Health IT Support at Your Medical Practice: Hire or Train?

At his three-person practice, Jason Flake wears many hats. He is the practice's office manager, and when computer problems arise, he is the primary go-to IT support staff person.

So it's no surprise that when his practice, which he runs with his physician father Thomas M. Flake Jr., in Southfield, Mich., was ready to upgrade to an EHR last year, training to use the new technology fell on him.

"I don't think they had in mind an individual solo practice," says Jason Flake, recalling how the practice signed up to adopt Cerner's cloud-based EHR because its local hospital affiliate, Detroit Medical Center, covered part of the cost of acquiring that EHR. "We're just a solo [physician] practice. We decided to do it all in-house."

Though the Flakes rely on a local IT contractor on the occasion that big technology problems occur, Jason Flake saw no need to hire someone full time to help with the new system - nor could they afford it.

"For me, it had to be easy," says Thomas Flake, noting that it took him one week to learn how to use the cloud-based EHR. "I'm not a computer-savvy individual."

Whether your practice is small and independent like the Flakes' or larger and hospital-based, someone will need to lead it through the transition to new technology, especially if it has just purchased an EHR.

But deciding whether to use current employees to take on IT responsibilities or hire new ones to serve as dedicated IT staff - a job that can include troubleshooting, data backup, and answering tech questions from clinical and administrative staff - isn't always easy. Issues such as money (IT help costs!), time (how much it takes to train someone in-house), and future technology needs can affect the level of IT investment you can make.

"With the emergence of new EHRs and new healthcare tools, all practices have to improve their IT IQ and their capabilities to manage and support these new tools," says healthcare consultant Bruce Kleaveland. "In the case of EHRs, you have more devices, tablets, laptops, printers, and servers, and as you increase the amount of devices, you need to increase the level of support needed to have them running smoothly."

The case for training in-house

So you've accepted that your practice is going to have to invest more time and money in IT.

What's the first clue that you can't just hire a dedicated IT staff person to join your medical group?

One answer: If shelling out $60,000 or more - what many experts feel is the minimum cost for a full-time IT staffer - isn't an option. This scenario applies to many, if not most, small practices, says Kleaveland. In that case, he says it's absolutely necessary that practices identify staff members who can take on IT responsibilities.

"Under all circumstances, practices of all sizes are going to want to have some resident IT [dedicated staff], some people who work within the office who have knowledge and capabilities that will help them support the current IT structure," says Kleaveland. "Whenever you implement a new system, there should be somebody at the staff who is the staff expert on the new system."

Brad Boyd, vice president of Culbert Healthcare Solutions, a company that focuses on IT strategic planning for physician practices and other healthcare organizations, agrees that the size of the practice matters when making the decision to train existing staff on technology.

"If you have an 800-physician group with two IT staff [members], there's no way that two people have the bandwidth to do all that work and maintain their operations," says Boyd. "But if you have two IT people at a 40-person staff, then you could invest the time to do [training] yourself."

In addition, practices might want to opt for training someone in-house if they already have someone on staff with a demonstrated interest in technology.

Boyd recalls one of his practice clients that tapped a woman who was head of their revenue cycle management team to lead a major EHR implementation, as she had strong management skills, strong insight into clinical operations, and understood how charge capture would occur within an EHR environment. She was also well-respected by her peers.

The good news for practices in favor of in-house IT training is that a growing number of vendors provide some form of training and support for their systems as part of the package deal for purchasing technology.

"Many of the health technology vendors have training programs for their specific products - whether it is an electronic health record or something else, vendors are actively engaging in training practices that are willing to purchase their software or technology enablers," says Helen Figge, senior director of career services at Healthcare Information and Management Systems Society (HIMSS). "It behooves the vendor to train the practices on the optimal use of their software because the best advertisement is a satisfied customer. Additionally, the vendor ensures that the product sold to the practice is being used to its highest caliber offering."

When negotiating with a vendor for purchase of a healthcare technology component such as an EHR, Figge advises practices to express their desire for training and even certification training if offered for the new product.

"That way when you purchase the technology for your practice," she says, "you optimize your practice's chances of using it to full potential."

But while training in-house has its merits, two arguments for a small practice not to invest in training in-house are if the practice isn't technology oriented or if staff members are already bombarded with too much work. In such cases, it might make more sense to start evaluating local IT contract services for help on an as-needed or full-time basis, says Kleaveland.

The case for hiring it

Sometimes it makes more sense for a practice to hire IT help, rather than simply train one of its own.

For example, a medium- or large-size practice that lacks a dedicated IT person might find it harder to manage an increasing array of devices and equipment and systems. And though the cost can be deep into the five figures, the advantage of hiring a full-time IT person is that your expenses will be predictable.

"The benefits are you have a staff person on-site who is available instantly that you are paying a defined salary and benefits for," says Kleaveland, adding that a dedicated IT staff person is typically in charge of installing new pieces of hardware, maintaining and supporting new software versions, and functioning as the help desk for routine technical problems."People don't bring on a dedicated IT person until there's so much volume of equipment that they can't run without it."

Allen Kriete, executive director of healthcare for TEKsystems, an IT staffing services company, says the need for hired IT help is poised to increase.

"I think that [healthcare] requirements are changing, as well as the security requirements and mobility requirements, and that will require [practices] to get some sort of competency for their organization, and that's difficult to train," says Kriete.

But because healthcare IT staff are in demand, if a practice decides to start interviewing full-time candidates, it needs to be ready to make a hiring decision fairly quickly.

"If you take 45 days to make a decision today, you're not going to get the best people," Kriete says. "When you go to look for somebody, really define what your requirements are. Find out what that person is looking for."

If hiring full-time IT staff is too expensive, hiring part-time IT help, or working with technology contractors, makes for a suitable alternative.

For super small practices (such as the Flakes'), if no one wants to dedicate themselves to IT, it makes sense to outsource all IT-related needs. And for not-so-small practices that want to save money on hiring someone full time and can do some training in-house, having a part-time IT help person may be a more ideal solution.

Just be warned: Not all IT tech shops, whether corporate or mom-and-pop-style, are the same.

Practices should look for a third-party consultant who is skilled in doing networking services and maintenance support during and following an installation. Sole consultants might not be the best idea, as they aren't always able to show up on short notice, warns Kleaveland.

"The problem with the one-man shop is that if the one-man shop gets overburdened or excessively busy, or has an accident or something like that, all of a sudden you don't have any backup," he says.

Finally, as with any shopping, when you're looking for a third-party IT consultant, Kleaveland advises practices to make sure the consultant's market rates are competitive for their area and that they have at least one practice reference. Their EHR vendor can also be a good resource for identifying a good IT company, he says.

Whether your practice hires a full-time or part-time consultant, there are certain universal qualities he or she should possess, says Figge.

"Hiring an individual comes down to [asking], 'Who would make a great candidate at my practice? Does that person exhibit exceptional communication skills? And, does [that] individual have the ability to motivate an office and is willing to continue with the learning curve in healthcare and its reform?'" says Figge. "The ability to have people skills in a practice is really paramount because the technology has to be used and appreciated and a person's ability to understand not only the patient's concerns but also clinicians' will be one of the determinations for a successful practice outcome."
And although past experience with EHRs is ideal, an IT consultant who has never worked with an EHR shouldn't be disqualified automatically.
"If you're looking for a specifically trained individual, having specific knowledge is helpful," says Figge, "but it shouldn't necessitate hiring someone, because those skills are easily obtainable."

Figure out what you need

When it comes to IT help, plenty of options await. To figure out what's best for your practice, experts suggest doing a basic needs assessment. Here's what to do:

1. Look at your numbers. When Boyd goes into a practice to do an assessment, he looks at how they're doing from a financial perspective. Among his considerations: Is the organization billing and collecting everything? Or are their costs way too high? "Some organizations don't have the money for [IT] help so they have to find out other ways to skin the cat," says Boyd. For example, if a practice is struggling financially and hasn't implemented an EHR, it might want to consider aligning with a hospital partner who can extend EHR technology under Stark Laws. Among the benefits of doing this: a greatly subsidized EHR and training.

2. Examine Your IT Needs. Does your EHR vendor have a good training program in place? Are you having trouble keeping up with technology updates? These are the kinds of questions that can help a practice figure out if it needs a little more support in the IT department. Boyd also suggests adding the following questions to your practice's technology assessment: What are our clinical and business strategies and are we able to support these with existing staffing levels and competencies?

3. Take Stock of your Staff. Is your staff enthusiastic or reticent about adopting new technology? Your answer could determine your next move. If you have someone who expresses an interest in new technology, has strong practice operations experience, and understands clinical workflow, investing in training makes more sense than hiring an individual already trained in IT who is lacking skills in other areas. "It's easier to train someone on IT than it is to train them on clinical workflow," says Boyd. "That is one reason why nurses are so effective in EHR implementations."

Whether you decide to train or hire your IT help, keep in mind that there are many ways to offset IT training costs.

The government's Regional Extension Center (REC) program, for example, provides practices with EHR consulting services at a nominal fee. Practices who work with RECs have access to on-site expert representatives who guide them through selecting and using an EHR, communicating with their vendor, and attesting for meaningful use.

Because the Flakes agreed to take on their local hospital's EHR, the hospital covered most of its cost. But Jason Flake says he also saved money on IT help because the EHR wasn't difficult to learn.

"The thing that drove the decision-making process was the usability itself," says Flake. "There are some systems that are more difficult to use than the Cerner system."

Marisa Torrieri is an associate editor for Physicians Practice. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the March 2012 issue of Physicians Practice.