The Path to Paperless

IT Redux — In-house or Outsource

In some practices, a combination of the two will work best.

By Peter J. Polack, MD, FACS

Previously, I wrote about how information technology (IT)

personnel are an increasingly important part of medical practices as EMR becomes a fact of life. A question I commonly receive is whether or not it is better to out source IT or hire a full-time in-house IT specialist.

Let’s Look at the Options

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

► Stick with paper. If you’re not going paperless, you’ll save on IT expenses, although the penalties you’ll incur from not implementing EMR will offset the savings.

►Full outsourcing. For most smaller practices, this might be the most costeffective option. But beware. Many so-called health-care IT companies have little or no experience with the intricacies of medical practice networks, let alone HIPAA. And you’ll be lucky if you have a designated person assigned to your practice. This can lead to real issues with continuity.

► 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 readily customize EMR templates, and more. On the downside, if this person should leave the practice, he or she will take a virtual Wikipedia of information that will be hard to replace. Or, just as bad, this same “irreplaceable” someone has poor people skills and the practice feels like it is being held hostage.

► 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 or ensuring the EMR system stays online.

You could certainly hire a lowerlevel junior IT employee for your fixit jobs and free the higher-skilled staff member for more important functions. Or, you could hire an out source IT company to handle fix-it and maintenance jobs and act as a help desk for your other employees. The cost is comparable when you figure in a full-time employee’s benefits.

One major advantage of the out source firm over an additional junior employee is the company’s 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 out-source 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 and 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 out-source firm. This is not a vote of no-confidence but a standard practice in the industry.

Practice Size Does Matter

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 large practice, 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. 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.