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?
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IT Department: Strategic asset or money pit, you decide