How to attack technical debt in healthcare

Scottish economist Adam Smith, author of The Wealth of Nations, once asked, “What can be added to the happiness of a man who is in health, out of debt, and has a clear conscience?” 

Nearly 250 years later, organizations often aspire to a similar triad but must manage a version of the middle rung that Smith could not have imagined. Technical debt surfaces when IT organizations delay or take shortcuts in software development and updates, with payback coming later in terms of application outages, security vulnerabilities and increased maintenance costs.  

What’s more, IT resources swerve toward managing complexity rather than pursuing future innovations. According to a 2020 McKinsey survey, 60 percent of responding CIOs felt their organization’s technical debt had perceptibly risen over the prior three years, with 10 to 20 percent of their budget originally tabbed for new product development being diverted to resolving tech debt. 

Technical debt in healthcare 

Following a pandemic-fueled push to support more digital capabilities, hospitals and health systems have renewed their interest in addressing technical debt. “Across the board, people were doing the bare minimum to keep the wheels on, and that’s typically an environment where technical debt arises,” observed Johna Till Johnson, CEO of research firm Nemertes. 

Related story: Maximizing the ROI of investments in healthcare digital transformation tools

At Providence St. Joseph Health, based in Renton, Wash., overcoming technical debt translated to significantly upgrading outdated and fragmented information systems. “Our digital transformation will help us deliver on our mission of serving patients and on approaching care in an innovative way,” explained CIO B.J. Moore, who spent his first three months on the job visiting Providence’s 51 hospitals to see what was working — and what wasn’t. 

His takeaways: “Our digital ecosystem includes an unmanageable total of 4,000 software applications, with all the redundancies and inefficiencies that come along with that. The current nature of the applications ties caregivers to keyboards and traditional personal computers for too long. They need access to information on their phones, they need a strong wireless network, and they need everything to be seamless.” 

In response, Providence is implementing a single enterprise resource planning system to replace multiple redundant systems for tasks such as ordering supplies and hiring new team members. According to Moore, the health system is also standardizing and updating its productivity and collaboration software and moving data to the cloud to better support teams and ensure secure communication. Other initiatives include using natural language processing to document clinical encounters and applying image-based analysis to automatically diagnose common conditions like skin infections/rashes and to catch different types of cancer earlier and more accurately. 

All this will take place while standardizing Providence’s electronic health record system, with the following goals in mind: 

• Lowering costs associated with legacy systems and outdated technology while improving operational outcomes. 
• Increasing interoperability across the system and improving the way data is gathered and presented at the point of care to improve clinical decision-making. 
• Leveraging cloud capabilities to relate all data together. 

• Freeing up resources to reinvest in the community. 

“When we make these changes — when we are digitally enabled at our core — the entire system benefits,” noted Moore. “They will lower costs, support our caregivers, give patients the access they want, and help us achieve better outcomes.” 

Attacking technical debt 

As Providence discovered, IT experts agree that proactively reducing technical debt over time is preferred to stopping other work and attacking problems in emergency mode. Organizations should establish policies, conventions and processes to amortize the reduction of debt over time. 

That may call for pulling developers from feature work to be on-call to handle problems as they arise. Additionally, IT should convene post-incident reviews to communicate what went wrong and how the solution could be applied to other situations. Along the same lines, resolutions should be celebrated as major successes. 

In the end, addressing technical debt reduces future risk, an element anyone in the C-suite can readily appreciate. 

Frank Irving is a Philadelphia-based content writer and communications consultant specializing in healthcare, technology and sports.