Big and Small Ways Healthcare IT Can Address Technical Debt

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By Doreen DeGroff | Mar 31, 2023

3 minute read Technology| EHR/EMR| Blog

The term technical debt, while not new, has recently been clarified and defined by McKinsey as the “off-balance-sheet accumulation of all the technology work a company needs to do in the future.” Furthermore, McKinsey’s technical debt research shows, “some 30 percent of CIOs surveyed believe that more than 20 percent of their technical budget ostensibly dedicated to new products is diverted to resolving issues related to tech debt.” 

Identifying Technical Debt in Your Organization 

To better understand how technical debt is impacting your organization, consider questions like these: 

  1. What technologies are we using today that we need to implement, replace, or sunset? 
  2. Do we have the resources to support legacy system requirements as well as requirements for defining and supporting future solutions? 
  3. What new skills does our resident technical team need to develop? 
  4. Which resources will work on priorities such as digital transformation efforts and which resources will be assigned to operational tasks (configuration management, legacy support, training, etc.)? 
  5. Can we locate and recruit all of the talent we need? 
  6. Do we have the budget to hire all of the talent we need? 
  7. Have we considered all forms of technical debt (remediating quick fixes and imperfect code, supporting processes, etc. downstream and upstream from impacted functionality, etc.)?  

Forms of Technical Debt in Review 

Issues also known as Type of technical debt 
Defects  Quality debt 
Software in need of enhancement  Feature debt 
Inconsistent or poor user experience  Service or experience debt 
Lack of technical knowledge  Skill debt 
Inefficiency  Process debt 
Renegade knowledge  Documentation debt 
Reactive development  Requirements debt 
Outdated network compliance  Cybersecurity debt 


Impact of Technical Debt on Healthcare IT Priorities 

A recent Cost Optimization Report by Gartner states that priority on strategic initiatives for growth and innovation combined with ensuring efficient operations with minimum resources and cost containment can ultimately lead to the presence of technical debt. And healthcare IT is not immune. In healthcare IT, organizations everywhere are facing: 

  • fall out of resources of the pandemic days delivering quick fixes that were consistent with many of the considerations of the moment, but those fixes were not always steady, reliable, compliant solutions that will improve experiences or outcomes in a post-emergency environment. 
  • employee turnover that could further complicate the situation as the resources who defined and/or developed the solutions may no longer be part of the organization. When they left, their expertise, knowledge of their approach, good intentions for updates, and required technical skills left with them.  
  • post-emergency functionality requirements and service offerings that could mean a heavy lift for training, development, and support teams. 

Impact of Technical Debt on Healthcare IT Budgets 

Tough decisions will need to be made in healthcare IT in order to optimize every penny of the budget allocated. Determining what systems to maintain and upgrade and which new purchases to make will be on the minds of every healthcare IT leadership team if it isn’t already. 

Helping them decide will be figures such as these from Gartner: 

  • engineers spend about 33% at of their time dealing with technical debt 
  • the average organization wastes 23 to 42% of their development time on technical debt 
  • 60% of CIOs reported increased spending on technical debt in 2020  

Overcoming Technical Debt in Healthcare IT 

There’s no reason for technical debt to win or to dominate. Resolutions do exist and there is a way out when you take the right actions for your organization. These are some considerations as healthcare IT organizations plan their path forward: 

  • Assess your situation well and involve the right experts and measurement methodology to track progress.  
  • Know your options for accessing resources and optimizing them in your organization.  
  • Archive institutional knowledge to allow for turnover that is inevitable.  
  • Prioritize process definitions that instill technical debt avoidance practices (a culture for reviewing, refactoring, mob or pair programming, etc.).  
  • Audit your current portfolio of solutions to determine where your solutions are leading or lagging (due to integration, automation, aging, etc.) and execute on a meaningful response to the findings. 
  • Invest strategically in hardware, software, infrastructure, tools (such as technical debt ratio calculations) and right-sized talent (contingent, contract, interim, and permanent).  

The Future of Technical Debt in Healthcare IT 

We won’t overcome technical debt in healthcare IT overnight. Each entity will require a path customized for their organization’s goals, talents, and starting point. The complications are real but surmountable with awareness of the options and definition of the details. Healthcare IT can address technical debt in the big and small ways and via the short and long term means necessary to realize the vision that’s right for each organization in the field. 

About the Author:
Doreen DeGroff

MEDITECH Senior Product Director, CereCore

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