Management

Healthcare Organizations Shouldn’t Delay Addressing Technical Debt

Although healthcare IT leaders are juggling many priorities, they need to have a clear strategy for tech debt remediation.

Mike Larsen

Mike Larsen is an accomplished information technology leader with over 19 years in the healthcare industry spanning inpatient and outpatient service lines. He has extensive project and program management experience, including the implementation of Epic electronic health records and the development of enterprise analytics and architecture functions.

Healthcare leaders have their organizations’ financial outlook top of mind amid a tough labor market. Nearly every conversation I’ve had with leaders has involved questions about cost containment or optimization as organizations juggle budget and operational concerns.

That has led healthcare organizations to scrutinize maintenance contracts and renewals, putting a spotlight on issues such as technical debt.

From its origins in software development, tech debt refers to the choices made to delay necessary maintenance or replacement of IT systems that will eventually impact an organization’s operations, according to Gartner.

Healthcare is not immune to tech debt, as most organizations still use a number of legacy software applications and medical devices. As healthcare organizations continue with their digital transformation, they must balance debt remediation with new platform investments.

The future of technical infrastructure is cloud, and this trend will likely have a net positive effect on tech debt. For example, cloud-native platforms and microservices have drastically changed the rules of engagement, allowing organizations to avoid traditional on-premises installations and deliver immediate value while reducing total cost of ownership.

DISCOVER: How do IT cost optimization strategies promote business value?

Make It Simple to Understand Tech Debt

Healthcare organizations have to recognize they have a problem before they can solve it. That’s why it’s important to share the implications of tech debt throughout an organization. The most successful IT leaders communicate the concept in the simplest of terms and connect the impact of inaction with the organization’s strategic mission.

Similarly, it’s best to avoid information overload and tech jargon, while conveying the risk to operations.

There are countless examples of new technology investments that have been handcuffed by tech debt. Say a health system is in talks to build digital patient access to support patient engagement. It is critically important for IT leaders to evaluate the current technical stack of applications, platforms and related interdependencies. In this way, organizations can address deficiencies as part of the overall technical implementation. This approach also guarantees that tech debt remediation is included in the total project cost.

Organizations can become quickly overwhelmed by tech debt at scale without tying remediation efforts to the vision of the organization. Avoid boiling the ocean by looking at specific processes or systems that must be upgraded or replaced to fulfill your organization’s mission.

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Rethinking Tech Debt in Healthcare

When I think of tech debt, I think about when the cost to maintain a legacy application exceeds the value to an organization. There are direct and indirect costs to maintain these tools in healthcare, whether it’s a server, an endpoint device or a cloud-based platform. When that cost exceeds the value, as determined by the organization, then tech debt or disrepair accrues.

Organizational leaders can look at tech debt as a liability on a balance sheet, strictly viewing the issue in financial terms. What they really should consider is tech debt as measured by the potential risks to care delivery and service to patients, keeping in line with healthcare’s overall mission. If tech debt is not addressed in a meaningful way, the cost of keeping the status quo will impact an organization’s ability to be innovative and drive positive change.

Don’t Let Tech Debt Fade into the Background

Healthcare organizations understand that there are risks involved when operating unsupported legacy systems, but fully eliminating such systems would be cost prohibitive, to say the least. No matter how tightly organizations plan for it, there will always be a level of tech debt that’s unavoidable. Every piece of hardware or infrastructure has a shelf life, or a mean time to failure, starting from the date of installation or the date it’s shipped out to a facility.

There are also budget realities that occur every year when replacements are delayed or deferred because there are competing priorities.

And, finally, tech debt requires not just the allocation of financial resources but also human resources. If these resources aren’t well allocated to address tech debt, issues will linger.

For example, Kurt DelBene, assistant secretary for information and technology and CIO of the U.S. Department of Veteran Affairs, discussed making key investments in the agency’s staff to address tech debt. “None of it works unless you have a great investment in people, and people are our greatest asset, and they are a scarce asset,” he said in a 2023 interview.

Still, organizations can mitigate some tech debt by avoiding the implementation of monolithic platforms or solutions, especially if those create more silos instead of fostering better connectivity across an organization’s ecosystem. The healthcare industry is evolving to require improved interoperability, so avoid solution lock-in scenarios that will exacerbate tech debt.

This article is part of HealthTech’s MonITor blog series.