In a recent TechRepublic IT Consultant post, Erik Eckel wrote about network issues at a small business. He describes a scenario where a client complains of slow performance and rushes to resolve the issue by providing a massively upgraded server only to find that performance still lags. He goes on to vividly outline what an on-site assessment of the network topography might look like. Everything Erik wrote sounded very familiar to me. First he described a network closet with a 24 or 48 port switch (he didn't mention that it probably wasn't adequately ventilated or secured). He then talked about an octopus of cascading daisy chained switches (we can only assume that if not at the 16 port switch Erik described, then shortly thereafter the switches are all un-managed, consumer grade equipment, too). Then Erik tipped his hand and confirmed my suspicions when he stated:
"...and another five-port switch in a nurse's station that shares a single Ethernet cable with a pair of machines and a network printer."
What kind of business throws a Raid 10, 32 GB, SSD, dual CPU/multi-core server at a performance problem and yet has a network that some hack threw together with daisy-chained D-Link unmanaged switches? A healthcare provider. I didn't even need to read the line about the five port switch (look closely, it might actually just be a *hub*) in the nurse's station to realize the kind of business that Erik was describing. As I was reading Erik's description, I could see the white shoes with crepe soles and the multi-colored scrubs rushing around the quiet, tiled hallways, working around patients in the hallways being weighed and having their blood pressure taken.
Erik claims the problem is amateur IT consultants, but I think that is a symptom. The problem is healthcare professionals; more specifically, the doctors who run the medical practices cause many of these issues.
I wonder what doctor confronted with a specific and serious medical aliment would consider the services of a one-stop general practice to perform the necessary services to restore her to health. No MD would go in for surgery if one guy claimed he was capable of doing it all -- the cutting, the clamping, the anesthetics, and any other specialties required to operate; and yet, doctors will hire one consultant to handle their entire IT solution, including systems, applications, networking, wireless, hardware, and printers.
Imagine if we used a generalist for all medical needs, and the human body went through revolutionary evolution every 18 months. That is what specialized IT support is like, because of Moore's Law. Imagine if 18 months after graduating, a neurologist found that the entire design of the spinal column had been replaced by a more advanced model. Medical experts have knowledge of a networked system that hasn't changed significantly in over 200,000 years. IT professionals deal with a networked system that has changed significantly, multiple times, over the last 40.
I'm an awesome systems guy. I have an intuitive sense built up over years of experience that helps me quickly isolate and diagnose many work challenges, but I also know my limits, and my skills break down quickly at the physical network layer. Daisy-chaining unmanaged switches is probably something I would consider a viable alternative in situations like those described in Erik's post. Networking is not my core competency though. This is an example of why, if doctors must rely on the performance of their network, their network should be handled by a skilled networking professional.
So why do doctors think the person who sets their practices' wired and wireless network is also qualified to set up the server, configure the EHR/EPM solution, and manage the Microsoft SQL database and all of your backups? Medical practices often think the IT one person should be able to provide full desktop systems support to every workstation, removing viruses, adding drivers, and handling problems with websites. The odds are good that a lot of things will be poorly implemented throughout the environment.
My gift as an IT professional is not how outrageously skilled and knowledgeable I am from one end of the IT spectrum to another; my gift is that I know enough to realize when I am out of my scope, and to say, "we need to bring in someone else who specializes in this area to deal with this issue." Too many IT professionals, especially the single-staff consultant, hate to admit that there are boundaries to their professional knowledge; instead, they hit Google and try to make themselves experts in uncharted territories over a weekend. This creates a vicious cycle. The MDs become convinced that IT professionals are all charlatans, so they become even more reluctant to sink money into hiring additional consultants and experts. Then the problems with their information systems perpetuate and grow, reinforcing their belief that IT only adds another hand dipping into their profits without returning anything of value.
Here is the rub: being a doctor is supposed to be outsource and recession proof to a degree, and this kind of IT work should be too. Consultants in Canada, India, Russia, or China cannot provide physical support for your environment in the United States -- that is the beauty of being in a service-oriented industry. This one-stop-shop mentality is a product of belt-tightening economic principles that try to get more productivity out of one person. The attempt to turn an IT professional into the site handyman is not effective. A handyman might be able to solve simple plumbing or electrical problems, fix a door that isn't closing properly, and do other odd jobs around a site, but in the long run a lot of his work is a temporary solution that often results in more expensive repairs later by a qualified specialist.
It is inexcusable for any industry to assume that one generalist can provide all the specialist requirements necessary to deliver a world-class information systems environment, regardless of whether we're talking about a small office or a huge enterprise. It is our responsibility to insist that healthcare in particular learn this lesson and take it to heart. Healthcare must invest wisely in their infrastructure, and in the talent that supports its systems. It is a new burden, but it is only going to increase. Only the medical practices that can figure out how to do this effectively will survive.
Donovan Colbert has over 16 years of experience in the IT Industry. He's worked in help-desk, enterprise software support, systems administration and engineering, IT management, and is a regular contributor for TechRepublic. Currently, his professional role is as a Linux support engineer for a fast-growing Linux/FOSS consultancy group. You can follow him @dcolbert on Twitter or his personal blog, located at http://donovancolbert.blogspot.com.