PRESENTED BY OBJECTIVES 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. Discover how an IT department can be structured and some of the positions it can contain. 3. Find out how your IT department can make your practice lean and efficient. PRESENTERS • Mike Baeske, Software Applications Specialist – Team Leader, Ortho NorthEast • Kevin Haverstock, IT Supervisor, DataDrivers ORTHO NORTHEAST • An Orthopedic practice founded in 1962 • 12 locations throughout northeast Indiana • 26 physicians, 7 anesthesiologists, 13 CRNAs, 24 mid-levels, 14 PT/OT • Part ownership of orthopedic hospital, MRI center, and ambulatory surgery center IT INFRASTRUCTURE • Servers • Storage • Backups • Facilities • Internet • Telephones & lines • Networking • Monitoring • Print/scan/fax • PCs/laptops/thin clients/monitors SERVERS DETAILS INSOURCING OUTSOURCING RAM (memory) is king. Also get the most processing power (CPU). Use multi-core processors. + You control the spending. + You determine how much you’re + No large capital outlay. + Outsourcing comes with experts Virtualization is the only way to go. ONE: 120 virtual servers on 5 physical servers. Configure for High Availability and Dynamic Resource Scheduling. willing to spend for speed. + You add memory & refresh who handle the details. + You are not spending valuable 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. 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. STORAGE DETAILS INSOURCING OUTSOURCING Get the most IOPS (speed). Utilize flash storage. + You control the spending. + You determine how much you’re + No large capital outlay. + Outsourcing comes with experts 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. willing to spend for speed. + You add capacity & refresh who handle the details. + You are not spending valuable time managing non-strategic tasks. 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. 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. BACKUPS DETAILS INSOURCING OUTSOURCING Should you backup to disk? To + You determine how expensive of a + No large capital outlay. + Outsourcing comes with experts solution to employ. tape? To both? Set retention policies for various + You have complete control over retention policies, offsite storage, etc. types of data. Utilize secure offsite storage. Make sure you have a sufficient backup window. + You control how quickly you can restore when needed. - Limit the software products utilized. Deduplication! Dispose of backup media properly. Tapes have a limited lifespan. Test backups and restores. - - You have a large capital expenditure when you need more hardware. who handle the details. + You are not spending valuable time managing non-strategic tasks. - You spend valuable time managing the resource. - You must have properly trained staff. - 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. FACILITIES DETAILS INSOURCING OUTSOURCING You need a computer room built + It’s close by when you need + No huge capital outlay. + Does not consume your square specifically for that sole purpose. It must be properly secured. Raised floor or overhead channels for cabling. Redundant A/C specific to the access to the equipment. + You’re in control of the security/access. - 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. - Takes up valuable square footage. footage. + You have a professional manager. - It is a huge expense. It requires time to manage the facilities. If you run out of space, good luck! - You won’t have quick and easy access to your equipment. You have no control over facility and management. FACILITIES INTERNET DETAILS INSOURCING OUTSOURCING You need sufficient bandwidth. + You’re in total control of the - Should have redundant paths and providers. Monitor uptime and utilization. Have a full featured and fast border router. Implement proper security and site filtering. providers and the security. - Proper setup and maintenance requires expertise. Even if your servers are hosted, you require Internet access at your facility. 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. 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. MONITORING DETAILS INSOURCING OUTSOURCING + You ensure that the proper + No capital expenditure required. + Usually a 24 hour NOC is used. + They can place a call to your 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. systems are being monitored. - Software can be expensive. Expertise required. Need a way to wake up staff at 2am. An email won’t do it. 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. PRINT/SCAN/FAX DETAILS INSOURCING OUTSOURCING The paperless office never really materialized. + You control the response times. + You control moving machines Medical industry relies heavily on faxing. around based on needs and volume. + Actually saves cost. + Definitely saves IT staff time. - You have to deal with slow Implement scan-to-email and email-from-desktop. Setup an MPS contract. Saves cost and saves staff time. - - - responding vendors. You are spending time fixing printer issues. - You likely have to call someone anyway. - You’re having to deal with having toner for machines no longer in service. You have to make sure you don’t run out of toner. Having the wrong vendor can cause staff discontent. Staff will blame IT for issues that are the vendor’s fault. PCS/LAPTOPS/TABLETS/THIN CLIENTS/MONITORS DETAILS INSOURCING OUTSOURCING Desktop PCs still have their place. + You control all hardware Productivity increase with dual monitors or large monitor with Snap feature. + No capital outlay. + Set parameters and let hardware Laptops: large or small. Docking station? Tablets: Centricity is not optimized for touch. Thin clients: secure, good if virtualizing apps. Encryption critical for HIPAA purchases, deployments and refreshes. - You’re spending time constantly dealing with user requests. company deal with deployments. - Loss of control. Dealing with special situations. IT DEPARTMENT JOB FUNCTIONS • Helpdesk • Systems Administrator • Network Administrator • Database Administrator • Security Administrator • Software Developer • Implementer • Trainer • Manager HELP DESK TECHNICIAN AKA: IT Support Specialist RESPONSIBILITIES • • • The frontline / face of the IT department 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. CREDENTIALS CONSIDERATIONS • • Entry Level • Easily Filled • Necessary position for Internal IT Department 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 • A+ Certification desired HELP DESK TECHNICIAN INSOURCING +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 OUTSOURCING +Can do remotely +Can come on site +Potentially pay for less than full time position - At vendors discretion for support SYSTEMS ADMINISTRATOR RESPONSIBILITIES • • • Manage physical and virtual servers to ensure software systems run optimally CREDENTIALS CONSIDERATIONS • Bachelor’s degree in IT. • • Certifications: Microsoft Certified Systems Administrator (MCSA), Microsoft Certified Systems Engineer (MCSE) 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 Storage Area Network SAN Management Has both broad and specialized knowledge • Good troubleshooting and problem solving skills. • Experience is key 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 CONSIDERATIONS Desired Certificates: Network+, Cisco Certified Network Associate (CCNA), and other Specialized Network Certificates • Much of their work is not utilizing their specialized skill. • When their skill is needed, it’s very important. • Likely interacts little with users NETWORK ADMINISTRATOR INSOURCING +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. OUTSOURCING +Easier way to pay for specialized expertise only when you need it. - You lose control over response time. DATABASE ADMINISTRATOR AKA: Database Programmer RESPONSIBILITIES • Properly stores company data. • More importantly, retrieves company information. • • Designs better ways of retrieving data via stored procedures, views, and indexes. CREDENTIALS CONSIDERATIONS • Bachelor’s degree with focus in database management. • Hard position to fill. • Commands a high salary. • Experience in your particular database(s). • Can cause serious issues if malicious or incompetent • Experience with data query/reporting tools used in your practice. • Good troubleshooting and problem solving skills. Often also a developer. SECURITY ADMINISTRATOR AKA: Cyber Security Specialist, Computer Security Specialist, Administrative Security Specialist 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 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. • Don’t ignore security and compliance. The penalties are too steep • • 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) SOFTWARE DEVELOPER AKA: Computer Programmer, Systems Analyst, Software Applications Specialist, EMR Forms Programmer, Crystal Report Developer RESPONSIBILITIES • • Develop and customize software solutions, potentially including EMR forms, Crystal reports, and websites CREDENTIALS CONSIDERATIONS • Experience with control structures, function design, debugging, and documenting code a must • Hard to fill position. • Must have the desire to write code. Experience programming in MedicaLogic Expression Language (MEL), HTML 5, and SQL ideal • Most strategic IT position. • Can create efficiencies to pay their salary many times over. Computer Science Degree desired • Will interact heavily with users. Needs good communication skills. • Troubleshooting escalation resource • SOFTWARE DEVELOPER INSOURCING +Works with users to turn their ideas into OUTSOURCING +Can obtain highly specialized skills only 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 . when needed. - Can get expensive when using them to develop ideas. IMPLEMENTER AKA: System Implementer, Implementation Engineer, EMR Liaison RESPONSIBILITIES • Gathers requirements of projects and conveys them to developers • Helps design workflows • Dedicated to testing the systems to ensure they are working as original requested CREDENTIALS CONSIDERATIONS • • Smaller organizations typically do not have a dedicated fulltime person • Tech savvy clinical team leaders could develop into this role Someone who knows the end user experience and somewhat the technological side of things TRAINER RESPONSIBILITIES • Trains staff on IT systems • Generates training material, potentially including print outs, emails, and videos • Verifies that staff know the minimum functionality to perform their job CREDENTIALS CONSIDERATIONS • Must be an expert in corresponding • Typically not a fulltime position IT system • Requires superb communication skills unless it is a large organization • 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) • GE or your VAR may have training available • Consultants can setup a personalized training plan for your needs IT SUPERVISOR AKA: Director of IT, IT Manager RESPONSIBILITIES • Manage and plan all technological projects in an organization • Hire new IT employees • Responsible for disciplining / firing problematic IT employees CREDENTIALS CONSIDERATIONS • IT Degree mandatory • Experience helps. • Needs good communication skills • Must intermediate between tech people and non-techie users. • Must understand the business and how to leverage staff and technology to further business goals. 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. • Hire entry level staff and develop them. Some companies don’t want to pay a recruiter’s fee. Other companies consider it a time savings method to find qualified candidates. Interviewing Tips • Look beyond the credentials • make sure the candidate will fit well with the department • Has a passion for the role • 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) • 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 Purchasing Products • Tried and proven products • Look for the efficiencies and payback that they provide • Vendor’s expertise and reputation • Comfort level with the people selling it • Support after the sale • TCO 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 Interacting with Outsourcers and Other IT Vendors • Written conditions essential (Statement of Work should provide all details) • What type of arrangement is it? • Licensing • • Recurring fee (potential installation fee) Stop paying, lose functionality • Purchase • • Higher initial cost, but may be more affordable in long run Source files / hardware included? 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? It’s 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 haven’t given you enough server horsepower or storage speed? 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? What’s 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? Outsourcers Potential Red Flags • Were they punctual with meetings or phone calls? • Are the promises realistic / recorded? • Is it an extraordinarily low price relative to competitors? • Do they have references? • Does their website or material have typos / errors? How to Make IT a Strategic Asset • Don’t spend time on things that aren’t 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. It’s their business, it’s not your business. • Virtualize applications – spend much less time installing and updating them. • Don’t forget disaster recovery & business continuity. 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. 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%, don’t 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 QUESTIONS?