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Technical debt is a healthcare imperative as important as patient safety and workforce sustainability, says Joel Bond, president and CEO of Bond Consulting and a senior engineering adviser at Providence Health & Services.
At the upcoming 2026 HIMSS Global Health Conference & Exhibition, Bond will discuss how to put together a tech debt plan that uses principles of agile development as a trust mechanism and fosters an environment of continuous improvement.
Tackling technical debt means fewer staff-sapping "heroics" such as having to spend weekends fixing crashes and less "operational harm," such as clinicians spending increased hours on documentation, he said.
Tech debt causes clinician burden
Tech debt begins with tech friction, like phone operating system updates that are incompatible with applications. And when instances of tech friction accumulate, they become tech debt, Bond explained.
However, tech debt can also be driven by a "system overhaul mentality." For example, when Providence upgraded to Windows 11, some of the health system's computers and devices could not be updated.
"When you're upgrading over 150,000 employees across multiple states, a lot of things start coming to light," Bond said. "I started noticing, we're actually not tracking tech debt the way that we should. We have a lot of legacy systems that will not accept Windows 11."
Tech debt accumulates when problems that need to be solved are pushed aside. At healthcare organizations, "it could be caregivers that are absorbing some of that," he said.
Introducing workarounds can slow clinical teams down by increasing their cognitive load. Additionally, documentation burdens caused by legacy systems can lead to frustrations that some remote caregivers and travel nurses don't want to deal with, said Bond.
"From my perspective as an IT guy working across many different health systems, I ask, 'How can we be better on our side to help the clinicians on their side?'"
Tackling tech debt in stages
At Providence, IT teams experience overtime to address backlogs of updates and have addressed emergency outages.
To address it, organizations must explicitly identify what qualifies as tech debt, such as outdated electronic health records, siloed databases, or legacy hardware that won't support Windows 11, said Bond.
Tech debt is easier to ignore when it is not visually represented, but it can lead to burnout and attrition. When an organization's leaders can see the debt, they are more likely to approve the resources needed to fix it, he said.
At HIMSS26, attendees will learn how to "create a way to track debt so it can compete for attention alongside shiny new features," and map the work alongside innovation tasks, according to Bond.
Tech debt remediation should not be a "side project" or something handled only in a department's spare time, he advised. And it should be spread throughout the year – breaking "big boulders" into "tiny rocks" that are addressed bit by bit.
It "leaves more room and space for new features to come in," he explained.
Bond also advocates for short, iterative feedback loops to rebuild clinicians' trust. The short cycles allow teams to identify where a new feature might clash with a legacy foundation before it's fully implemented.
"Tradeoffs stop being emotional and really start being intentional," he said.
Bond's session "Tech Debt is Human Debt," is scheduled for Tuesday, March 10, from 2:15 p.m.-3:15 p.m., in Palazzo L/Level 5 at the Venetian at HIMSS26 in Las Vegas.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.
