Tech Debt First Aid: Setting Up Your Healthcare Business for AI

As a healthcare CTO, you're no stranger to the daily grind of managing legacy systems that constantly need patching up. Your software is just barely coping under the weight of new demands, and you wonder how you'll ever get ahead. Your team’s time is eaten up by maintenance tasks instead of driving innovation. It’s frustrating. Everyone is buzzing about implementing AI, but before it can work its magic, you need to tackle the technical debt holding you back.

Data is everywhere, especially in healthcare. And it's not just sitting there—it's multiplying. Every day, the mountain of data grows a little higher. Right now, the healthcare industry is responsible for about 30% of the world's data, according to RBC. By 2025, that number is expected to climb to 36%. And with the Internet of Medical Things (IoMT) bringing in data from wearables and other devices, we're looking at an exponential increase.

This avalanche of data ties directly into the concept of technical debt. As data volumes expand, so does the complexity of managing and securing it. Systems that were once sufficient become strained under new demands. If we don’t address this growth proactively, we risk accumulating technical debt that could hinder our ability to use this data effectively, impacting everything from daily operations to patient care.

Think of it like decluttering your home before a big renovation. Clearing out the old and organizing what you have creates space for new, exciting changes. By addressing technical debt and streamlining your data, you're setting the stage for AI to bring real, impactful improvements to patient care and operational efficiency. Let's explore how to transform your technical landscape, making AI a powerful tool in your arsenal.

How is AI Being Used in Healthcare?

AI is reshaping healthcare by enhancing how we diagnose and treat diseases. With data pouring in from EHRs, medical imaging, and wearable devices, AI has the tools to make sense of it all. Algorithms can now process this data in real time, revealing insights we never thought possible. Take AI-driven diagnostic tools, they can detect issues in medical images more accurately than human eyes. A study by Stanford University found that their AI algorithm could identify pneumonia from chest X-rays better than radiologists. 

Predictive models go a step further, forecasting patient risks and recommending preventive actions. This means fewer hospital readmissions and better patient outcomes. For example, predictive analytics can help identify patients at high risk for complications after surgery, enabling preemptive care strategies.

Beyond diagnostics and treatment, AI is also a game-changer for everyday operations. It can handle administrative tasks like scheduling, billing, and patient triage, giving healthcare professionals more time to focus on patient care. AI also makes supply chain management more efficient, ensuring that medical supplies are ordered and stocked properly. This reduces waste and cuts costs, making operations smoother and more cost-effective.

However, before diving into AI, it's crucial to address technical debt. The 2021 HIMSS survey found that a staggering 73% of healthcare providers use medical equipment that is controlled by outdated legacy operating systems. Legacy systems can impede the integration of new technologies. By resolving technical debt first, you’re setting up your institution for a smoother transition and maximizing the benefits of AI in your healthcare operations.

Defining Technical Debt in Healthcare IT

A survey by McKinsey Digital found that 10-20% of new technology budgets ends up going toward technical debt instead. You’ve seen it happen: urgent updates and short-term solutions lead to a tangled mess of legacy systems and outdated code. Who has the time to innovate?

This is technical debt, and in healthcare IT, it’s a significant hurdle. With the vast amount of data generated daily—from EHRs to imaging and beyond—technical debt can slow you down when it matters most to innovate. Let’s demystify the concept of technical debt, why it matters, and how to manage it to pave the way for seamless AI integration.

What Is Technical Debt in Healthcare?

In healthcare, technical debt builds up with quick fixes and workarounds to meet immediate demands, compromising system quality and performance in the long run. This is particularly common in busy healthcare settings, where pressing issues often take precedence. Manifestations of technical debt include poorly documented code, legacy systems that are hard to upgrade, and integration issues with new technologies. While it may accelerate projects initially, technical debt leads to increased maintenance costs, decreased system reliability, and slower innovation over time.

Understanding and managing technical debt is vital for healthcare CTOs, especially when you’re planning to integrate cutting-edge technologies like AI. By properly addressing technical debt, your healthcare solutions remain robust, secure, and scalable — ultimately enhancing patient care and meeting your KPIs.

Identifying Technical Debt in Healthcare 

What to you need to watch for:

1. System Outages and Slow Performance

Keep an eye out for recurrent crashes during peak usage times or processing delays when retrieving patient data. These interruptions are red flags that your underlying technology might be struggling to keep up with current demands. Technical debt is elusive and deeply rooted, so it usually requires a thorough system deep-dive, but a good place to start is performance monitoring. 

A comprehensive monitoring system can help you ahead of outages and slowdowns by examining your system’s performance in real time. Look for patterns like increased response times, frequent timeouts, or high error rates—especially during routine operations. Don’t underestimate the power of user feedback, either. 

Regular input from your staff and patients who interact with your systems daily can provide a critical understanding of how well your technology is performing. These insights will reveal where the hidden pressures your systems are under stem from and suggest if the time for that legacy software deep-dive might be sooner rather than later.

2. Integration Issues

Are new tools or software updates harder to integrate than expected? To be more specific, watch for signs like excessive custom coding required to make systems work together or prolonged deployment times. Are there recurring complaints about certain systems not communicating well with each other? 

Regular compatibility tests can also shed light on how well your systems work together. Difficulty achieving compatibility or needing frequent workarounds are strong indicators that your system’s architecture may need reevaluating.

3. Manual Processes and Poor Documentation:

If your team is often bogged down by manual data entry tasks or spends hours searching for information that should be readily available, your system is ripe for a digital makeover. Examine if your staff is entering the same data into multiple systems or spending considerable time updating patient records that could be synchronized automatically across platforms. 

This redundancy not only wastes time but also increases the risk of errors. Are critical processes such as patient intake, billing, or inventory management still paper-based? Your workflows aren’t the only ones at stake here; they also now affect data accessibility and security.

Pay attention to how reports are generated. Are your employees manually collecting and entering data into spreadsheets? Is there a delay in report availability due to these manual inputs? Automating these reports can save valuable time and provide real-time insights.

4. Frequent Bug Fixes and Patches:

Last but definitely not least, frequent bug fixes might be the biggest hidden drain on your budget. While patches are a normal part of system maintenance, they build up fast. Instead of charging ahead, take a step back. Recurring bugs point to previous patches that were ineffective or to a fundamental flaw festering in your system. 

It's crucial you keep an eye on how much of your IT team's time and resources are going into just patching up bugs and applying fixes. If you find that a significant portion of their effort is focused solely on maintaining system stability, these routine tasks are sapping resources that could be better geared toward integrating AI.

Each time a patch is applied, observe how it affects overall system performance. If performance degrades or new issues arise post-patch, this could signal that the fixes are incompatible with your existing system architecture. Before rolling out patches system-wide, enhance your testing processes. Implement staged deployments where patches are tested in a controlled environment that closely mimics your live system. This can help catch problems before they affect your entire network.

Ignoring Technical Debt

Ignoring technical debt in a healthcare IT environment can lead to a cascade of severe consequences that not only affect your day-to-day operations but can fundamentally jeopardize the entire organization's functioning. Here’s a detailed look at the potential repercussions:

Severe System Failures 

Over time, unaddressed technical debt accumulates and increases the likelihood of catastrophic system failures. Imagine a scenario where critical patient data becomes inaccessible during emergency situations or major system outages occur during peak operation hours. We’ve long left mere inconveniences in the rearview mirror; this can directly threaten patient safety and care.

Escalating Maintenance Costs 

As technical debt mounts, the complexity and cost of maintaining your IT systems can skyrocket. You might find your budget increasingly consumed by the need to patch antiquated systems rather than investing in new technologies or system improvements. You’ll directly divert funds from strategic initiatives intended to enhance how you do business.

Compliance Violations and Legal Risks 

In 2023, 725 data breaches were reported to OCR, and across those breaches, more than 133 million records were exposed or impermissibly disclosed. If your systems are outdated, there's a real risk they won't meet the latest security protocols. This can lead to breaches of sensitive patient data. Imagine the fallout: hefty fines, legal headaches, and a reputation that could take a serious hit. More than that, think about the impact on patient trust. Once that trust is broken, it's incredibly hard to rebuild. Protecting your data means protecting the people who rely on you every day.

Decreased Staff Morale and Efficiency 

When staff are forced to contend with outdated or inefficient systems, it can lead to frustration and burnout. High-performing employees may seek other opportunities where they can work with better technology, leaving you to look for new additions to the team who also need to be onboarded, trained, and introduced to complex legacy code.

Inability to Scale or Innovate 

As the healthcare sector keeps pushing forward, the ability to integrate new technologies such as AI and machine learning becomes crucial. You recognize this; after all, that’s why you’re reading this article. You should also recognize how technical debt can severely hamper your organization’s ability to adopt these innovations, putting you at a competitive disadvantage. While others advance, your systems remain stuck, unable to support new services or improve existing ones.

The message is clear: ignoring technical debt doesn’t just delay the inevitable—it amplifies the risks and costs involved. Addressing technical debt proactively is essential to ensure that your IT infrastructure supports, rather than hinders, your organizational goals and the care you provide to patients.

Strategies for Managing Technical Debt

Now that you’re aware of the technical debt weighing down your operations, it’s time to move from diagnosis to action. As a healthcare CTO, your role is crucial in leading the charge to overhaul outdated systems and embrace the innovations that can truly revolutionize patient care. In the following sections, we'll explore strategies that can help you manage and mitigate technical debt effectively. 

And if you find the journey overwhelming, remember that a partnership with a full-cycle software company could be the key to unlocking seamless integration and future-proofing your technology stack, letting you focus on what you do best: leading healthcare into the future.

Don’t Skip the Audits

While it might be tempting to view IT audits as a costly inconvenience, they are actually indispensable in the healthcare sector. Audits shouldn’t just be another task in your ongoing Sprint. They are a critical exercise in safeguarding your organization’s lifeblood: patient data.

Why Regular Audits Matter

At the core of IT audits in healthcare is the protection of sensitive patient information. Audits systematically evaluate your organization's security measures, identifying vulnerabilities that could lead to data breaches. Conducting regular audits might require upfront investment, but the payoff in mitigating risks and enhancing system reliability is substantial. You’re taking one of the most important steps in preemptive management that ensures ongoing operational integrity and trust in your healthcare services.

Areas of Focus in Auditing

Depending on your specific IT setup, audits can cover a wide range of areas. This might include:

• Systems and Applications

Audits in this area focus on checking whether the operational systems and software are performing efficiently and remain robust against new and evolving security threats. This includes verifying that security measures are up-to-date and strong enough to defend against cyberattacks.

• Development Practices

Here, audits assess how new software and updates are created, tested, and rolled out within your organization. The goal is to identify any potential security or operational risks early in the development process. This helps ensure that the software is not only functional but also secure before it goes live.

• Management of IT 

This aspect of auditing looks at the daily management of IT resources. It focuses on how well your IT team handles routine and critical tasks like system updates, data backups, and implementing disaster recovery plans. Effective management is key to maintaining system integrity and availability.

• Telecommunications

With the increasing reliance on telehealth solutions, audits in this area scrutinize the security and reliability of your network communications. This is essential to ensure that patient data transmitted over these networks is protected from interception or disruption.

By making regular IT audits part of your standard operational procedure, you protect your organization against the unexpected. Your infrastructure will be able to support and enhance your healthcare delivery rather than posing a risk to it.

Refactoring or Total System Overhaul?

After completing IT audits, you’ll know the nature of the technical debt uncovered and your strategic goals. Here's a breakdown of each approach to help you determine the best path forward.

1. Refactoring

• Why: Opt for refactoring when the core systems are fundamentally sound but could benefit from optimization. This approach is ideal for extending the life of the software while minimizing risk and disruption.
• What Stays the Same: The system’s overall design, functionality, and interfaces remain unchanged. This ensures continuity of service without disrupting user experience or requiring significant staff retraining.
• What Changes: You’ll be making incremental improvements to the codebase of your system without altering its external behavior or functionality. Refactoring is primarily aimed at improving the non-functional attributes of the software, such as its maintainability, performance, and scalability.

2. Rearchitecting

• Why: Rearchitecting is suitable when your existing system's architecture prevents scalability or adaptation to new requirements. It's a strategic choice when you need to modernize infrastructure without a full rebuild. 
• What Stays the Same: While the underlying architecture changes, the front-end functionality that users interact with remains consistent.
• What Changes: This approach involves changing the software’s architecture without completely rewriting the application. Rearchitecting might include moving to a microservices architecture or integrating newer, more scalable frameworks and technologies.

3. Rewriting

• Why: Choose to rewrite when the existing system is too outdated to meet current and future needs effectively or when the cost of maintaining old code outweighs the investment in a new system.
• What Stays the Same: While the new system is intended to offer similar or enhanced functionalities, practically all aspects of the technology stack and codebase are new.
• What Changes: Everything. You’ll be developing the application anew from scratch, usually with updated technologies and standards. It involves reimagining both the back-end and the front-end functionalities.

4. Replacing

• Why: Replacement is the best option when existing systems no longer align with the business’s strategic direction or when it is more cost-effective to purchase a new solution than to overhaul the old one.
• What Stays the Same: Replacing usually means significant changes in how internal processes are handled due to adaptation to the new system's workflows and functionalities. 
• What Changes: This strategy involves replacing the existing system with an entirely new software solution, which could be a commercial off-the-shelf (COTS) product or a different existing solution that better meets the organizational needs.

Each modernization strategy comes with its own set of implications for system performance, user experience, and organizational impact. Choosing the right approach depends on a careful assessment of audit outcomes, cost-benefit analyses, and strategic alignment with long-term healthcare goals. Partnering with a full-cycle software company that understands the nuances of healthcare IT systems and can guide you through each step of modernization can greatly aid this decision-making process.

Roadmapping and Prioritization 

When prioritizing technical debt resolution, especially in alignment with AI initiatives, it's essential to stay strategic and balanced. This doesn’t mean you need to halt your regular business activities. Instead, view this as an opportunity to modernize your legacy software alongside mapping out your AI projects. 

One valuable approach to guide these decisions is understanding and managing the Technical Debt Ratio, a concept highlighted in a McKinsey report on the significance of tackling technical debt strategically.

Understanding Technical Debt Ratio

The Technical Debt Ratio measures the cost of fixing development work against the cost of initially creating it. This cost can be quantified in terms of money or time. A higher ratio indicates that the cost to fix the debt is approaching or surpassing the cost of building the system in the first place, signaling that immediate action might be necessary.

Managing this ratio helps you:

Assess Financial Impact: It provides a clear financial perspective on the implications of technical debt, helping you understand whether it's more cost-effective to continue maintaining the current system or to invest in its redesign or replacement.

Prioritize Actions: By quantifying the impact of technical debt, you can prioritize which areas of your system need urgent attention based on their potential risk versus the cost of remediation.

Using the Technical Debt Ratio in Roadmapping

No matter which type of modernization you opt for, you can and should treat technical debt as an ongoing improvement process rather than a one-time fix. Organization is half of the work, and in this case, that means creating a balanced roadmap. Here’s how:

• Assess and Quantify Debt

Regularly assess your systems to identify and quantify technical debt. This involves not only recognizing outdated or inefficient code but also measuring how much it costs to maintain versus rebuild or replace.

• Pinpoint Milestones

Start with areas where the cost of fixing the debt is high relative to the value it brings or where it poses significant risks to system stability and business operations.

• Allocate Resources Wisely

Allocate your budget and IT resources according to the roadmap, focusing first on high-priority areas. This targeted approach ensures that you're not only managing technical debt effectively but also optimizing your investment in IT infrastructure.

• Monitor and Adjust

Other than that, be flexible. Technical debt and system requirements will evolve. Stay adaptable to accommodate new innovations or urgent technical debt issues that may arise.

Remember, managing technical debt shouldn't come at the expense of innovation. By strategically aligning debt resolution with AI initiatives, you can ensure both areas progress in tandem.

Resource Allocation

Now that you have a roadmap for managing technical debt, the next critical step is effective resource allocation. Balancing resources based on the Technical Debt Ratio is essential to maintain your development velocity without compromising ongoing operations.

Assessing Team Composition and Workload

If your team is small, with professionals juggling between off-the-shelf solutions and custom-developed systems, you may find that your maintenance capabilities are stretched thin. In such scenarios, hiring an additional workforce becomes crucial. This not only helps maintain the existing infrastructure but also ensures that your team can address technical debt without neglecting new development needs.

For teams that are rich with talent and versatility, the focus should shift to identifying gaps in expertise. Even a resourceful team can encounter challenges that are outside their skill set or experience. Here, it becomes even more important to bring in specialists who can fill these gaps. Hiring experts who can focus on mitigating technical debt and guiding continuous development in the right direction can significantly enhance your team’s effectiveness.

By strategically allocating resources where they're most needed—especially in areas highlighted by your technical debt assessment—you keep your systems reliable and responsive. This targeted approach doesn’t just fix problems as they arise, it empowers you to prevent issues before they can start, keeping your operations running smoothly and your team free to focus on innovation and implementing new technologies. Every dollar and every hour spent moves you forward, not just keeping you afloat. 

To Sum Up

Managing technical debt is much like dealing with a sickness—it's best to catch it early and treat it meticulously. By proactively identifying and addressing areas of inefficiency within your IT systems, you set the stage for embracing AI and other advanced technologies in healthcare.

By committing to regular audits, strategic modernization, and intelligent resource allocation, you elevate your organization's operational efficiency and readiness for technological advancements.

Investing time and resources in managing technical debt equips your healthcare system to respond more swiftly and adapt more robustly. This approach enhances patient care, boosts your organization's performance, and cements your status as a leader in the healthcare sector. 

With this strategic focus, you are not only on the road to overcoming current limitations but also opening doors to new possibilities, enabling your team to leverage AI effectively and lead with confidence. If you’re ready to embrace the challenge of technical debt and transform it into a catalyst for growth, book a free four-hour workshop with our industry experts.