Modernizing Legacy Healthcare Systems: A Data Mart Transformation for Clinical and Research Excellence

Challenge

What happens when critical research and clinical care data are housed in a mainframe database from the 1980s and must be migrated to a more modern electronic health management system?

Legacy systems often bring significant technical debt and resistance to change. Aging technology systems can plague even the best organizations by requiring a major redesign of how data is collected and stored. This was the challenge faced by a healthcare organization, world-renowned for its innovative advancement in science and medicine. To help navigate this complex transition, the organization engaged Forum to lead the modernization effort and guide the transformation.

Over the decades, medical research at the organization had expanded beyond the original narrow diagnostic focus that was first established in the custom mainframe database. As the organization grew, the database became increasingly unstable and inefficient as it needed to be frequently patched to accommodate the evolving data.

Previous efforts to modernize the system had failed, leaving key stakeholders skeptical that the legacy platform could ever be fully replaced. Large-scale system upgrades are inherently difficult, especially when they require organization-wide adoption. But when the change affects how people have worked for decades—particularly in contributing data that supports research grants and fuels new clinical trials—it must be handled with care. The transition must be gradual, deliberate, and grounded in a step-by-step approach.

In research healthcare settings, clinical care and research are deeply intertwined. Clinical trials depend on data collected in the clinic, and research programs drive requirements for what data needs to be captured. This creates a symbiotic relationship where clinical workflows must support detailed, structured data collection for long-term research use.

Forum Solutions helped a world-renowned healthcare organization to modernize decades of critical research data—transforming a fragile 1980s mainframe into a unified, future-ready data mart that now powers the most robust longitudinal research dataset in its field.

Many clinical studies require longitudinal data spanning 15–20 years, introducing significant challenges for data infrastructure. The core solution needed a data mart that could integrate legacy mainframe datasets with modern electronic health records—ensuring consistency, accessibility, and fidelity across decades of evolving systems.

Approach

Forum Solutions partnered with subject matter experts (SMEs) to design a data mart that could blend the legacy mainframe data with the new data from modern electronic healthcare systems, incorporating differing data formats and specific methods required to update official medical records. The outdated medical data needed to be blended with more modern data in a structure that was research ready.

Forum Solutions led the requirements gathering process in partnership with key client SMEs. We managed expectations and priorities across the client teams to create a balance between research and clinical requirements. We began the change management process early and met with SMEs often, as some SMEs had spent their entire career working with the data in the old system. We collaborated with them to understand how they had spent decades building and maintaining statistical datasets to support the research data needs.

These SMEs had deep expertise in the data, were partners to the research investigators and frequently cited on research publications. Importantly, this change in technology was not advocated by them, making adoption a challenge. For them, the new data mart was like having their favorite book written in a language they did not understand. They knew what data was in there but struggled to understand how to get it out.

Our team collaborated with them to present the new technology and the benefits of upgrading to the new data mart. Their deep knowledge of the data helped us understand how to best blend the legacy data with the new clinical data. By working alongside the SMEs, our project team was able to build trust with them and bring them along on the journey.

Results

The Forum team successfully delivered a unified data mart that combined decades of legacy data with modern electronic health records—creating the world’s most robust longitudinal research dataset for specific disease interventions. This solution not only preserved data integrity but improved accessibility and reporting efficiency, allowing researchers to work with a broader, more comprehensive dataset than ever before.

Over time, SMEs gained confidence in the solution and began independently exploring the new technology even before full rollout. Forum’s phased change management approach fostered trust and engagement, resulting in SMEs independently exploring the technology and integrating it into their workflows.

Extensive data validation—spanning hundreds of datasets—confirmed the integrity and reliability of the new system. Minor discrepancies were resolved without compromising accuracy, reinforcing stakeholder trust. The result was a durable, trusted platform. The new data mart streamlined reporting and expanded research capabilities without compromising trust or precision.

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