The Path to Paperless

IT Services: In-house or Outsource?

Or, if you can afford it, a hybrid approach can offer value.

By Peter J. Polack, MD, FACS

ILLUSTRATOR: MARK HEINE / DEBORAH WOLFE, LTD

Previously I wrote about outsourcing your IT services support [Jan 2008] as well as how to hire an IT director [Jan 2011]. But one question that I am commonly asked is, “How do I decide whether to keep IT services in-house or whether they should be outsourced?”

Electronic health records systems have become an integral part of the practice of medicine and having some-one with IT expertise in your corner is no longer a luxury but a necessity. But for most medical practices, this decision is strictly a monetary one. Still, there are more issues to consider than just budget.

Some ophthalmology practices will be better served by having their IT services in-house and available to offer support and fix problems at a moment's notice. Other practices will do fine by outsourcing their IT services to a capable third-party that has a good track record of prompt and reliable service. Following are a number of criteria that you can use to determine whether you need an IT person on the payroll or not.

Who Should Have IT In-house

► You are completely clueless about technology and need someone at your beck and call.
► You want someone with particular expertise in your specific EHR software.
► You want someone who has specific knowledge of your medical specialty.
► The physicians in your practice want their daily IT needs handled on an expeditious basis.
► Your practice can afford to pay a competitive salary and provide benefits for a full-time IT person.

Who Should Outsource Their IT Services

► You cannot afford to hire a full-time IT person.
► You have a small practice and you consider yourself ‘tech-savvy.'
► You are using a Web-based EHR system and have a minimal IT infrastructure.
► You need or require 24/7 support.
► The complexity of your practice demands redundancy in the support services.
► There is a large volume of basic, mundane tasks that have to be handled on a daily basis.

Can You Go Hybrid?

Another option to consider: the hybrid model. Whether you decide to outsource IT services or bring in your own full-time person, a concern in either case is the transfer of knowledge. If you have a full-time IT employee, that person's fund of knowledge — about your practice, about your EHR system, about your processes — walks out the door with him or her. Even if they are meticulous about documenting all of their processes, this can still be a devastating loss. While this risk can be lessened with an outsource firm, there is still the potential for loss if their services are terminated and you have to hire another firm.

By having both an in-house IT person and a third-party IT firm at your disposal, you could build in enough redundancies so that your practice can be protected in the event of a staffing change.

The outsourcing firm can provide around-the-clock monitoring of your IT infrastructure and handle basic, day-to-day operational issues such as computer troubleshooting, password resets, and printer repairs. Your in-house IT employee can oversee the outsourcing firm, while at the same time looking out for the best interests of the practice, providing physicians with prompt, personalized attention, and concentrating his or her efforts on more specialized work such as EHR templates, meaningful use issues, and the like. The hybrid model is going to cost more but the peace-of-mind may be worth it. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.