Networking

Insist medical practices hire specialists rather than one generalist

Donovan Colbert explains why the healthcare industry must invest in hiring specialists and not IT handymen to handle its information systems environments.

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.

About

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 profession...

9 comments
LocoLobo
LocoLobo

I have more than 1 small network switch in various offices. We were moved from 1 location to 2 separate buildings last year. We spent all we could on our new network. Yes we did hire experts to set up our new network. That cost as much as the physical move. We literally could not afford to lay enough cable for all our networking needs. So what do we do? Throw away necessary computers? Well we might if we get downsized some more. But for now we are making do with what we have. As I look at other places, we aren't the only ones doing so.

bkindle
bkindle

"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 that there are boundaries to their professional knowledge; instead, they hit Google and try to make themselves experts in uncharted territories over a weekend." I would agree 100%, but there is nothing wrong with someone who will try to learn a little. I think the biggest problem is with consultants not being willing to admit defeat and yield to someone who may know a little more by trying to "fake" it and not being forth coming about their lack of knowledge. Most places I have done work for in the past have been more than willing to let me take a crack at something to learn in order to have someone they could call locally instead of dealing with overseas support, and I ended up knowing more about the technology than the support folks did. Added bonus for the client and myself. The way I read Erik's article is that he was speaking to the fact that there is a difference between laziness and doing something the right way or according to a best practice. I too have ran into this same issue, and unfortunately have been force to do as well (daisy chain workgroup switches against my will). I think a lot of consultants run into this problem from prior consultants (or owners cousin) who were just flat out lazy and didn't take the time or the effort to build a network, or are ignorant and just need to be taught. If a consultant really cares about the customer, they will admit their limits up front, but can also be like the doctor and refer you to a good specialist, and maybe get to learn how to do perform the task themselves in order to increase their own skillset. Just my two cents.

dcolbert
dcolbert

I'm sorry, but if your business model cannot afford to pay the costs for the infrastructure it needs to function correctly, then it isn't a workable business model. That is part of the problem, for sure - people take short-cuts and cut corners because if they did everything that is required to truly deliver their product or service, it would be "too expensive". But that results in inevitable failures and flawed service deliveries and unsatisfied customers in the long run, and I bet that *costs* the economy *billions* of dollars annually. Unfortunately, it is very difficult to get the small business to be interested in actual *economics* beyond the immediate economics of their business operation (and even then, a lot of small and medium businesses just run with what they're doing and hope the whole economic part of the business equation will just sort of fall into place like magic). If your business is competing against a well funded adversary that has the capital to do the right things right, including hiring dedicated specialists to deliver infrastructure and systems that adhere to industry best-practices, they're going to out-compete you, probably even if they're charging a premium for their service (which they can justify, because their service will be more reliable and deliver higher performance because it is well designed, and end-users/consumers will pay more for anything that means less hassles). In the meantime, your firm struggles and loses more customers and becomes less able or willing to pay those extra expenses required to deliver an experience that is competitive with your adversary - it becomes a viscous circle. To me, for firms like this, the question is if they're going to commit or quit. It might be a long, slow, painful struggle toward "quit", but if they're not going to commit, that is the inevitable result. It is up for you to decide what your firm looks like, but if they're not willing to commit, they're going to fail sooner or later - and you should probably start looking now. I think most firms though, commit a little here, don't go all-in a little over there, and have varying degrees of dedication to paying the costs it requires to deliver consistent best practices in operations. The nice thing about playing in Fortune 500 companies like Intel was that costs were very rarely an issue there. Getting it done "flawlessly" was the focus - and having endless resources is a HUGE benefit when your goal is flawless delivery to best known practices. I think Apple's huge success has been in part attributable to a "no half-way done solutions" philosophy. It is worth noting that Apple started adopting that mentality when they were BROKE and facing bankruptcy. So the "we don't have enough money to do what Apple did" excuse doesn't really fly, for me. In fact, Steve Jobs had to go to Bill Gates with his hat out, which was probably a little humiliating at the time - but that is *exactly* what Steve did - and look at how that worked out in the long run. Because the magic of Steve Jobs was mostly in his ability to COMMIT - and to do whatever HE thought was necessary to achieve the goal. I don't think that made Steve Jobs a particularly likable person, but it made him one helluva CEO. In "Only the Paranoid Survive" Andy Grove tells a story about how he and Gordon Moore were having a bad time with Intel when the Japanese memory market was destroying Intel's core business (at that time, memory). They came in and said, "we're going to end up getting fired, or we can come in, and look at it as if we were our replacements, and figure out what we would do in THAT case, and save our jobs and the company". All Grove is saying here is that we do NOT step outside of our box. We say, "We CAN'T afford to do this thing to compete" even when the alternative is to *go out of business*. Someone else looks at it and says, "You can't afford NOT to do this thing to compete", because they're not on the inside of your business. Being on the inside causes you bias. But we know all these things, and lots of firms still fail every year - because the *knowing* and the *doing* are two different things.

tbmay
tbmay

Me: "We SHOULD hire a pro to cable, pull a drop to each desk...get good gear....." Customer: "Good Lord...How much is all that going to cost....." Me: "I'll have to talk to the cabling contractor....." Customer: "Contractor!!!!!! Can't we just run to Office Max and get some switches and hide cables behind the desks????" This conversation happens even after it's clear they've gone past the point where that's a good idea.....but you see how much they value the network. BTW....I'm out of the physical networking game altogether. I do terminate VPN's; however, I am not going to have that argument any more. Edit: Donovan, that was a very good article. I would have agreed with 100% until just recently when I decided to stop fighting things I couldn't change. Your reference to generalists being unwilling to admit they were outside their scope is something I would have given you two thumbs up on as recently as last year. I've since decided that issue is never going to change, no matter how obvious it might be to you and me. You'll find photographers trying to convince rookies to stop doing free shoots. Some customers don't know the difference between good photography and bad photography. Very similar beef. There are lots of people who STILL think because their high school kid can replace a video card, he is on the same level as a skilled software engineer. When they think like that, you will be very lucky to change their minds. I just flat don't try any more. Any new client who want's to approach me about work, I direct them to my site, where they fill out a form....with substantial references to my FAQ's page where I address such things as "This should be easy." and "My friend said...." In a nutshell, they should just get their friend to do it, or do it themselves. I also increased my pricing to make work worth doing. The result....cheapskates have left....which is for the best. Sure, some of them poor-mouth me and get their "nephews" to try to take over. Good clients have agreed to the rates. I'm not completely sure what the answer for the employee is to this problem. I do know people don't understand information technology well enough to value it. And many DELIBERATELY don't understand it well enough to value it.

spawnywhippet
spawnywhippet

I am currently an architect for one of the worlds biggest IT companies and have long been a proponent of doing it right the first time. However, I can promise you, we ARE that 'well-funded adversary' and we are currently losing a great many deals in this financial climate to smaller companies who will do it cheaper, quicker and dirtier. I keep hearing customer's say 'I like your proposal better, but we're going with XYZ company who are cheaper.' While this is not a sustainable practice for any party involved, XYZ company is getting cash flow and we are not. Our only options are to either reduce prices to below cost or reduce quality to retain some margin.

LocoLobo
LocoLobo

You're right, the sharks are feeding. Mostly off each other. Maybe I will look for another job. But not today. But that doesn't solve my immediate problem. Connecting 6 computers to the network in a room with only one LAN connection. That's the worst I have. Eventually we will have more LAN cables. Or we will be dead. Only time will tell. I like the Grove example. Although not how I put it to myself. When we were told we were being downsized and would be moving I told myself this is the time to rebuild. This time let's try to do it right. Again money was a major factor. I felt lucky that my boss does understand the importance of IT and was willing to get the help we got.

HAL 9000
HAL 9000

We have no money to waste on unnecessary things like doing it properly do it cheap and then we'll complain and make your life a misery because it's all your fault that we are having so many problems. It's bad enough in Hospitals where there is a complete nightmare but Small Private General Practitioners are the worst place possible for any IT person to work. Could be why I stopped working those places years ago and have felt much better ever since. ;) Col

tbmay
tbmay

Though you alluded to it in your article, and have talked around it. There's something about I.T. work that makes many people try to devalue it. They don't want to respect it at the level they would the home builder. I'm not completely sure what it is, but if that weren't the case, we wouldn't even be having this discussion. That is honestly the root cause of at least half of I.T. workers' frustration. There is a perception that basically anyone can do "it." Your recommendations for specialty is going to fly in the face of what these people want to believe.

dcolbert
dcolbert

If you're well funded, and you have a better product, things will come around. Now, on the other hand, if your company has become fat, lazy and complacent, something that is *always* a risk to the successful, incumbent, fortune 500 bellwether, You may just have overhead that means you're not doing it as well *and* you're charging too much, too. As an example, we recently took a gamble on an IBM XIV after years as an EMC Clariion shop. EMC lost on cost, but also on performance, complexity, support model, availability and reliability. The IBM XIV product looks as if it is a new paradigm that will out-compete the traditional Tier 1 and 2 SAN across the board. Cisco has seen their market encroached on by hungry upstarts who offer products with more generous and affordable licensing terms while offering products that meet or exceed Cisco products for network reliability, redundancy, resiliency and ease of maintenance, administration and support. Doing it perfectly is always best. Someone else may have figured out how to do it more perfectly than you - and your way is not perfect anymore. But - I do agree... constant planning and getting hung up on what you CAN'T have or afford is obviously a recipe for failure too - we've seen enough case-studies to know that the most successful companies move forward, constantly making small course-corrections and adjusting imperfect, flawed deployments, projects and road-maps. You've got to find a fine balance between the two. Having a group of handymen build your custom home is going to be a disaster. You need the various specialties that go into the construction of a house. You don't want the guy who lays the tile and brick doing the framing and the electrical. I mean, you might do that... but your house might end up on Holmes on Homes. On the other hand, you don't necessarily need a master-mason who has done work on world-renown architecture to do all the brick-and-stone work in your modest, two story suburban tract-home. A local contractor with solid references is probably good enough to get-er-done.