Managed IT Services vs Break and Fix Model

There are a couple approaches to handling your IT support in a medical office. The first method is called the break and fix model. As can probably be inferred, this model is where you only call for IT support when something breaks. For example, your computer won’t turn on and so you call tech support. A lot of people use this model and it can work effectively if done right. The key to success in this model is making sure that whoever sets up your IT initially knows what they’re doing so that it won’t break very often. Otherwise, you’ll be having the IT person their all the time fixing problems. One challenge with this model is that you’re still going to have some sort of down time when something breaks. Basically, the time it takes for your IT support to get out and fix it.

This is one reason why many people prefer a managed IT service model. In this case, an IT company regularly comes out to your clinic to do some regular maintenance. It’s kind of like a tune up for your computers. If done well, this can mean that you’ll avoid downtime that may occur if your computers aren’t maintenanced regularly. However, this doesn’t mean that you won’t ever have downtime. Sometimes computers/servers/network devices fail even with the best maintenance. The nice part with a managed IT service model is that if and when something fails, the company is already familiar with your IT environment because they’ve been there doing regular maintenance.

I’m sure there are a number of other advantages and disadvantages to each. However, this should get you thinking about the various IT support options. Let’s hear your thoughts in the comments. And yes, you’re going to need some sort of IT support when you start doing an EMR. It’s inevitable.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

14 Comments

  • Hi John,

    Longtime reader of your blog. Love it. Our company only provides managed services for our clients.

    Advantages:

    1. Partner in the practices success. If the practice succeeds, we the IT provider succeed.
    2. Client can focus solely on using the EHR and related LOB applications and making their practice more effective because of it. We will focus on the IT across the board. We will triage problems and provide in some cases an unlimited amount of support to see the problem through. We aren’t thinking about the clock. Nor is the client.
    3. Proactive IT maintenance across the board on their infrastructure. Downtime will be minimized. One contact for all IT related items.
    4. Fixed, predictable fees.
    5. We (the IT provider, at least we do at EMR Group) learn to master their software application. In many cases we go to training and certification classes with the client. The client now has a local, expert on the application. We can triage calls, and in many cases solve problems much quicker. Doing this as break fix won’t work.

    Disadvantages

    1. Client might balk at the initial monthly fees although this is rarely an issue for us.

  • I concur with Jeff above – great blog-I read it often.

    As with Jeff from EMR Group above, we also provide Managed IT Services in the Northeast for Medical Offices and Hospitals. One of the biggest benefits we here from our Physicians is that they never have to worry again – if a problem does arise (which still is bound to happen even with a Managed Service contract) they at least have some working on it proactively versus being reactive to a problem. 9 times out of 10, the support team will see a problem coming before the users even notice it – that gives them time to proactively repair it before it causes downtime for the office.

    Another big plus (to expand on what Jeff said above) is one stop shop for all IT needs. If the Managed Service provider is setup properly, they should be able to be the one-stop-show for the office meaning any technical issues they have are routed to the Managed Service provider and they will handle re-routing the call to another support company if needed.

  • Jeff said, “Doing this as break fix won’t work.”
    Actually I’ve seen it work quite effectively for some people. The key was to have it set up properly in the first place. Plus, smaller clinics are better at this. Also the size of the office and technical skill of the office matters too. Just depends.

  • Tim,
    It’s nice when the IT company has training on the EMR software you choose. How does your company handle training on the EMR software? Do you require the clinic to pay for you to be trained or pay for the training yourself? No doubt this can be a huge asset to a clinic when the EMR vendor is giving them the run around.

  • Size of the clinic and skills in the office DO matter, but see smaller clinics come to manage services after doing the break-fix and hitting a wall. Setting up the IT infrastructure properly is by default regardless of break-fix or MSP.

    We also recognize that one size doesn’t fit all and MSP agreements are tailored to suit small practices (1 provider), if necessary.

    Why are smalller clinics better at this? Can you elaborate? What if a solo doc went onto Centricity or NextGen? Similar issues to a larger practice but on a somewhat smaller scale. What if that provider had two locations? We’ve seen it. What if the provider was a technical whiz? This provider knew how to manage their IT. Why would they want to spend any time on IT other than within their EHR/PM to customize? Most physicians we’ve dealt with, whether small or large, don’t want to stay in the office any more than they need to.

  • Jeff,
    Sure, small practices can hit the wall and need a managed service too. In fact, some of them should use a managed service from the start. Just depends.

    Small clinics can do the break and fix model better since they won’t have the scale of problems which will provide them the savings that can come from having a managed service. Then, there’s all the other questions (look more like reasons) why they might just do a break and fix model also: technical whiz (to a certain extent) in house, they enjoy working on technology, etc. Although, these can apply to a larger practice as well.

    As far as a solo doc implementing Centricity or NextGen, then they probably should get a managed service. However, even more important than getting a managed service is they should select a different EMR. Nothing in particular against NextGen or Centricity, but they are likely overkill for a solo practice. Plus, can you imagine the type of response you’ll get from large EMR vendors like those 2 if you’re a solo doc calling for help? Plus, selecting another EMR who focuses on smaller clinics (which those 2 don’t as much as other EMR vendors), then your need for IT support will be less as well.

    Managed IT services are great in many situations. However, there are plenty of cases where the break and fix model can work well. One key that I probably should have mentioned in the post is that if you are going to do the break and fix model, it’s still valuable to have a trusted IT partner who you can call if and when you need something “fixed.”

  • John: in answer to your question regarding training, we provide hands-on training for some EMR’s not all. We have a group of specialists that have Subject Matter Expert knowledge on certain packages. For other EMR’s, we provide best effort level 1 support – beyond that we would call the software vendor on their behalf. The idea behind our Managed Services is true one-stop-shop and one phone call for the office personel. In our expierence, these office administrators do not have the time to be calling 4 different support lines before they get their problem resolved. Plus, it turn into a bunch of finger pointing that they should not have to deal with.

  • I’ve seen a lot of Dr’s, mostly ones in solo or small practices, that never thought to budget IT costs once the EMR was implemented. They thought software support was all they were going to need. Some used a friend, neighbor or relative that’s an IT professional to help them with the implementation. And in some cases this IT person did a great job. The problem comes in when something happens to the network, like a server crash or device failure that causes downtime. They look to the same person to help get it fixed but that person can’t get there b/c they have a full time job. This is usually when we get the call to help out.
    A managed services provider will do everything they can, proactively, in order to keep the network and computers from going down in the first place and if something does go down, they have the capabilities to remote into the network and try to resolve it immediately. We find that we resolve 75% – 80% of the tickets we receive remotely without having to send a technician onsite. If it can’t be fixed remotely, we dispatch a field tech.
    It’s important that physicians planning for an EMR implementation have their expectation set properly on costs (including IT support) so they can budget accordingly prior to implementing.

  • We find that even for small practices a flat-rate manged services plan is often the best value. Client gets unlimited support, and they know exactly what they are spending on a regular basis. As the computer/network consutant we know that our client’s goals of keeping things running smoothly are alligned with our’s.

  • Good point about the fixed monthly costs of a managed service being easier for a clinic to plan for.

    Brian,
    I’m interested in your comment, “A managed services provider will do everything they can, proactively, in order to keep the network and computers from going down in the first place”

    I’d love to see a list of the IT services you proactively provide to a doctor’s office that keep the network and computers going down. It’s a similar argument for why doctors should do preventative care versus treating the problems. So, I’m interested to see what services you provide that provide “preventative care” to a doctor’s IT infrastructure.

    Anyone else can join in as well. If the lists are decent, I’ll include them all in a future blog post with a link to your company website.

  • I am interested in the business model associated with a managed services solution. My company, The Weston Group, currently provides only time & materials costs solutions for our services but are looking to explore fix priced options. The issue we have is: How much? We commonly find that our physicians and administrators are looking for the least expensive option initially and get a little spooked by some of the monthly reoccurring costs associated with the Managed Services solutions. Do you provide AV software with a Managed Services solution? What about web filtering and spam filtering?

    We provide the following services:
    Desktop Support
    Network Support
    Server Support
    Database Management
    EMR/PM Support – form building, interfacing, etc
    Web App Development

  • Our complete managed care solution includes:

    24/7, network/computer monitoring of server, workstation and critical infrastructure (routers, switches and VPN appliances).

    Server performance monitoring, remote management and remediation by my engineers

    Hard drive health, free space and asset tracking

    Consistent/uniform Microsoft updates

    Anti-malware licenses and monitoring (AV and Spyware).

    anti-spam

    Comprehensive business continuity plan and system

    Help Desk

    Onsite support

    Limited/small projects

  • The more predictive nature of managed services, if done right with monitoring, is definitely a step in the right direction. Downtime can be scheduled, problems anticipated (not always) and productivity and accessibility kept at a very high level.

    It does surprise me that some folks still think a break/fix approach actually saves them money. The must not put any value on the productivity of their employees.

  • Scott,
    I think the break and fix model has worked very well for some of the people I work with and has saved them TONS of money. Although, for most people that’s probably not the case.

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