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.”
