Small medical practices must perform many information technology (IT) functions—EHR system management, cybersecurity, imaging, billing, and controlling and keeping tabs on infrastructure operations, among others,—to achieve the clinical and financial outcomes necessary for their success.
While most such offices don’t have in-house IT staff, some do, whether they train existing personnel to perform these functions or hire dedicated staff who already have these skills.
This article looks at both approaches, examining the pros and cons of each, and when, or if, it makes sense to combine them.
Before a practice decides who will oversee its IT functions, it must know which functions are essential to clinical and financial success. EHRs are a given, but so is a practice management system that integrates patient data with health records and creates a workflow that expedites patient appointments.
To accomplish this, the EHR must have an API (Application Programming Interface) that has easy back-and-forth communication with the management system, and both components must be HIPAA-compliant. While not mandatory, it’s certainly desirable to have a patient portal that lets patients access their appointment schedules and records online.
Cost & Risk
The tradeoffs of hiring IT staff versus outsourcing the function is that a practice has greater operational control over employed staff, but assumes higher costs and risks, says Graham Caparulo, principal consultant with Diligex, a New York City-based provider of outsourced IT services to small and medium-sized medical practices.
“On the risk side, if you have your own staff and a data breach, there’s no one to point the finger at except yourself,” Caparulo says. (Under the HIPAA Omnibus Rule, if a contractor has signed a HIPAA Business Associate agreement with the practice to comply with HIPAA privacy, security and breach notification requirements, it is liable for any HIPAA infractions it commits.)
Contracting out IT lets a practice focus on its core business of providing healthcare. Moreover, the practice may get a broad base of contract employees with a wide variety of technical competencies, and it’s not left exposed if the in-house IT staffer gets sick, goes on vacation, or leaves the practice.
“The average tenure of an IT person is about two or three years,” says Caparulo, “so do you want to go through this every couple of years or shift that over to somebody else?”
Before hiring outside contractors, the practice needs to conduct a thorough internal inventory to determine what the staff members and doctors already know about the existing IT system, identify their IT product and service needs, then develop a Request for Proposals based on those precise needs.
At some point, however, it usually makes sense for a small practice to hire someone for what Caparulo calls “level one or front-end triage issues,” such as if a front-desk staffer can’t log in to the EHR, access e-mail, or print out a medical record. In those instances, it’s better to have a more technically adept practice employee on hand to solve the problem. “They’ll likely get things resolved quicker than if they go through an outsourced provider,” says Caparulo.
A practice that doesn’t outsource its IT functions might train its own employees—even if they have little or no IT experience—instead of hiring someone. While this approach certainly costs less than hiring a full-time, dedicated IT employee, the question becomes: is it worth the time to train a tech neophyte currently on the practice’s staff, and will the growth in size and complexity of an IT structure be too much for that staffer to manage in the future? It might be easier to choose this path if the practice’s IT vendor makes training and system support part of the services it provides.
On the other hand, many people today are increasingly comfortable with sophisticated digital technology, says Ken Hertz, FACMPE, a principal with MGMA Health Care Consulting Group, in Englewood, Colo. These staffers can learn the workings of the EHR and perform certain IT functions in a practice, potentially removing the need for a full-time IT employee.
These “super users” can be and “are highly trained in software, and in understanding and problem-solving with the EHR or practice management software. A vendor can furnish that training.
“Now, they’re not going to solve your network problems and things like that,” Hertz cautions, while noting that super-users who develop more experience handling software can sometimes help with networking and hardware problems as well.
But the more complex services, such as interoperability and telemedicine, ought to be left to contract experts, Hertz says. “You want somebody who knows all about HIPAA issues, cybersecurity issues, encoding messages and so forth.”
For some small practices—like that of Karen Smith, MD, a family physician in rural Raeford, N.C.—hiring new or training existing in-house staff isn’t an option. First, the cost is prohibitive—about $30,000 per year, according to practice administrator Michael Hendricks. That would be an operations budget-buster for Smith.
Second, it’s more practical to use a sub-contractor from nearby Ft. Bragg to provide IT support, “Even if we had an IT specialist to come in and train us it’s out of our purview because we would literally have to study that technology and know what the upgrades are,” explains Smith.
Each service the practice installs incurs training costs. It’s also highly important that the contractor have an industry-specific knowledge base.
“Subcontract with someone who stays up to date with technology and who understands healthcare,” Smith says. “You really need an IT person who understands the nuances of medicine.”
Practices also should understand how IT pricing works. More labor-intensive functions, such as a help desk, are likely to be costly, Hertz says. But vendors may charge a lower monthly fee for certain standard services, such as security, anti-virus security, back-up, monitoring alerts, and hardware support.
Finally, Hertz says, a vendor contract should address response time for dealing with technical issues or downtime. “They may say, ‘Yeah, we said we’d be onsite, but didn’t you read the part of the contract where we said we’d probably be there within three days?’”