When it comes to saving money, keeping services in-house can be one of the most practical solutions. Yet the opposite also holds true — when it comes to needlessly spending money, keeping services in-house can be a sure way to do it. If you know someone who has “fixed” their own car, the work ultimately delivered a big headache and a big bill after they had to have a professional not only fix the original problem, but had to correct further damage done by someone not prepared for the job. The situation comes down to know-how and resources. Health IT is like that car fix — keeping services in-house can deliver substantial savings, but if your team isn’t up to the task, those savings can quickly disappear only to be replaced by hefty bills from special service calls and emergency support.

In order to make sure your facility is on the right track, it’s critical that your IT team takes the time to think about their strengths and weaknesses and then give an honest assessment of each.

DOTmed HealthCare Business News spoke with Michael Gray, principal of Gray Consulting, about the questions health IT professionals need to ask when it comes to determining which services should be kept in-house and which should be outsourced.

Before you can answer the question about outsourcing, two questions need to be answered that will serve as the foundation for everything going forward in your IT department.

Who’s in charge?
It’s the question that sets the stage for all other questions and concerns. By determining who’s in charge, responsibility can be assigned and accountability can be determined. “Historically, radiology PACS decisions and probably because of that initial process, cardiology system informatics decisions were made by the specific departments,” says Gray. “There was very little concern about how things worked together from the independent teams.”

IT would only be on-hand to put out fires and patch problems when the different departments made purchases that didn’t play well with other aspects of the infrastructure. With disparate systems, inevitably a time would come when data contained within one department would be needed, but inaccessible to another department. That lack of access can cost your facility money. Correcting that lack of access also costs money, with more purchases of plug-ins or entire systems needed.

More forward-thinking facilities realize the importance of having all the different departments on systems that could incorporate data from each other and IT teams are typically the gatekeepers put in charge to ensure that system integration between departments is at the desired level.

Clinical functionality is still determined by departments, but how it works with the infrastructure should be the responsibility of the IT department — or at least they should have a say in guiding the decision if they’re up to the task. “They have to ask themselves, ‘Am I the right one? Do I deserve to make this decision?’” says Gray.

What’s the future going to look like?
Once it’s determined who’s in charge, the next question requires some predicting. In this case, history helps tell the tale. Facilities with a good sense of where they’ve been will be able to better-determine where they’re going and to then plan accordingly. Decisions about purchases can be dictated by the anticipated needs of the future. For instance, a small private practice or group that has only grown a few percentage points over the past decade is unlikely to have double-digit growth in the next five years, so they’re unlikely to need high-end informatics systems to quickly pull from thousands of exam files. Money can be saved by estimating the needs and avoiding systems that are more robust than needed. The initial purchase of a system is typically the best time to get everything you believe you’ll need. However, it’s worth discussing with your software and hardware providers to determine the difference in cost between buying what you believe you’ll need, or paying for upgrades in the future.



Do we go to the cloud?
The answer to the question of whether or not you’ll be going to the cloud should at least, in part, be answered by estimating future needs. Cloud solutions are becoming more commonplace and intuitive interface is helping to make them more user-friendly.

“Over the course of the last 10 years, the financial situation has been such that facilities can’t afford to make stupid mistakes in infrastructure,” says Gray. “The obvious solution is put the decision into the hands of IT, but if your organization doesn’t have a strong IT team, you’re a prime candidate for cloud-based solutions.”