 

Cost and Resources Required for Healthcare Software Support

Let’s separately review labor resources needed for software support and price estimations.

Roles Required for Healthcare Software Support

So, a development team for support and maintenance jobs for digital health software would require:

  • Help Desk Specialists. They are software assistants that help users remotely via phone, email, chats, and so on. Teams of help desk specialists commonly operate 24/7.
  • Software Developers. Engineers that improve software code. The scope of their responsibilities and workload depends on software maintenance tasks.
  • DevOps Engineers. These specialists implement changes in the software. It includes addressing infrastructure limitations, introducing Continuous Improvement/Continuous Delivery (CI/CD) practices into the workflow, setting up automation, meeting the back-end needs of applications, and so on. The effort required from DevOps engineers depends on the medical project scope and the frequency of updates it needs.
  • Quality Assurance (QA) Engineers. They are software testers that verify that essential software changes do not cause code conflicts and make sure the solution works well. QA engineers perform functional, integration, and regression tests.
  • Application Support Engineers. These specialists are responsible for continuous software monitoring and performing routine checks. They address issues with the performance stability of applications and run maintenance of database systems. In small teams, DevOps and support engineers have the same scope of responsibilities, though in large enterprises DevOps is more of a high-level role.

The list is not extensive, of course. Large projects may require additional efforts from domain experts, project managers, UX researchers and designers, and other specialists. 

Costs of Healthcare Software Maintenance

There are two basic compounds of a support services’ pricing:

  • Hourly rates. Support and maintenance teams’ wages vary depending on their role, experience, the region they live in, plus domain expertise.
  • Workload/Time spent. The number of dev team members and the amount of time they spend on your project weekly may significantly fluctuate. The average involvement is about 10-30 hours per project, but the number rises after the release of new features, new marketing campaigns that bring more users, and so on.

The basic formula to calculate an approximate investment is to multiply an average wage by the number of hours to be spent on your project. 

Let’s assume that you need a team consisting of one DevOps engineer, two software developers, one quality assurance specialist, and one project manager. In case each of them spends about 20 hours per week on your project, and their average wage is $50, the weekly support and maintenance cost for your app is $5,000. For more accurate estimates, contact an agency or software vendor you’d like to work with and ask them about their rate (don’t forget to check their portfolio). 

What Are the Risks of Neglecting Regular Software Maintenance?

Let’s talk about the ramifications of not maintaining digital health software. The main risks are:

  • Security risks

Healthcare data breaches happen frequently. The most common reasons (apart from human error and lack of cybersecurity awareness) are weak network security, misconfigured software settings, and software vulnerabilities. Since the methods of cyberattacks are upgraded regularly, it is impossible to prevent data breaches in the development stage. It’s necessary to install measures for their quick detection. Not conducting regular security audits and not patching up vulnerabilities increase the risks of an attack bringing the software down.

  • Unplanned downtime and administration risks

As previously mentioned, the operation of healthcare facilities is based on software that needs to work constantly and consistently. The types of data hosted in HMS, PMS, and EHRs are medical records, contact details, insurance information, bill payment details, appointment dates, and so on. If they shut down, it’s impossible for medical workers to, for instance, find patients’ history and their recipes, see their lab results, and so on. That downtime can cause direct harm to patients’ health. 

  • Risks of not meeting regulatory requirements

HIPAA-like regulations that protect patients’ data exist in many countries, and it’s preferable if you comply with them if you want your digital health app to go to market without encountering troubles with the law. Some regulations protect people’s data on the web in general, like General Data Protection Regulation (GDPR). It covers the user data of EU citizens. If you want your software to be reimbursed by insurers and/or used as a medical device or digital therapeutic, it should comply with FDA requirements. The simplest of regulations digital health app developers face are Android and iOS requirements for apps and apps with wearables. All these are updated regularly, and the risks of violating their provisions increase exponentially if software maintenance is neglected.  

  • Risks of medical errors

Unclear UX of digital healthcare software can lead to, for instance, doctors prescribing an unnecessary drug, non-optimal drug, or a non-optimal dose if the system incorrectly auto-fills the drug name. Patient databases that aren't consistently updated with the latest lab results might cause doctors to set up another unnecessary and expensive test. Poor software design confuses both patients and doctors and leads to inaccuracies. Collecting feedback on your software and updating it helps avoid these. 

Where to Begin with Healthcare Software Maintenance?

The healthcare industry requires software developers, vendors, and healthcare institutions that adopt new software to pay close attention to regulatory standards and operational stability. It’s best to combine reactionary and long-term maintenance for software support. 

Here are the steps to follow to optimize software maintenance and make sure that your app works seamlessly:

  1. Determine the requirements for healthcare application maintenance and support. Conduct risk assessments and define the critical, most vulnerable parts of your software and the processes it’s applied within. It may be privacy and security aspects, software-related infrastructure, user experience, etc. These would be aspects requiring further maintenance and improvement.
  2. Choose a maintenance model. Select the combination of app maintenance types that cover your business needs. For example, it is not always possible to finance predictive maintenance, but your healthcare app must have both corrective and reactive maintenance.
  3. Build your team and plan an implementation strategy. Once you have a basic understanding of what maintenance and support you need, you can identify what specialists are required to oversee them. After you’ve assembled the team, address the most critical, high-impact concerns first.

Support and maintenance are often overlooked when planning cost estimates for the project — but these operations help your app and business be more adaptive and resilient to disruptions. Within the industry that’s both the most lucrative target for hackers and incredibly dependent on external factors, these qualities are vital.

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