Questions For Your IT Support Person

They have no dress sense, talk a different language and probably aren’t bothered about either. Pulse IT has some questions for your IT support person.

Business savvy IT support outfits long ago identified the health sector to be an attractive niche to operate in. Their clients have high earning potential, Government and advertising subsidised computing and relatively conservative system requirements.

On the other side of the coin, IT support people (ITSP) face doctors reluctant to pay for outside help, low levels of IT literacy among practice staff and an environment where computers are a critical tool and downtime isn’t tolerated. Our first “Question Time” poses some questions for practices to ask their IT support person (ITSP). They have been narrated for clarification, and can act as a checklist to ensure that common traps are avoided.

1. What are the terms of our relationship?

The contractual terms of the arrangement with your ITSP need to be clearly defined before a mouse has been clicked or a disk inserted. Typical support contracts will include an on-call retainer component, in addition to an ad hoc support rate.

Whatever the arrangement, ensure that there is incentive for the ITSP to do their job well. Paying a fixed price per year is a simple way to achieve this, so long as specific minimum standards are agreed upon and enforced. Establishing an arrangement based on a purely ad hoc rate provides no incentive for the ITSP to work efficiently or objectively.

2. Do you have the appropriate insurance?

While IT contracting is a relatively safe profession, all workers who enter your practice need to be covered by appropriate insurance policies. This may include public liability, professional indemnity and workers compensation.

A breach of patient confidentiality, data loss or something as simple as a staff member tripping over the contractors bag can have far reaching and damaging effects on the practice.

Consult a insurance professional if you are unclear as to what is required.

3. What are your after hours contact details and when can I call?

Computer problems don’t adhere to business hours, and nor should IT support. Due to the reliance on IT systems in medical practices, after business hours is generally the only time major work can be performed.

When negotiating the terms of the arrangement with your ITSP, ensure that a provision for after hours support is included. If this isn’t done beforehand, expect to pay penalty rates, fix the problem yourself or endure downtime.

4. In the event that we can’t contact you, who do we go to for help?

For various reasons, IT support companies rarely grow larger than a handful of staff. The IT knowledge you are paying for is usually stored in the heads of a few key staff members, and they will not always be available when you need them.

Talk to your ITSP about arrangements for such cases, and ask them to recommend an alternative operator for such emergencies. While this may rise a few eyebrows, your ITSP should have nothing to worry about if they are performing adequately.

5. How many staff do you have, and what are their rates?

As well as having more people available to assist in the event of emergencies, larger IT support organisations will have staff with a range of qualifications, ability and charge out rates.

Having a senior technician installing minor software updates or wiring ethernet cables is not cost effective and shouldn’t be necessary. If the task appears to be simple, request a junior tech in the first instance. In the event that a problem is beyond the junior, they should still be able to rectify the problem with phone input from someone more knowledgable.

6. Do you retail the hardware or purchase on our behalf?

While hardware margins are slim, some ITSP purchase and on sell computers, printers and other equipment to their clients to boost their revenue. Usually this results in equal and sometimes better prices for the practice.

An important point needs to be made however: If an ITSP sells you hardware, they are directly responsible for the warrantee of the product, not the company they purchased it from. If for example you are invoiced by your ITSP for a Lexmark printer and it breaks within the warrantee period, it is their responsibility to follow the repair up with their supplier in a timely fashion. This is enshrined in the Trade Practice Act, so don’t wind up in a position where you are chasing an upstream supplier directly.

7. Will you install and support my clinical package?

While some ITSP market themselves as “total solution providers”, the reality is that there are very few operators that can deliver on this promise. While most ITSP have a good grasp of networking, operating systems and hardware, very few will have the same level of knowledge when it comes to your clinical package.

Your ITSP may have good intentions, but the reality is that some problems can only be resolved by the software vendor e.g. program bugs, 3rd party software integration etc. As you are probably already paying an annual support fee to cover such situations, don’t be persuaded to pay twice.

The greatest assistance the ITSP can be in such situations is to apply their problem solving skills and communicate the situation to the software vendor. If your current software vendor isn’t fulfilling the terms of your arrangement, address this with them.

8. Does our software vendor have remote access?

Many issues relating to practice software can be quickly resolved if the vendor has access to the users screen. While faxed screenshots, lengthy telephone conversations and emails can usually give the software vendor’s support team enough information to provide a resolution, allowing them remote access nearly always expedites the process.

There are many secure ways to facilitate remote access, and there are many ways to expose your network and data to the world and its nasties. Be sure your ITSP is confident they know the difference!

Ideally, the practice manager or practice principle will be able to issue the software vendor remote access details as required. After the problem has been resolved, the password should be changed to close the potential security hole.

9. Where is the documentation for our system?

As an ITSP typically builds you IT system from already documented hardware and software, system wide documentation rarely materialises. While duplicated documentation is not required, instructions that connect the various parts of the system to your practice work flow should be written. If you don’t have one already, a section in the practice manual should be created to contain these notes.

10. Where is the job log for the work you just completed?

While most ITSP will provide a basic overview of what work was carried out in their invoice, rarely is this enough to fully understand what has just happened. A detailed summary may not be of much use to you as a practice staff member, however your software vendor or indeed another ITSP may find this information extremely useful in resolving issues, particularly if they relate to work just carried out.

11. What’s the password for...?

For the same reasons outlined above, any passwords that may be needed by other approved parties need to be easily accessible by authorised practice staff members. Usually this would be the practice manager and/or practice principle. There are secure ways of storing passwords within a computer system, so writing them in the practice manual or on a “hidden” scrap of paper isn’t appropriate.

12. What’s the strategy if:

  1. The server goes down?
  2. A client goes down?
  3. The Internet goes down?

These three scenarios need documented action plans that can be initiated with little or no assistance from the ITSP.

For this to work, the ITSP will need to be proactive and additional hardware, documentation and training may be required. This will add additional expense up front, but is money well spent and should minimise downtime and on site service visits.

13. Does our practice meet the IT requirements for the RACGP 3rd edition standards for accreditation?

While few like the additional hoops accreditation has imposed on General Practice, the ones related to IT are very achievable and need to be addressed.

The majority of ITSP won’t have heard of the Royal Austrlaian College of General Practitioners (RACGP) and have little understanding of the practice accreditation process. If you’re ITSP is not aware of the Standards, don’t expect them to build your system to meet them.

14. Have you reviewed the General Practice Computing Group’s (GPCG) Security Guidelines?

While the GPCG isn’t undertaking any new projects currently, the “Security Guidelines” is still a relevant and important document.

This document is available on the Pulse IT DVD and from the GPCG website .

15. Why do I need to have another computer turned on to print?

Modern operating systems make seemingly complex things easy. The ability to share a printer connected to a single computer with a whole network is one such example.

While this scenario is typically very stable and can save money, relying on another computer for printing has the potential to cripple your printing capability if the required computer is down.

As a general rule, printers that need to be accessed from multiple machines should be purchased with a network card. Any laser printer that is suitable for use in a medical centre will have the option for a network card, so external print servers should be avoided.

If this is not possible due to budgetary constraints, ensure that a written procedure is available to allow a non-technical person to connect and share the printer from another computer in the event of problems with the “host” computer. The cost of calling in your ITSP to perform these steps will erode the cost savings by omitting the network card in the first place.

16. You’ve just sold me an expensive Tape drive for backups, but my clinical data file is only 600MB?

As outlined in Backup Technology, there are many different ways to perform backups. While tape drives DO have application in some cases, the vast majority of medical practices are suited to other options, which can be deployed cheaper and don’t suffer the downsides of tape. Keep in mind that just because they are commonly used in enterprise doesn’t make them immediately suitable for your important data.

As with every IT purchase, ensure you ITSP can provide cost/benefit justification.

17. Why don’t we have a Uninteruptible Power Supply (UPS)?

UPS devices are a very cost effective way of protecting your server and the data it holds. Every practice should have at least one.

In the next edition of Pulse IT we pose some questions to your practice software vendor.

Posted in Australian eHealth

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