Sociotechnical debt in health information systems: How culture, structure, and vendors shape digital risk

Abstract

Digital transformation in the healthcare sector is constantly evolving. Hidden technical costs often slow down operational workflows. This study explores how technical debt, alongside its extended sociotechnical dimensions, affects future costs. Technical debt refers to the future costs incurred when short-term solutions are chosen over more sustainable approaches. Recent research has expanded this perspective, moving beyond purely technical artifact challenges to incorporate human, organizational, and systemic factors into a broader discussion known as sociotechnical debt. This work synthesizes existing literature to distinguish between technical debt and sociotechnical debt. Using semi-structured interviews with five healthcare IT professionals, this exploratory study generates new insights into how sociotechnical debt is perceived and manifested within organizations. The findings offer qualitative data points across three categories: how culture, organizational structure, and third-party dependence affect sociotechnical debt. In conclusion, the findings provide a broader view of sociotechnical debt in the healthcare sector, demonstrating that these three categories are closely related to the challenge. Sociotechnical debt is a complex and highly relevant issue shaped by multiple dimensions, including organizational culture, governance, and third-party dependence. Increasing transparency among stakeholders—including at national levels—as well as promoting localized, modular IT solutions, may support future efforts to address this issue.