Technical Debt in Imaging | Imaging Technology News

Technical Debt in Imaging | Imaging Technology News


Technical debt is a term that is increasingly being introduced in debates and presentations in the health computing squares of webinars, conferences, blogs and white papers. Historically, a term software development, has been stuck to express the situations that many organizations face as they navigate the roadmaps between 5 and 10 years in the future.

There is no specific definition for technical debt. The website Tecopedia defines it as: “Technical debt is a programming concept that reflects the additional development work that arises when easy-to-implement code is used in the short term rather than applying the best overall solution.” In a sense, you incur technical debt every time you prioritize the urgent solution over a better long-term solution, or as Charles Hummel coined the phrase (and wrote the book), “Tyranny of the Urgent”. And, like consumer debt, it has a cost. Buying on credit will cost more than paying in cash. But also, as with consumer debt, it’s not necessarily a bad thing.

Gaining momentum

Where this term seems to be gaining strength is in the space for evaluating technology platforms within IT infrastructure and architecture. The complexity and strength of performance required to support business imaging requires well-designed and deployed solutions that support integration, interoperability, data exchange, data management, security, and other critical functions. In most cases, organizations are looking for existing solutions that have been selected, designed, or deployed to achieve real, urgent, and short-term goals. Whether it was the software recording platform at the end of its useful life or an opportunity to achieve a revenue or performance goal, in most cases, these systems were selected without having to account significantly for how these systems could put the organization in technical debt.

The result is that many decisions that are being made to strengthen the ecosystem to support the business image are paying costs for poor or low-performance systems that will not be replaced soon. This requires designing software stack solutions that incorporate peripheral technologies that fill the gaps and meet the requirements of healthcare delivery and data management. This additional cost is the price to pay to prioritize the urgent over the best solution. Consider the high interest rate you get when you buy a used car. If you don’t have transportation for a new job, you really have no choice, but the cost can be excessive in the long run.

Debt is transferred to other areas of an organization. This includes the impact that support teams may be working to maintain low-performance systems and grabbing an excessive number of unsatisfied user assistance tickets. Or system administrators who manage data manually due to the lack of embedded and optimized tools that may have provided better designed solutions. And of course, as more infrastructure moves to the cloud, there is a constant cost to systems that are only designed to work and function well on the premises.

Technical debt management

So what options are available for those who want to manage (how can it never be eliminated) technical debt? There are several good practices that can be learned from the software development industry that move into the healthcare IT.

Address and quantify your current technical debt and continue to monitor long-term. By cataloging your debt, you can begin to “pay off” that debt by channeling resources toward better long-term solutions and informing data-driven decision making that will lead to greater organizational efficiency and stronger support systems in your landscape.

Improve processes to minimize the accumulation of new debt. This seems obvious, but if decisions are made based on urgency about what is best, debt will continue to accumulate. Implementing a roadmap can be a great exercise (albeit difficult and a bit tedious) and when implemented can help guide decisions by providing a framework for the future. Things will happen along the way that may redefine the roadmap with some unplanned diversions or events, but overall direction and prioritization of results can support a path to avoid new technical debt. This also includes taking a close look at what has historically caused technical debt within the organization. Are there any triggering events that should have been avoided or could have been avoided, such as not being up to date with updates and upgrades or not funding major projects? Self-examination, while difficult, is important in building better models for selecting, acquiring, designing, and deploying technologies.

I think this topic will continue to expand into more conversations. It is a great model for assessing where we are and where we want to go as organizations. Because we have to do more with less, a full accounting of the cost of any decision will be analyzed with greater scrutiny from different areas of the organization. And as the old adage says, we pay now or we pay later.

Jef Williams

Jef Williams is a managing partner of Paragon Consulting Partners LLC, a healthcare consulting group based in Sacramento, California.





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