What Is Technical Debt, and How Is Healthcare Managing It?

What Is Technical Debt?

IT systems require regular maintenance. As the technology evolves, systems become outdated and eventually require upgrades or a replacement. An organization incurs technical debt when the decision is made to delay necessary maintenance or put off replacing an aging system.

“Outdated systems and technologies can cause inefficiencies that result in higher costs, safety concerns and security breaches,” Waisbrot explains, adding that there is also an increased risk of “extended outages and unplanned downtime.” 

“Every organization has some technical debt,” says Chuck DeVries, senior vice president and technology officer for Vizient. “It’s like credit card debt. It’s not the end of the world to have it as long as you’re taking care of it.”

Examples of Technical Debt in Healthcare

An outdated email system or database server is an example of technical debt. “If you haven’t performed the right patches, then you’re open to vulnerabilities, and someone could more easily hack the system,” says DeVries.

“As more systems have become cloud-based, you may look at technical debt a bit differently because that’s a managed environment,” DeVries continues. “With an electronic health record platform, for example, the vendor may handle particular software version patches, but your organization needs to be ready to accept those updates into your workflows.”

Technical debt also refers to tools with additional capabilities that the healthcare system hasn’t used yet. Dr. Jason Hill, innovation officer for Ochsner Health, offers an example of a camera system that enables support staff to help supervise patients virtually.

“Let’s say the camera has an application programming interface that you could plug in, and you could train an AI to help monitor those patients. But you just want the hookup between the patient and the provider. The delta between those two would be considered your technical debt,” says Hill. 

How to Measure Technical Debt

Viewed through a financial lens, technical debt can be measured by evaluating whether continuing to fix a legacy system is more expensive than replacing it. 

As DeVries says, it may be easier for an IT team to request the resources it needs to address technical debt if it’s explained using dollars and cents. “That’s the lingua franca of business,” he says. “You may say, ‘I need 40 hours of the IT team’s time to pay down the technical debt.’”

Technical debt is also quantified based on whether it hinders job performance or negatively impacts patient care. 

“You will never have zero technical debt as long as you’re implementing new technology. Organizations need to identify what the acceptable level is,” Hill emphasizes. “One option is you move fast and accumulate financial debt, but you achieve functionality before everyone else. The other end of that scenario is you move too slowly, and the standard of care speeds past you.”

Strategies for Reducing Technical Debt

Having a structured way to consistently track how IT systems are performing is an important first step, DeVries says. “Understand what the backlog looks like and identify where the risk pieces are. You can’t fix what you don’t know.”

DeVries also recommends running regular security scans to check for vulnerabilities. 

To become more agile, Hill adds that healthcare organizations could focus on the minimum viable product. “What do I need to get this technology ready so people can start using it? Then you can build on it,” he says.

READ MORE: Why should healthcare providers address technical debt?

Another key strategy is to stagger updates rather than attempting to address all of the technical debt at once.

“At UW Health, we invest in replacements, new technology and modernization in smaller, more consistent and manageable time frames,” Waisbrot says. “There is more visibility and real-time value, with an expectation for funding each year, instead of making large capital investments every few years.”

Waisbrot says his organization’s decision to focus on software instead of physical facilities has also been a positive change. “We decommissioned most of our regional data centers. Our new strategy involves colocation facilities and cloud resources,” he explains. “The benefit is we can leverage the cloud to create an agile infrastructure to more rapidly meet demand.” 

The Overall Cost of Technical Debt

Healthcare organizations are a top target for hackers. The average cost of a healthcare data breach was $9.77 million in 2024, according to IBM.

The threat of cyberattacks is “one of the scarier risks of technical debt,” says DeVries. “Big breaches almost always trace back to some software that wasn’t up to date, which is usually at an operating system level.”

Failing to prioritize technical debt could also mean the organization is unequipped to use new technologies like AI. There are also financial costs, as Hill points out. “Outdated technology puts you behind the curve. If you don’t keep up with the pace of change, then later you’ll have even more catching up to do.”

DeVries adds that making technical debt a consistent priority is the best way to drive infrastructure modernization. “You don’t buy a building and then never do anything to it. You have to paint it and refresh the interior. Those are the types of things you need to do with software, whether it's on-premises or in the cloud. If you stay on top of technical debt, that’s your best path to success.”