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A New Approach to Getting IT Done — UsingManaged Services By Patrick McBrayer Chief Technology Officer HIMformatics, LLC  Growing Complexity Advances in information technology have revolutionized the practice of medicine. Electronic health records (EHRs) and a host of other tools have helped practitioners be more effective and provide safer healthcare to patients. Slower to develop has been the supporting infrastructure that makes these marvels possible and keeps them running in a mission-critical environment. Just a couple of decades ago, most hospitals ran their applications on a single mainframe or midrange computer. IT staffs were small because data and power-hungry applications had not yet become widely available. Today it's different. Organizations leverage 500 to 1,000 or more server environments running multiple applications from multiple providers. This new environment demands far higher levels of technical expertise, experience and resources. For most healthcare organizations, marshalling this level of resources has proved challenging. Many community hospitals are managing a level of technology appropriate to a Fortune 100 company with the same limited staff they had in years past. Leveraging Outside Resources Faced with this new reality, organizations are turning to sourcing strategies of various levels. Implementation Services. Many organizations have long taken advantage of implementation services to leverage the expertise of outside experts during the rollout process. Outsourcing Services. Less common is outsourcing management and maintenance of the IT function. Instead of setting up their own help desks, a third party provides the service either on- or off-site. Where expertise or resources are lacking, individual pieces of the IT function can be taken on by outside experts. In addition, organizations are finding that maintaining and continually expanding the infrastructure needed for these applications isn't worthwhile even if they are a large organization. Recently, I consulted with a hospital on such an upgrade. Just eight years before they had built a data center sized at six watts per square foot. Today, that same organization is contracting for space that could accommodate up to 200 watts per square foot. Remote Hosting. Faced with these resource demands, hospitals are moving applications and data storage out of their own facilities and into remote hosting environments that can offer defined service level agreements (SLA). Outsourcing of IT Function. The opportunities for this kind of outsourcing have grown in recent years to include local operators and large corporations with a national reach. This variety of choices presents both opportunities and pitfalls. Outsourcing financial and clinical solutions to an outside company clearly offers benefits, but a poorly thought out or executed deal can be costly in many ways. What to Outsource? Each institution must develop and execute a clear process for deciding what function can be effectively transferred to an outside managed services provider. This becomes an evaluation that must extend beyond simple cost cutting. Too many hospitals just ask "How can I do this cheaper?" There are actually two questions that should be considered: "What are the service levels required by the organization?" and "How can I most effectively and efficiently deliver the required service levels?" In a healthcare environment – where mission-critical clinical operations are essential – cost and dependability of service is a critical factor. Today's managed services providers leverage far greater resources than would be possible for a single hospital by spreading the cost over a number of customers. Improved Service Level Agreement. As a result, these companies can provide service level agreements that are often far greater than the customer could achieve internally. Driven by industry standards and competition, they can offer a wide menu of critical services such as disaster recovery, along with performance guarantees that a typical IT staff can't provide. Greater Access to Expert Resources. By partnering with a larger organization, the hospital also gains access to the higher skill levels needed to support this large and complex environment. Predictable Budget and Upgrades. Another key is investment planning. Service providers are not only able to offer consistent pricing, but regular and predictable upgrades of applications and infrastructure. Where those mainframes might have been refreshed once in a decade, modern systems are on a tighter three- to five-year timeframe. Who to Select? Knowing what you want to outsource leads to perhaps the most important step of all — who is the best provider for you? The choices, of course, are many, and there is a wide range of sizes of organization and differing focuses. Some are focused solely on maintaining infrastructure, while others have the ability to truly own the performance of the applications they host. And that brings us to the importance of being able to evaluate a provider's offering all the way from SLAs to its ability to understand and integrate a wide variety of software solutions. The key factors for healthcare organizations in selecting a partner for managed services include:  Your objectives and the problems you are trying to solve. The service levels you need and the total cost of delivering these services. What will happen if and when the contract ends.Careful planning and evaluation can ensure that your organization not only avoids the pitfalls but is able to fully embrace the advantages of managed services. The results will be not only better services and performance, but financial rewards that can help to ensure the success of the institution today and into the future. Patrick McBrayer is the Chief Technology Officer for HIMformatics, LLC, a leading healthcare information technology consulting firm. He has more than 20 years of healthcare technology integration and management experience as a consultant and as the CTO at Baptist Healthcare System in Louisville, Ky. and Piedmont HealthCare in Atlanta, Ga.
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