What can IT do for your growing pain practice?

By: Paul Lynch, MD, Tory McJunkin, MD, & Randy Braunmpmnlogo

Dear Arizona Pain Specialists,

My IT manager has submitted several proposals for purchasing new software and hardware to supplement our current systems.  All of our systems are working now, so I can’t help but think most of these updates are unnecessary.  Should I approve these purchases?  Is it normal for a company to have large dollar technology purchases even when there is nothing wrong?

Thank you,

Sticker Shocked

Dear Sticker Shocked,

Without knowing the details of such proposals, it’s difficult to say if your practice has a sufficient technology infrastructure. That said, it is not outside the realm of possibility to spend a large amount of money improving your existing infrastructure. When considering tech upgrades, there are a series of big picture questions that need to be asked. You should start with the most important part of the process, a needs assessment.

The Needs Assessment

All projects, small and large, must start with a needs assessment to be properly executed. The scope of the assessment can vary greatly depending on the project, but the goals are the same: to garner commitment from all parties who will be affected by the project, and to ensure that those who use the final product have a chance to provide feedback before purchasing. Those influenced by the purchase should be able to provide the decision makers responsible for purchasing with a list of software/hardware features needed, as well as rationale for how the purchase would improve workflow. As project size increases, the needs assessment and employee feedback required for appropriate decision making become more important.

The needs assessment goes directly to your point, “all of our systems are working now, so I can’t help but think most of these updates are unnecessary.Your IT manager should be able to explain to you why you “need” this new software or hardware and how it will improve daily workflow.

Research & Testing

After completing the needs assessment, the system administrator (IT manager) should research hardware and software options to meet the established objectives. The following criteria should be taken into consideration:

  1. Total Cost of Ownership (TCO) – is there an annual subscription fee? Do you need to host this application on your own in-house server and, if so, will you need to purchase this server?Remember that less initial cost is not always better. The cost should be weighed against a list of pros and cons about the software. Assign a dollar amount to each feature to help make decisions. Neglecting this step could mean a greater overall cost in the long-run, even though initial cost appears much cheaper. For example, an e-mail system that does not include out-of-office replies, forwarding, or distribution groups may cost half as much as a competing application that includes all of these features, but it would not satisfy the needs assessments of most pain practices.
  2. Upgrades and patches – is the device or software updated regularly with new bug fixes and features? Does the manufacturer still release new products or is this an old, outdated support product?You don’t want a dead product. Companies who produce infrequent updates may take months or years to resolve bugs with their software or devices. This could lead to a loss of productivity due to issues with the software, a lack of compatibility with newer products, and security vulnerabilities.
  3. Support – how many local support options are there? Is there a spare unit on hand if there is a hardware failure? Can the system administrator troubleshoot the common issues with the device?You should always have multiple support paths for your final solution. A local consultant should be at the top of your list, but remote support options are also acceptable.
  4. Scalability – This refers to the ability of a system or network to either assimilate growing amounts of work into the already existing system, or for the system to expand to accommodate the enlarged workload. You may have 10-15 employees now, but will this option work when there are 40-50 employees? 100 employees? How soon will you need to worry about having sufficient technology for that many employees?A general rule of thumb is to consider how a system will expand with an additional 50 users. It’s important to know if there are costs associated with user licensing and if your server hardware is capable of supporting more than your current user load.
  5. Implementation Time – how long will it take to implement this software or hardware solution? Will an outside consultant be necessary to complete the steps? Can your system administrator handle the installation and configuration?It is always advisable to implement a robust system that completes your objectives and is easy to administrate. It takes manpower to administrate systems, so the less complex the administration task, the more time your staff has to handle other responsibilities.
  6. Workflow – this is perhaps the most important piece of the research process. How does this application or hardware fit into your existing workflow? Is it difficult for employees to use the system while they’re working or does it help them do their job more efficiently?The objective of any piece of software or hardware is either to increase security or to improve functionality. A system shouldn’t be implemented when it doesn’t achieve one of these objectives. If a system is not improving your security or your usability, there is no reason for implementation.
  7. Security – in the medical industry, every application must be scrutinized for security. Does the vendor store patient information on their servers? When sending patient information, is the application encrypting that data or, at the very least, de-identifying the data? Are the users monitored and logged by the system? Can you differentiate between employees?Business owners often skimp on security for a variety of reasons, including cost, inconvenience, or they underestimate its importance. This is a big mistake. Security should be taken very seriously and you should avoid any application that does not provide you with some basic features, such as unique user logins, an audit-trail, and user/group level permissions.

IT Project Implementation Analogy

Any new IT implementation has the basic goal of providing successful solutions through a quality user experience.  Success must be defined for your organization’s needs and can vary from faster internet, better EHR experience, less network downtime, better phone routing system or any other IT solution.  Any IT project’s implementation time and budget will typically be balanced to reach the goal of quality.  Think of your project’s success as quality for your organization.  A successfully implemented IT project can be thought of as a pitcher of water.  When the rim of pitcher is brimming with water your organization has reached success for a particular project.  You can fill the pitcher with two different things: time and/or money.  If you need a project implemented successfully within a week, you don’t have very much time and it will cost you more money.  If on the other hand you have a long-term project, you may be able to budget less money towards this endeavor and still reach the same level of success.

  • Success – is the successful implementation of a particular IT project. The size of the pitcher is determined by the needs assessment. If your practice has a long list of requirements and specifications for a piece of software your needs will be larger. If your list contains more flexible, less specific requirements, then your needs will be smaller.
  • Implementation Time –represents the amount of time you have to implement the project. A project that must be executed within one week would be represented by a very small amount of human capital, whereas a project that isn’t going to be applied for several months would be the opposite.  Essentially, greater implementation time means you can pour more time into the success of the project (the pitcher).
  • Budget – the bigger the budget, the more money you can pour into the success of the project (the pitcher).

You should start by determining what constitutes success for a particular IT project. The needs that you are attempting to meet will determine the implementation time and size of the budget. The goal is to set realistic expectations for the budget and implementation time and realize that an improperly funded or constrained project will not be as successful as one that is properly supported.

Piece-meal Implementation – A Developmental Paradigm

Normally, software and hardware are not binary systems. You can, for example, purchase certain components that will fulfill the immediate needs of the company and also allow you to improve upon them later. When working with a piece-meal style development and implementation process you must be careful to use a system that provides flexibility for improvement at a later time. A good idea is to purchase software and hardware that allow for future growth, or that is inexpensive enough that you don’t mind replacing it when you decide to finish the full implementation.

When deciding what system to choose for an incremental — à la carte — implementation, ask what features will be missing during the initial deployment. You need to plan for the changes in work flow that will come with new features, and you need to plan the entire rollout so there are no surprises halfway through the implementation. For instance, a small pain practice with only a few employees doesn’t necessarily need an e-mail system that includes distribution groups. However, they wouldn’t want to buy a system that didn’t include a distribution groups feature as that could hinder their future growth.

As with any implementation, communication is the key to success. It should be very clearly outlined when features will be implemented, which departments will be affected, and who will take responsibility for ensuring that employees are following any new processes and procedures. Remember that it costs money to have a failed implementation. Not only do you lose the cost of the software or hardware, but you also lose labor costs and time spent researching the product. Your employees will also suffer because of an improperly executed incremental deployment, especially if their workflow is being changed regularly or if they have to work around, and not through, the system you implemented to help get their jobs done.

So what can you do?

It is common to have high expenses during the growth phase of a company, especially for technology and infrastructure development. Remember, technology is here to make workflow better, not worse. It is sometimes easy to forget that employees will be using the systems you’re implementing and this is when many of the issues mentioned above can interfere with your company’s workflow.

Follow the aforementioned guidelines when reviewing proposals and assigning new projects, and use the following three recommendations to help your system administrator make his/her decisions:

  1. Clearly define objectives for the project and stick to them. Changing objectives mid-project will cause major delays in all phases, and may require the system administrator to begin anew. If you find that your projects frequently need major revision throughout the implementation process, then you should re-examine your needs assessments process.
  2. Provide your system administrator with a reasonable budget and implementation timeframe. You will exhaust him/her if you constantly keep all projects under extreme time constraints or without proper funding. Have your system administrator develop a return on investment analysis after you’ve proposed the budget. It’s possible that it may cost more than you expect but have better returns in the long-term.
  3. Understand that technology, while not revenue generating, is about loss prevention and efficiency. Leverage information technology resources to streamline workflow and to increase the stability of systems.

Trust those you’ve hired to run your IT department, but ask these staff members to show you how and why increased technology purchases will benefit your practice. If they produce a strong needs assessment with sufficient staff feedback, make the recommended changes as possible. A smart, effective practice uses the best technology available, including human capital, such as an intellectual IT department who can provide appropriate advice.


Dr. Tory McJunkin and Dr. Paul Lynch founded Arizona Pain Specialists, a comprehensive pain management practice with three locations, seven pain physicians, ten midlevel providers, three chiropractors, on-site research, and behavioral therapy.  They teach nationally and are consultants for St. Jude Medical and Stryker Interventional Spine.   Through their partner company, Boost Medical, they provide practice management and consulting services (including IT) to other pain doctors throughout the country. For more information, visit ArizonaPain.com and BoostMedical.com.