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IT Services for Your Medical Practice – In-House vs Out-Source

IT in boxPreviously I wrote about how information technology (IT) personnel are an increasingly important part of medical practices as EMR becomes a fact of life, as well as the challenges that administrators face in recruiting and hiring these individuals. A question I commonly receive is whether or not it is better to outsource IT or hire someone full-time.

With a typical IT employee commanding $70,000 or more with benefits, practices will want to seriously consider all of their options:

  1. Stick with paper. If you’re not going paperless, you’ll save on IT expenses – although this may be offset by the penalties you’ll incur from not implementing EMR.
  2. Change your receptionist’s job description. So Suzy is good with computers and you’re tempted to make her your new IT director. While this will certainly save you money in the short term, this will ultimately prove disastrous.
  3. Full outsourcing. For most smaller practices, this might be the most cost-effective option. But beware: with all of the healthcare dollars floating around, suddenly everyone is an EMR ‘Expert.’ Many so-called healthcare IT companies have little or no experience with the intricacies of medical practice networks let alone HIPAA compliance. And you’ll be lucky if you have the same person assigned to your practice – there can be real issues with continuity.
  4. Full-time IT employee. I’ve said before that this position will be as common as a nurse in the practice of the future. This is your ultimate EMR advocate who knows the physicians and how they practice, who is familiar with the nuances of your particular specialty, who can customize EMR templates, and more. On the downside, if this person should leave the practice, he or she takes with them a virtual Wikipedia of information that is hard to replace (transfer-of-knowledge risk). Or, just as bad, this same ‘irreplaceable’ someone has poor people skills and the practice feels like it is being held hostage.
  5. A hybrid arrangement. In many practices, the full-time IT director can be overwhelmed with the tsunami of ‘crises’ ranging from password resets to printer paper jams. This leaves little time for more critical things like keeping the office network going, ensuring that the EMR system stays online, etc. You could certainly hire a lower-level ‘junior’ IT employee for your ‘fix-it’ jobs and free the higher-skilled staff member for more important functions. Or you could hire an outsource IT company to handle fix-it and maintenance jobs and help-desk for your other employees. The cost is comparable when you figure in a full-time employee’s benefits. You’ll need to spell out the job responsibilities and decide who will make major decisions such as purchasing of computer or other hardware.

One major advantage of the outsource firm over an additional junior employee is their capacity for a higher-level overview. This gives you protection against the transfer-of-knowledge risk, where your highly-skilled IT director leaves and takes the ‘keys to the kingdom.’ A competent outsource firm will help develop a master document of your entire IT infrastructure (network, server schema, passwords, etc.) – an important part of your overall disaster recovery/business continuity plan – and keep things going as you transition to a new person. Your current IT director’s job description should include his or her planned exit strategy in concert with the outsource firm; this is not a vote of no-confidence but a standard practice in the industry.

Having IT support and services is the new reality for medical practices. How the practice is best served both from a financial standpoint as well as in terms of customer service will be determined in large part by its size and resources (in our case, we have had success with the hybrid system). But with the lifeblood of most practices being so dependent on its computer network, it is not a decision to take lightly.


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