PRESENTED BY Slide 2 OBJECTIVES 1. 1. Learn about the positives
and negatives to both an internal IT department and outsourcing IT
services, as well as insourcing and outsourcing infrastructure. 2.
2. Discover how an IT department can be structured and some of the
positions it can contain. 3. 3. Find out how your IT department can
make your practice lean and efficient. Slide 3 PRESENTERS Mike
Baeske, Software Applications Specialist Team Leader, Ortho
NorthEast Mike Baeske, Software Applications Specialist Team
Leader, Ortho NorthEast Kevin Haverstock, IT Supervisor,
DataDrivers Kevin Haverstock, IT Supervisor, DataDrivers Slide 4
ORTHO NORTHEAST An Orthopedic practice founded in 1962 An
Orthopedic practice founded in 1962 12 locations throughout
northeast Indiana 12 locations throughout northeast Indiana 26
physicians, 7 anesthesiologists, 13 CRNAs, 24 mid-levels, 14 PT/OT
26 physicians, 7 anesthesiologists, 13 CRNAs, 24 mid-levels, 14
PT/OT Part ownership of orthopedic hospital, MRI center, and
ambulatory surgery center Part ownership of orthopedic hospital,
MRI center, and ambulatory surgery center Slide 5 IT INFRASTRUCTURE
Servers Storage Backups Facilities Internet Telephones & lines
Networking Monitoring Print/scan/fax PCs/laptops/thin
clients/monitors Slide 6 SERVERS DETAILS RAM (memory) is king. Also
get the most processing power (CPU). Use multi-core processors.
Virtualization is the only way to go. ONE: 120 virtual servers on 5
physical servers. Configure for High Availability and Dynamic
Resource Scheduling. INSOURCING + + You control the spending. + +
You determine how much youre willing to spend for speed. + + You
add memory & refresh technology as you see fit. - - You have a
large capital expenditure when you need more hardware. - - You
spend valuable time managing the resource. - - You must have
properly trained staff. OUTSOURCING + + No large capital outlay. +
+ Outsourcing comes with experts who handle the details. + + You
are not spending valuable time managing non-strategic tasks. - -
You are not in control of what hardware is employed, upgraded and
refreshed. - - You are one of many customers. - - You pay a monthly
fee forever. Slide 7 STORAGE DETAILS Get the most IOPS (speed).
Utilize flash storage. Implement 3-tiered storage (flash, fiber
channel, SATA). Get plenty. Data growth is way too fast. Implement
a data retention/deletion policy. Refresh technology as often as
possible. INSOURCING + + You control the spending. + + You
determine how much youre willing to spend for speed. + + You add
capacity & refresh technology as you see fit. - - You have a
large capital expenditure when you need more hardware. - - You
spend valuable time managing the resource. - - You must have
properly trained staff. OUTSOURCING + + No large capital outlay. +
+ Outsourcing comes with experts who handle the details. + + You
are not spending valuable time managing non-strategic tasks. - -
You are not in control of what hardware is employed, upgraded and
refreshed. - - You are one of many customers. - - You pay a monthly
fee forever. - - Costs keep going up due to data growth. Slide 8
BACKUPS DETAILS Should you backup to disk? To tape? To both? Set
retention policies for various types of data. Utilize secure
offsite storage. Make sure you have a sufficient backup window.
Limit the software products utilized. Deduplication! Dispose of
backup media properly. Tapes have a limited lifespan. Test backups
and restores. INSOURCING + + You determine how expensive of a
solution to employ. + + You have complete control over retention
policies, offsite storage, etc. + + You control how quickly you can
restore when needed. - - You have a large capital expenditure when
you need more hardware. - - You spend valuable time managing the
resource. - - You must have properly trained staff. OUTSOURCING + +
No large capital outlay. + + Outsourcing comes with experts who
handle the details. + + You are not spending valuable time managing
non-strategic tasks. - - You are not in control of what hardware
and methodology is employed. - - You are one of many customers. - -
You pay a monthly fee forever. - - Costs keep going up due to data
growth. - - Restores may not be timely. Slide 9 FACILITIES DETAILS
You need a computer room built specifically for that sole purpose.
It must be properly secured. Raised floor or overhead channels for
cabling. Redundant A/C specific to the needs of computer equipment.
Humidity control. Not tied into the HVAC in the rest of the
building. Conditioned power and battery backup. Generator. Facility
equipment regularly tested and maintained. INSOURCING + + Its close
by when you need access to the equipment. + + Youre in control of
the security/access. - - Takes up valuable square footage. - - It
is a huge expense. - - It requires time to manage the facilities. -
- If you run out of space, good luck! OUTSOURCING + + No huge
capital outlay. + + Does not consume your square footage. + + You
have a professional manager. - - You wont have quick and easy
access to your equipment. - - You have no control over facility and
management. Slide 10 FACILITIES Slide 11 INTERNET DETAILS You need
sufficient bandwidth. Should have redundant paths and providers.
Monitor uptime and utilization. Have a full featured and fast
border router. Implement proper security and site filtering.
INSOURCING + + Youre in total control of the providers and the
security. - - Proper setup and maintenance requires expertise.
OUTSOURCING - - Even if your servers are hosted, you require
Internet access at your facility. Slide 12 TELEPHONES AND LINES You
must have sufficient capacity trunks or PRIs. Use ATAs for analog
fax lines. B1 lines are too expensive. Have redundant paths if
possible. Hardware, software & phones with sufficient features.
Slide 13 NETWORKING Have full featured switches with extra ports.
Have on-site backup switches. Have proper class of cabling. If
multiple locations, have proper hardware and communications lines.
Slide 14 MONITORING DETAILS If pretty much anything in the
infrastructure goes down, you likely have a critical business
impact. Monitor all critical systems. Notify on-call person. Wake
them up. Have a procedure in place to fix the problem. Use products
such as Orion by SolarWinds. INSOURCING + + You ensure that the
proper systems are being monitored. - - Software can be expensive.
- - Expertise required. - - Need a way to wake up staff at 2am. An
email wont do it. OUTSOURCING + + No capital expenditure required.
+ + Usually a 24 hour NOC is used. + + They can place a call to
your staff and describe the situation. + + They can work with the
telecommunications vendors. - - Can be a hefty monthly cost. - -
Can be set it and forget it. New equipment/systems do not get
added. Slide 15 PRINT/SCAN/FAX DETAILS The paperless office never
really materialized. Medical industry relies heavily on faxing.
Implement scan-to-email and email-from-desktop. Setup an MPS
contract. Saves cost and saves staff time. INSOURCING + + You
control the response times. + + You control moving machines around
based on needs and volume. - - You are spending time fixing printer
issues. - - You likely have to call someone anyway. - - Youre
having to deal with having toner for machines no longer in service.
- - You have to make sure you dont run out of toner. OUTSOURCING +
+ Actually saves cost. + + Definitely saves IT staff time. - - You
have to deal with slow responding vendors. - - Having the wrong
vendor can cause staff discontent. - - Staff will blame IT for
issues that are the vendors fault. Slide 16
PCS/LAPTOPS/TABLETS/THIN CLIENTS/MONITORS DETAILS Desktop PCs still
have their place. Productivity increase with dual monitors or large
monitor with Snap feature. Laptops: large or small. Docking
station? Tablets: Centricity is not optimized for touch. Thin
clients: secure, good if virtualizing apps. Encryption critical for
HIPAA INSOURCING + + You control all hardware purchases,
deployments and refreshes. - - Youre spending time constantly
dealing with user requests. OUTSOURCING + + No capital outlay. + +
Set parameters and let hardware company deal with deployments. - -
Loss of control. - - Dealing with special situations. Slide 17 IT
DEPARTMENT JOB FUNCTIONS Helpdesk Systems Administrator Network
Administrator Database Administrator Security Administrator
Software Developer Implementer Trainer Manager Slide 18 HELP DESK
TECHNICIAN RESPONSIBILITIES The frontline / face of the IT
department The frontline / face of the IT department Troubleshoots
technical issues with staff via phone calls, remote connections, or
face to face interaction Troubleshoots technical issues with staff
via phone calls, remote connections, or face to face interaction
Sets up various end-user hardware, possibly including: PCs,
monitors, laptops, tablets, or printers. Sets up various end-user
hardware, possibly including: PCs, monitors, laptops, tablets, or
printers. CREDENTIALS Must have keen problem solving skills and
experience with a wide range of software Must have keen problem
solving skills and experience with a wide range of software Must be
able to communicate well with people of varying technological
backgrounds Must be able to communicate well with people of varying
technological backgrounds A+ Certification desired A+ Certification
desired CONSIDERATIONS Entry Level Entry Level Easily Filled Easily
Filled Necessary position for Internal IT Department Necessary
position for Internal IT Department AKA: IT Support Specialist
Slide 19 HELP DESK TECHNICIAN + + Knows your staff, software, and
workflows + + Readily available to assist - - Staffing needs to be
proportional to organization size; otherwise, requests cannot be
handled in a timely manner and long wait times on phone + Can do
remotely + Can come on site + Potentially pay for less than full
time position - At vendors discretion for support
INSOURCINGOUTSOURCING Slide 20 SYSTEMS ADMINISTRATOR
RESPONSIBILITIES Manage physical and virtual servers to ensure
software systems run optimally Storage Area Network SAN Management
Has both broad and specialized knowledge CREDENTIALS Bachelors
degree in IT. Certifications: Microsoft Certified Systems
Administrator (MCSA), Microsoft Certified Systems Engineer (MCSE)
Good troubleshooting and problem solving skills. Experience is key
CONSIDERATIONS Very important they have a high and broad skill
level. Likely interacts little with users. Command a high salary.
Necessity if not hosting systems externally Slide 21 NETWORK
ADMINISTRATOR RESPONSIBILITIES Keeps the network up and passing
data. Configures device security. Setup and management of switches
and routers Voice over IP (VoIP) administration CREDENTIALS Desired
Certificates: Network+, Cisco Certified Network Associate (CCNA),
and other Specialized Network Certificates CONSIDERATIONS Much of
their work is not utilizing their specialized skill. When their
skill is needed, its very important. Likely interacts little with
users Slide 22 NETWORK ADMINISTRATOR + + You have total control. +
+ Often their lesser-skilled tasks can be performed by other IT
staff. - - Hard to have enough work for a full time person. +
Easier way to pay for specialized expertise only when you need it.
- You lose control over response time. INSOURCINGOUTSOURCING Slide
23 DATABASE ADMINISTRATOR RESPONSIBILITIES Properly stores company
data. More importantly, retrieves company information. Designs
better ways of retrieving data via stored procedures, views, and
indexes. Often also a developer. CREDENTIALS Bachelors degree with
focus in database management. Experience in your particular
database(s). Experience with data query/reporting tools used in
your practice. Good troubleshooting and problem solving skills.
CONSIDERATIONS Hard position to fill. Commands a high salary. Can
cause serious issues if malicious or incompetent AKA: Database
Programmer Slide 24 SECURITY ADMINISTRATOR RESPONSIBILITIES Ensures
HIPAA and PCI compliance. Initiates implementation of security
protocols on servers, encryption standards, and regulates employee
access Keeps bad guys out and company data in. Performs risk /
vulnerability assessments and management CREDENTIALS Degree with
focus in IT security, particularly B.S. in Cyber Security. Entry
level certifications: Security+, Certified Ethical Hacking (CEH)
Professional certifications: Microsoft Certified Systems Engineer
(MCSE), Certified Penetration Tester (CPT), Certified Information
Systems Security Professional (CISSP) CONSIDERATIONS Desire to keep
up with constantly changing world. Desire to educate users on how
to be diligent. Thick skin. Position is a necessary evil and a
thankless job. Dont ignore security and compliance. The penalties
are too steep AKA: Cyber Security Specialist, Computer Security
Specialist, Administrative Security Specialist Slide 25 SOFTWARE
DEVELOPER RESPONSIBILITIES Develop and customize software
solutions, potentially including EMR forms, Crystal reports, and
websites Develop and customize software solutions, potentially
including EMR forms, Crystal reports, and websites Troubleshooting
escalation resource Troubleshooting escalation resource CREDENTIALS
Experience with control structures, function design, debugging, and
documenting code a must Experience with control structures,
function design, debugging, and documenting code a must Experience
programming in MedicaLogic Expression Language (MEL), HTML 5, and
SQL ideal Experience programming in MedicaLogic Expression Language
(MEL), HTML 5, and SQL ideal Computer Science Degree desired
Computer Science Degree desired CONSIDERATIONS Hard to fill
position. Must have the desire to write code. Most strategic IT
position. Can create efficiencies to pay their salary many times
over. Will interact heavily with users. Needs good communication
skills. AKA: Computer Programmer, Systems Analyst, Software
Applications Specialist, EMR Forms Programmer, Crystal Report
Developer Slide 26 SOFTWARE DEVELOPER + + Works with users to turn
their ideas into reality. + + Troubleshooting issues takes less
time when it is same person that originally coded it - - Need to
find talent and need their services full time. + Can obtain highly
specialized skills only when needed. - Can get expensive when using
them to develop ideas. INSOURCINGOUTSOURCING Slide 27 IMPLEMENTER
RESPONSIBILITIES Gathers requirements of projects and conveys them
to developers Gathers requirements of projects and conveys them to
developers Helps design workflows Helps design workflows Dedicated
to testing the systems to ensure they are working as original
requested Dedicated to testing the systems to ensure they are
working as original requested CREDENTIALS Someone who knows the end
user experience and somewhat the technological side of things
Someone who knows the end user experience and somewhat the
technological side of things CONSIDERATIONS Smaller organizations
typically do not have a dedicated fulltime person Smaller
organizations typically do not have a dedicated fulltime person
Tech savvy clinical team leaders could develop into this role Tech
savvy clinical team leaders could develop into this role AKA:
System Implementer, Implementation Engineer, EMR Liaison Slide 28
TRAINER RESPONSIBILITIES Trains staff on IT systems Trains staff on
IT systems Generates training material, potentially including print
outs, emails, and videos Generates training material, potentially
including print outs, emails, and videos Verifies that staff know
the minimum functionality to perform their job Verifies that staff
know the minimum functionality to perform their job CREDENTIALS
Must be an expert in corresponding IT system Must be an expert in
corresponding IT system Requires superb communication skills
Requires superb communication skills CONSIDERATIONS Typically not a
fulltime position unless it is a large organization Typically not a
fulltime position unless it is a large organization Can setup a
training pyramid, where IT trainer will train staff to train Can
setup a training pyramid, where IT trainer will train staff to
train For mainstream software, training material may be available
to purchase (CBT video or training DVD) For mainstream software,
training material may be available to purchase (CBT video or
training DVD) GE or your VAR may have training available GE or your
VAR may have training available Consultants can setup a
personalized training plan for your needs Consultants can setup a
personalized training plan for your needs Slide 29 IT SUPERVISOR
RESPONSIBILITIES Manage and plan all technological projects in an
organization Manage and plan all technological projects in an
organization Hire new IT employees Hire new IT employees
Responsible for disciplining / firing problematic IT employees
Responsible for disciplining / firing problematic IT employees
CREDENTIALS IT Degree mandatory IT Degree mandatory Needs good
communication skills Needs good communication skills CONSIDERATIONS
Experience helps. Must intermediate between tech people and
non-techie users. Must understand the business and how to leverage
staff and technology to further business goals. AKA: Director of
IT, IT Manager Slide 30 Staffing Tips Know where to advertise.
Local newspaper display ads can cost $2,000. Advertise on
Monster.com for $300. Where should IT people be checking job
openings? Reach out to local colleges/universities or
training/certification companies. They can tell you who their best
students are. Hire staff through a temp agency or on a short term
contract. Some companies dont want to pay a recruiters fee. Other
companies consider it a time savings method to find qualified
candidates. Hire entry level staff and develop them. Slide 31
Interviewing Tips Look beyond the credentials Look beyond the
credentials make sure the candidate will fit well with the
department make sure the candidate will fit well with the
department Has a passion for the role Has a passion for the role
Soft skills (work ethic, citizenship, communication skills) can be
more important than technical expertise Soft skills (work ethic,
citizenship, communication skills) can be more important than
technical expertise Make sure a candidate actually knows the
fundamentals (not necessarily your specific systems or languages)
Make sure a candidate actually knows the fundamentals (not
necessarily your specific systems or languages) Where applicable,
have a short practical exercise to see if they can think on their
feet and apply their knowledge beyond just getting a degree Where
applicable, have a short practical exercise to see if they can
think on their feet and apply their knowledge beyond just getting a
degree Slide 32 Purchasing Products Tried and proven products Look
for the efficiencies and payback that they provide Vendors
expertise and reputation Comfort level with the people selling it
Support after the sale TCO Slide 33 Purchasing Services Tremendous
expertise exists outside of your organization; take advantage of
the knowledge of others Many in-house IT staff are
jack-of-all-trades, master of none. You can purchase the services
of very in-depth experts. A look at your organization from an
outside perspective is often quite beneficial Workflow analysis
Security vulnerabilities Performance optimization Slide 34
Interacting with Outsourcers and Other IT Vendors Written
conditions essential (Statement of Work should provide all details)
Written conditions essential (Statement of Work should provide all
details) What type of arrangement is it ? What type of arrangement
is it ? Licensing Licensing Recurring fee (potential installation
fee) Recurring fee (potential installation fee) Stop paying, lose
functionality Stop paying, lose functionality Purchase Purchase
Higher initial cost, but may be more affordable in long run Higher
initial cost, but may be more affordable in long run Source files /
hardware included? Source files / hardware included? Slide 35
Interacting with Hosting Outsourcers Compare different
vendors/datacenters. All are not the same. Examine their entire
infrastructure: building, power, backup power, cooling, fire
suppression. What redundancies do they have? Do they have single
points of failure? Get an SLA that spells out performance
guarantees, uptime and penalties. Look at their hardware and
storage. Will they be giving you fast enough hardware? Its in their
best interest to give you good enough but not better. What is their
technology refresh policy? What are your options if you feel they
havent given you enough server horsepower or storage speed? Slide
36 Interacting with Hosting Outsourcers When do they do maintenance
that brings you down? How long will you be down and what time of
day? What lead time notification will you receive? What is their
Internet bandwidth? How are you charged? You need to look at both
bandwidth and Gb/month. What providers do they use? What redundancy
do they have? How and when do they backup your data? Whats their
retention policy? Their restore policy? How do they handle offsite
storage? How does your monthly price change as your data grows?
What about data ownership? How do you get your data back, including
your backup data, if they go out of business or you move to another
hosting company? Slide 37 Outsourcers Potential Red Flags Were they
punctual with meetings or phone calls ? Were they punctual with
meetings or phone calls ? Are the promises realistic / recorded ?
Are the promises realistic / recorded ? Is it an extraordinarily
low price relative to competitors ? Is it an extraordinarily low
price relative to competitors ? Do they have references ? Do they
have references ? Does their website or material have typos /
errors ? Does their website or material have typos / errors ? Slide
38 How to Make IT a Strategic Asset Dont spend time on things that
arent making the practice better. Email important, but not
strategic. It can be outsourced. Company website: Information and
ideas come from your company. Site development, graphic arts and
marketing expertise are best left to the experts. Hardware
infrastructure there are companies that are experts. Its their
business, its not your business. Virtualize applications spend much
less time installing and updating them. Dont forget disaster
recovery & business continuity. Slide 39 How to Make IT a
Strategic Asset Vanilla software or modified software? Do you want
to modify your practice to fit the software, or modify the software
to fit your business. Purchase software developed at companies who
have demonstrated and proven its value, not from a company who
writes software and hopes somebody buys it. Medical practices must
be lean and efficient. Patients must move through quickly to
maximize physician billings, and to ensure patient satisfaction.
Purchase software and implement workflows that demonstrate proven
efficiency, or develop/develop/develop. Slide 40 How to Make IT a
Strategic Asset Utilizing Software Developers and Database
Administrators Focus on low hanging fruit, large gains with low
development time projects Many projects should be broken up in
phases If Phase 1 will take 3 days and fix 80% of the issues, while
Phase 2 will take 3 months and fix the other 20%, dont delay 3
months for perfect, reap the reward of Phase 1 while completing
Phase 2 Setup the software to help the user do the right thing
Automate rules and tasks as much as possible, make the software do
the heavy lifting Slide 41 QUESTIONS?
