Technical debt

Digital Transformation


There has been a climate change in IT. No surprise there. Technology, by nature, evolves. It adapts to the needs of consumers. It happens fast. It’s constant.

We know what’s coming, and we know that change is inevitable, yet healthcare IT departments still can’t keep up.

Ten years ago, network infrastructure and applications were largely supported by low-cost offshore IT shops – because:

  1. They knew the tech
  2. They were cheap

Digital transformation has added complexities. Again, no surprise. The skills once needed to build and maintain systems that organize healthcare data and run operations have evolved, but resource allocation is stagnant.

As value-based care pushes the CMIO agenda, traditional preventative care models – and the processes and systems supporting them – are in need of an update.

Who’s Going to Handle the Work?

Tension between operational support and modernization is putting the heat on IT departments. The race to implement new systems – sacrificing long-term system sustainability for faster market penetration – also builds technical debt.

At some point, IT will need to support the systems they’ve rushed out, further straining resources. As the walls close in, the organization is left with a choice; shift IT delivery towards new value-based models, or maintain operations.

The quest to increase output and cap resources leads to low-cost-first outsourcing, landing IT departments in the realm of offshore vendors. Unfortunately, not all technical debt is created from rushed projects. Much of it accrues when projects fall short of quality expectations – thus a greater need for maintenance and quality – both of which are tough to find half way across the world.

Offshore IT Costs Have Increased Despite a Lack of Operational Knowledge

The increase in interconnectivity (a curse and blessing of cloud technology) has led to a stacking of compiled IT services and more complexity. Technical debt is, unfortunately, a side effect.

Forbes recently wrote that “the average per-line cost of technical debt is $3.61, and for Java code, a staggering $5.42,” which does not include developer angst, turnover, and the effect on operations and connected systems.

Don’t expect the offshore cost model to change.

Many, if not most, IT service companies charge by the hour – not by solution delivered. The more complex the project, the more hours they need. And there aren’t many guarantees. You pay for the work, whether it solves a problem or not.

Ask most offshore IT shops and you’ll find that, yes, they can talk about the technology, but will have no idea how to apply it to your business or operational needs:

“Let’s talk about Java.”


“How can we help nurses improve mobile care using a Java-based platform?”

“No idea. But we know Java.”

Offshore vendors often focus on individual tasks instead of the broader mission. Low-cost incentives are negated by project delays and a lack of transparency.

Here’s the thing: you don’t measure outcomes by hours worked or tasks completed. You measure them by how many lives you improve – and how fast you can do that. Breaking out of the technical debt cycle requires strengthening systems and processes to scale new innovation. In other words…

…Healthcare IT departments require problem solvers more than ever.

The Connected Vendor 

If offshoring is unsustainable, and cost is still top-of-mind, how can we find balance?

There is a growing demand to find a partner who can fill technology resource gaps while acting as a consultative advisor – aligning IT with your organizational and business objectives.

A recent Gartner Cost Optimization report identifies the issues most healthcare providers are facing; each one relates to technical debt or innovation. They include:

  • Gaining efficiencies without damaging the business in the process
  • Maintaining focus on key priorities to meet specific operational needs
  • “Rightsizing” the organization to align with business requirements
  • Enabling funding availability for strategic initiatives
  • Managing the IT portfolio proactively to maximize the IT value
  • Improving capacity for high performance
  • Positioning the organization for sustainable growth
  • Need to support and enable innovation efforts across the organization

With increasing pressure for one IT team to learn new skills, the question has become how to allocate those resources to scale digital transformation efforts and still run the organization – all at a cost-effective rate.

The connected vendor works with your organization at all levels:


The connected vendor speaks in terms of business objectives, not tasks. Expect added cost savings in the form of compounding solutions. As they tie together your digital transformation systems (integrate systems, sunset old technology, and handle data migration), you benefit from process efficiencies and big-picture impacts.


Expect the connected IT vendor to work closely (even onsite) with your team to move projects to completion. They will be flexible, with a rapid transition model already in place – and demonstrable proof of how they can improve your business processes.


The connected vendor does not speak in terms of generic, tech-driven perspective, but demonstrates how they can help you adapt by understanding your unique challenges and offering strategic advice.

The connected vendor, above all, will bridge enablement technologies to your vision of providing better, more cost-effective care.

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