Technical debt is on the minds of healthcare CIOs. In March 2023, CereCore sponsored an online survey of healthcare IT executives, all CHIME (College of Healthcare Information Management Executives) members, on their top concerns. In that survey, over 67% reported technical debt is a concern particularly around scope creep and costs, outdated IT infrastructure, problems maintaining systems or staying current with upgrades. Also in the survey, CIOs ranked cybersecurity high on their priority list, which is a direct impact of technical debt.
To complicate matters, healthcare IT (HIT) organizations are also facing the fall out of quick fix solutions deployed during the pandemic, employee turnover and resulting disruptions, and post-emergency functionality requirements. Whatever the form or cause of technical debt, patients and their providers can be impacted — a suboptimal experience that no one in HIT intends.
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.”
In the Technical Debt and the Patient eBook, healthcare leaders can discover how to mitigate the impact of technical debt on patients with some questions to help your organization identify where technical debt is creating risk or inefficiencies or both.
Ways to Mitigate the Impact of Technical Debt on Patients
As members of the healthcare IT community, let’s take the actions necessary to address technical debt and mitigate the risks and inefficiencies it poses. Consider these priorities:
Risk #1: Patient information
Protect patient information. Has routine maintenance of your systems fallen behind and only select fixes are being applied? Consider cloud or network management services for addressing technical debt associated with cybersecurity or invest in on-premises infrastructure to become compliant.
Risk #2: Regulatory compliance
Maintain regulatory compliance. Is your team unable to configure, test, and move software updates to live by an indicated date? You may need to contract with a managed services provider who can help you comply with regulatory software releases and reporting deadlines. Keep in mind that international standards organizations also update their requirements from time to time and those may impact your data centers and other network operations.
Risk #3: Patient care
Embrace digitization. Are you postponing delivery of new functionality? Are you unable to integrate new functionality with clinical workflows? Are your users performing workarounds? It could be time to partner with an EHR implementation partner to improve speed to market for upgrades and optimization. New market entrants such as Amazon and Walmart provide a seamless patient experience that your aging infrastructure may not allow you to compete with.
Risk #4: Operational cost
Invest strategically. A Forbes study found engineers are spending about 33% of their time dealing with technical debt and the average organization wastes 23 to 42% of their development time on it. If this is the case in your organization, develop a roadmap for infrastructure and application refresh and modernization. Also, consider partial or full healthcare IT outsourcing for day-to-day operations so engineers can focus on development. With resource costs consumingroughly 70% to 80% of operating costs, addressing technical debt may have the best ROI.
Risk #5: Employee burnout
Optimize technical resources. Does insufficient employee bandwidth at your organization lead to missed deadlines? Is your IT staff turnover increasing? Is your team showing signs of burnout? It could be time to analyze problem areas, IT tickets, and other documentation to find ways to resolve repeat problems. Also consider moving repeatable workloads to a managed services partner who can adjust to demand fluctuations and also provide skilled IT labor for temporary project needs.
Risk #6: Strategic alignment
Audit and act. Does your Ieadership team understand the organization’s technical debt situation? Determine what solutions in your portfolio are leading or lagging (due to integration, automation, aging, resources, etc.) and execute a meaningful response to the findings. Fully document the risks of inaction so senior leadership understands. Consider enlisting help with the assessment and strategic planning needed.
Bottom line: Develop a strategy to tackle technical debt
Addressing technical debt requires honest answers to some tough questions about your organization. Here are a few to help you start the conversation:
Are we considering all forms of technical debt—remediating quick fixes and imperfect code, supporting processes, downstream and upstream from impacted functionality?
What do we need to implement, replace, or sunset in order to modernize our EHR?
Do we have the resources to support legacy system requirements as well as requirements for defining and supporting future solutions?
What new skills does our resident technical team need to develop?
Technical debt is an issue for HIT, but it shouldn't impact patients.
Our complimentary eBook helps you identify symptoms of technical debt in your organization so you can consider options for addressing them. Gain ideas from the proposed mitigation strategies, and let us help as needed.