Refactoring EHR Software: Turning Legacy Code into Clean Code

What are EHR Software Applications?

An Electronic Health Record (EHR) software is a digital version of a patient’s paper chart in a healthcare facility. It includes a comprehensive set of patient data, such as medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory test results. EHR Software go beyond the standard clinical data collected in a provider’s office and include a broader view of a patient’s care.

However just like any other product, its lifecycle is dictated by both external and internal factors that urge the necessity of maintaining and optimizing the software to keep it up to date and cope with the industry standards. This process is called sofware maintenance & refactoring and is the last part of an application lifecycle.

Often, refactoring, or the process of restructuring software code, is overlooked. Why? Mainly because the improvements it offers are invisible to the end-users. Prioritizing immediate revenue-generating enhancements or meeting specific customer needs might seem more compelling. Indeed, many in the IT sector would argue that focusing on the frontend makes more business sense.

Yet, behind the scenes, product and development managers understand that refactoring plays a pivotal role in software quality and efficiency. Initial software development often involves compromises to meet pressing deadlines or specific customer needs. But this often incurs “technical debt”, which must be addressed eventually.

Understanding Refactoring:

Refactoring is the process of reorganizing software without altering its original features. The goal? Enhance software performance and simplify future development. Essentially, it’s about investing development time in enhancing software quality rather than adding new features. Refactoring, when rooted in practical experience rather than theory, yields the best results.

Why Refactor?

The risks of postponing refactoring are significant. The onus is on technical leads to advocate for refactoring and collaborate with the development team to plan its execution. Integral to this process are quality assurance (QA) and testing since they identify critical areas needing improvement.

Commencing a Refactoring Project:

Initiating refactoring requires a clear strategy within the team taking on the challenge.

Some of the most common mistakes encountered in a refactoring project are:

1. Ambiguous Goals: Even though refactoring doesn’t add new features, its outcomes should be measurable. Set clear objectives to guide the team in the process, such as:

• • Identifying primary issues to address.
  • Â Defining desired outcomes and their beneficiaries. 
  • Assessing potential risks and mitigation plans.

2. Inadequate QA/Testing: Without thorough QA/testing, refactoring might introduce more issues than it resolves. Ensuring ample unit testing before refactoring can provide a safety net against unintended consequences.

3. Expanding Product Backlog: It’s tempting to refactor large code segments quickly. But this can lead to an overwhelmed development team, struggling with both new and old code. Segmenting the code and tackling it in manageable blocks can streamline the process.

4. Insufficient Documentation: Legacy software often comes with poorly documented code, making it challenging for new developers. Refactoring critical components demands a deep understanding of the code, best left to seasoned developers familiar with the legacy system.

5. Inconsistent Reporting: Celebrating the milestones achieved during refactoring can motivate the team and validate the effort to stakeholders. Demonstrating tangible benefits, like reduced support hours and enhanced software scalability, provides a compelling narrative of the project’s success.

Challenges in a Software Refactoring Project 

Moving forward we would like to share some challenges that we faced in our collaboration with a customer using a complex EHR/EMR software application based on PHP. 

Understanding our customer’s needs 

The initial step in our refactoring process was a thorough understanding of our client’s requirements. This crucial phase involved:

1. Identifying codebase sections for refactoring: we pinpointed specific areas or modules in the codebase that need revamping.
2. Clarifying desired outcomes: this includes improvements in performance, strengthened security measures and integration of any new features.

Leveraging Test-Driven Development (TDD) for Efficient Coding

Our approach began with gathering all necessary requirements, followed by initiation of the coding process using Test-Driven Development (TDD).

• • Creating Test Cases: we started by writing tests that reflect the existing functionalities of the targeted code segments. These tests act as a protective layer, ensuring the integrity of current features during the refactoring process.
  • Refactoring in Phases: guided by the initial failing tests, we methodically refactored the code in small, manageable increments.

This method significantly enhanced the team productivity and sped up the delivery process.

Addressing Legacy Constraints in PHP 5.2

Given the legacy limitations of PHP 5.2, our focus areas were predominantly security enhancement and performance optimization:

• • Updating Deprecated Functions: we replaced outdated functions with more secure, modern alternatives.
  • Enhancing Security Measures: this was achieved through stringent input validation, output escaping, and the use of parameterized queries.
  • Optimizing Performance: we streamlined critical sections of the code to boost performance efficiency.

Conducting a Thorough Code Review

Before concluding the refactoring process, we conducted an exhaustive code review. This essential step ensured that the code aligns with established coding standards, best practices, and verifies the accuracy of the new functionalities.

Staging and Deployment

After the refactoring phase, we deployed the updated code to a staging environment for extensive testing. This is a precursor to its release in the production environment. Post-deployment, we diligently monitored the application to quickly address any potential issues.

Conclusion: The Far-Reaching Impact of Refactoring

Our systematic adherence to client requirements and the TDD methodology ensured a smooth transition in the refactoring of the legacy PHP 5.2 project. This resulted in the timely delivery of new features with minimal bugs.

Refactoring, often perceived as a technical backend task, has far-reaching implications on a product’s lifecycle. A meticulously executed refactoring strategy lays the groundwork for a software system that is robust, flexible, and efficient.