In the race to modernize healthcare technology, hospitals are learning an old lesson in a new way: Clean their plate before reaching for dessert.
For Becket Mahnke, MD, chief medical information officer at Wenatchee, Wash.-based Confluence Health, that mantra is literal policy. “We keep tech debt in check with a ‘vegetables-before-dessert’ rule,” he said — meaning that routine maintenance and clinical decision support reviews take precedence over flashy new tools. The idea is simple but rarely easy: Fix what you already have before adding something new.
That discipline is increasingly critical as health systems juggle a surge of AI pilots, digital front-door platforms and EHR overhauls. Every upgrade risks adding another layer to the “technical debt” — the cumulative cost of outdated, redundant or overly complex systems — that hospitals already struggle to manage. The result can be sluggish workflows, hidden expenses and, in the worst cases, patient safety risks.
At Los Angeles-based UCLA Health, CMIO Eric Cheng, MD, sees that tension daily. “Clinical users and leaders know that changes take time, but they don’t realize how much of it is due to technical debt of overly complex build.”
Dr. Cheng said it falls squarely on the CMIO to recognize and address that debt. Cleaning up legacy systems may not be glamorous, but without it, even the most advanced digital tools can buckle under their own weight. “Nobody else can better advocate for that than us,” he said.
At Roseville, Calif.-based Adventist Health, CMIO Amer Saati, MD, describes a process built around prevention. Every new project undergoes enterprise-wide architecture and data governance reviews to ensure standardization and reuse of existing tools. Regular audits of clinical informatics and digital operations teams surface redundant systems before they calcify into liabilities. “Intentional governance and lifecycle discipline” are key safeguards, Dr. Saati said, ensuring innovation does not outpace infrastructure.
At Scottsdale, Ariz.-based HonorHealth, the informatics team takes a similar approach. “We are trying to review all new requests for technology solutions through the lens of our core platforms,” CMIO Matthew Anderson, MD, said. “Developing longer term and deeper relationships with a few core platforms will be better from a cost, maintenance and utilization standpoint.”
That long view can be hard to maintain in a field where technology cycles move fast and patient demands move faster. Neal Chawla, MD, CMIO at Raleigh, N.C.-based WakeMed, calls it a “tough balance.” The pressure to deliver new functionality is constant, but so is the risk of redundancy as EHR vendors race to release overlapping features.
“Good due diligence is important to assess if something we buy in the short term is at risk of becoming redundant in the long term,” he said. “But when there is good functionality out there that helps our patients live better lives today, it’s a hard message to wait.”
The challenge for CMIOs, then, is not just about managing code, it’s about managing culture. It means convincing clinicians and executives alike that a clean, coherent tech ecosystem may be the most important innovation of all.
As Dr. Mahnke put it, sometimes the healthiest systems are the ones that eat their vegetables first.
