Anderson (S.C.) Area Medical Center joined the computer revolution early, investing in color-screen personal computer workstations back in 1984 and supporting the march to ever more complex clusters of PCs since then.
But the latest venture into high-speed, wide-area networks ended the streak of self-sufficiency, says Darrell Hickman, the system's chief information officer.
"The network technology was very much a big hit for us," Hickman says. "The level of complexity was very much higher than we were used to."
Four network engineers and three PC support staffers had held down the fort, with outside help at times to fill occasional gaps in skills. But with new, industrial-strength integration, "we have not been able, with our own resources and our own staff, to keep up with the technology," he says.
The "hit" includes not only $6 million on network infrastructure during the past four years but an ongoing contract that pays for network management, some extra on-site personnel and comprehensive computer hardware and software support. The annual cost of those services: $600,000 to $650,000.
The costs of moving to the next level of integration will be stiff, says Michael Gorsage, senior manager in the Atlanta office of First Consulting Group, a Long Beach, Calif.-based healthcare information systems consulting firm. "People have to go out and acquire new types of talent that are different from what they have paid for in the past," he says.
A good network engineer costs $80,000 a year, whether on the in-house payroll or built into an outside contractor's service charge, Gorsage says.
But upfront costs borne today can yield operational savings down the line, he adds. Designed properly, a centralized network infrastructure can be run more efficiently than the fragmented local islands of technology common today. And the information systems department can end up requiring fewer staffers overall.
The operational expense of information systems springs partly from duplication: Duplicate teams of computer pros are needed to tend to separate computer networks. Merged organizations contribute their disparate software applications, each requiring staffers skilled in the unique properties of a particular software package. Often the separate systems are executing the same business function, such as payroll or registration, but in incompatible ways.
While the commitment to a network infrastructure initially will cost millions of dollars in capital expenses and increase telecommunication expenses, the consolidation opportunities over time will drive costs out of computer operations, says Eric Ringwall, vice president of technology services with Daou Systems, a San Diego-based company that designs and implements healthcare networks.
By standardizing payroll, human resources, patient accounting and other important information systems, an organization can phase out multiple software and systems support specialists and perhaps reassign them to emerging network-centered duties, Ringwall says.
The savings may not come smoothly or overnight. At the sites converting to new and unfamiliar computer programs, the changeover and employee training add up to a transitional expense and a dose of anxiety. But the benefits of common business operations and reporting formats across the health system should offset the costs and streamline operations, he says.
Atlantic Health System's initiative to replace disparate financial and personnel systems with common software applications at four hospitals includes consolidating spread-out technical staff and retraining them for new priorities, says Jim Klein, the Florham Park, N.J.-based system's vice president and CIO.
Though he's aware of mounting operational budgets elsewhere to build and maintain networks, Klein says his technology buildup benefits from attaining a critical mass.
By reaching a big enough aggregate size, a network can hold down capital and operating costs through purchasing clout and economies of scale. Klein expects Atlantic Health's $10 million information systems operating budget to remain stable with the same number of full-time-equivalent staffers, many of them assigned to different tasks than before.
Technology itself can further tame the operational costs of networks. A new breed of on-line remote monitoring tools is taking form to assist with everything from preventing undue congestion on the network to fixing PC problems without having to make a trip.
By designing a network architecture that can make use of such tools, says Gorsage, an organization can hire the best computer pros available, do a lot of remote troubleshooting and use fewer people overall.
The need to manage multiple software systems simultaneously on the same network increases the importance of "congestion management," pinpointing problems before they threaten to slow down or crash the network, says Andrew Rushmere, president of Aviant Information, a Simi Valley, Calif.-based company specializing in healthcare network planning and design.
Using the analogy of a common appliance, Rushmere says, "If there's a washing machine attached to the system, I should know when it turns on, when it turns off and how much water it's using."
Hickman says Anderson Area spent the extra money to install a Microsoft operating system called Windows NT instead of the more typical Windows 95 because the health system got better desktop computer management capabilities with Windows NT.
From a central location, staffers will be able to connect to a PC and watch what a user is doing, even remotely controlling the screen, he says. "We avoid about half the trips we would make to the desktops to handle problems."
One of the biggest headaches for a CIO is an inventory of thousands of PCs that are unmanaged and need continual upgrading, says Ringwall. Without the investment in remote monitoring tools, information systems staff could be inundated with crises, always reacting instead of anticipating brewing problems, he says.
As a result, the information staff will be incapable of providing sufficient service or the department will have to overstaff to handle the load, he says.