Hardware Mantra: Refresh, Reduce
March 2005
"The aging process is taxing our resources and draining maintenance and support efforts." No, that's not President Bush presaging the death of Social Security, it's a paraphrased refrain voiced by health care organization CIOs describing their aging computer hardware.
Two years ago at Cleveland Clinic, for example, the I.T. department had to keep a stable of 14,000 personal computers "refreshed" in terms of support and updated application requirements, and replace computers well past their prime, says Jon Burns, senior executive for information technology.
So the 1,058-bed delivery system last year decided to shift its hardware strategy and centralize its purchasing efforts. It now leases PCs and the I.T. department will refresh or replace the computers every four years, at minimum. "We never should have a PC more than four years old," Burns explains. "That was a problem when we had a decentralized purchasing process."
Keeping up with equipment needs is a paramount reason I.T. departments have claimed responsibility for managing such hardware as servers and PCs. It's an idea many health care organizations are putting into action, Burns says, "if you're going to solve the problem of technology aging at the rate it ages.
Everyone's tolerance for aging technology is different. Our cost to support aging tech is going up and we're running into project delays when implementing new applications and finding the hardware is too old to run it."
Provider and payer organizations are taking various approaches to I.T. hardware purchasing. But the common threads are centralized buying and, where possible, standardizing on vendors.
CIOs' purchasing strategies include centralizing the hardware buying task into their I.T. departments to ensure hardware, from computers to power sources, doesn't hang around too long. They also are working with fewer hardware vendors to improve pricing and reduce maintenance and support costs and complexities.
Piecework
For some health care organizations, particularly providers, I.T. hardware purchasing historically has been a disjointed process, led by piecemeal, department-level decisions on PC and servers purchases. But that's changing as spending on hardware and other I.T. continues to devour larger portions of the capital pie.
For providers, the push to implement or upgrade electronic medical records and computerized physician order entry systems is driving new hardware purchases, says Don Michaels, a retired health care I.T. consultant from the Boston office of PricewaterhouseCoopers, a New York-based consulting firm.
"Those applications require a lot of additional hardware," he explains, "including bigger servers."
Because patient care is more decentralized, information systems need more points of access. "Whether hardwired, wireless or in-between, such as PDA docking stations, providers need more equipment to get at the most up-to-date patient information," Michaels says.
PC and server purchases are regularly scheduled events at many health care organizations. The PC replacement process recurs every three to four years and the expense is built into capital budgets.
Pricing has become less an issue in preventing organizations from buying hardware, Michaels says. That's especially true of memory and servers, whose prices continue to fall.
Less regular hardware buys, including wireless network equipment and mobile computers, either originate in the I.T. department or a clinical or business unit. Needs assessment and return on investment projections are completed by one or the other, but some hardware buys, including PCs, are less about ROI than about avoiding support costs, experts say.
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