< + > The Hidden Security Risk of Tech Debt in Healthcare IT

The following is a guest article by Jason Ward, VP of IS & Tech Support at Collette Health

In healthcare IT, technical debt is often discussed in terms of cost and complexity. Legacy systems require constant upkeep, slow down innovation, and complicate interoperability. However, there’s a more urgent consequence that deserves attention: technical debt is a growing cybersecurity liability that directly affects patient safety.

Every unpatched server, unsupported application, and custom workaround introduces risk. As ransomware attacks increase and regulatory scrutiny intensifies, the connection between accumulated tech debt and compromised security is no longer theoretical. It’s a real and growing threat to clinical operations.

Legacy Systems: A Quiet but Dangerous Attack Surface

According to the U.S. Department of Health and Human Services, 96% of hospitals operate with end-of-life systems or software that contain known vulnerabilities, including medical devices. These systems are often wrapped in layers of custom code and duct-taped integrations that make them fragile and difficult to secure.

Unsupported software doesn’t receive critical patches. Siloed systems make it hard to enforce consistent authentication, audit logging, or encryption standards. Even routine upgrades can trigger cascading failures, which leads teams to delay modernization.

This creates a fragmented environment where attackers don’t need to breach your perimeter. They only need to find the weakest legacy endpoint. In healthcare, that vulnerability doesn’t just threaten uptime; it threatens patient safety and data integrity.

The Accidental Risk of “Quick Fixes”

Technical debt doesn’t accumulate because of negligence. It grows from well-intentioned decisions made under pressure. For example:

• A custom HL7 interface built to meet a go-live deadline
• A temporary VM spun up to support a new device
• A legacy PACS system kept online until “next year’s budget”

These decisions make sense in the moment. Over time, however, they create an environment that is harder to secure, monitor, and scale. Security teams end up managing exceptions instead of enforcing standards.

Every “quick fix” from the past becomes a strategic risk in the present. Unlike financial debt, the interest here is measured in vulnerabilities, not dollars.

Modernization as a Cybersecurity Strategy

Too often, technical debt is framed as a budgeting or efficiency issue. In reality, it’s a core component of your cybersecurity posture.

Reducing reliance on outdated systems consolidates your attack surface, improves visibility, and enables consistent security controls. It also makes it easier to adopt modern tooling, such as zero-trust architectures, automated patching, and real-time threat detection.

The HHS 405(d) report found that hospitals with higher adoption of the Health Industry Cybersecurity Practices (HICP) framework also had stronger alignment with the NIST Cybersecurity Framework. This correlation shows that modernization improves cyber maturity and resilience.

Ransomware: The Real Cost of Delay

Ransomware is now the top cybersecurity concern for healthcare CISOs, according to the Health-ISAC Annual Threat Report. These attacks don’t just compromise data; they disrupt care.

• In 2021, a ransomware attack on Scripps Health cost over $113 million and forced hospitals to divert stroke and heart attack patients
• A Michigan ENT practice shut down permanently after attackers deleted patient records
• A Vermont health system had 5,000 computers encrypted and 1,300 servers disabled, costing over $63 million

The incidents are just a few examples, and they are far from being outliers. They are becoming more common, and legacy systems are often the entry point.

The CIO’s Role: From Custodian to Strategist

For CIOs, CTOs, CMIOs, and infrastructure leaders, the message is clear. Technical debt is no longer just technical baggage; it is a strategic vulnerability.

Every decision to defer modernization is also a decision to extend exposure. In healthcare, where data is sensitive and downtime can be life-threatening, that’s a risk we cannot afford.

Reframing technical debt as a cybersecurity issue helps shift the conversation. Modernization becomes mission-critical, not optional. It also empowers IT leaders to advocate for infrastructure investments as defensive measures that protect organizational resilience and patient safety.

About Jason Ward

Jason Ward, VP of IS & Tech Support, oversees Collette Health‘s Information Technology, DevOps, and Customer Care Center teams. With nearly twenty years of experience in enterprise IT, Jason has provided technology leadership to organizations of all shapes and sizes, including small businesses, non-profits, healthcare systems, and large enterprises. His vision for building scalable, high-performance, and secure IT infrastructure and processes forms the basis of Collette Health’s technology platforms and information security program.