David Hallberg

In Lean Times, Lean on Creative Solutions

Last year’s economic tailspin is old news, but its downstream impact on the healthcare environment is very much today’s headline. Staff are being cut, operational budgets are being slashed, and capital budgets are disappearing more rapidly than you can cut a P.O. How can you still manage a complex client/server architecture in this environment?

With patience, planning and a large dose of creativity.

I’ve been in healthcare IT for well over 17 years and have seen my share of budget cuts. This latest round, while severe, is just that: the latest round. And it’s a reminder that our work in healthcare IT is a marathon. To finish strong you need to focus on the basics: determining who the key people are in your organization and trusting their skill and creativity to pull you out of your nose dive.

When I started in healthcare, our capital limit was $300. Staff reductions and capital expenditure cutbacks were the norm. When a PC died or was needed, my team had to order pieces and parts and assemble them. If a printer died, we had to cannibalize other dead printers to build one that worked. We knew what it meant to “reduce, reuse, and recycle.” And it seems like these current times offer the perfect challenge for a staff to relearn these three R’s.

Start by determining what resources are available. Do you have a bunch of old PCs, switches, routers, servers, and old SANS that were too slow for the clinical application or PACS system? Instead of discarding all of this hardware, you may be able to refurbish it. You’ll be trading capital costs for labor, but capital expenditures are usually harder to get approved. You are much more likely to win a battle for increased overtime required to keep a department’s systems running.

During lean times a number of years ago, I started evaluating the cpu usage on some application servers(hardware) and found that while they were running on some very powerful equipment, they were hardly using any cpu. So I began moving our older servers to be the application servers for these applications. I also invested in creating an inventory of all of the hardware in our data centers and storage areas. I discovered several racks of gear that were still powered up and running but doing nothing. Their applications had moved to newer hardware or a different data center years before, but no one had bothered to turn them off. This utilization pattern has been one of the major reasons virtualization has been so successful.

One of the drawbacks to reusing older hardware is the work needed to get it to a functional state before redeploying. You have to upgrade BIOS’s, device drivers, perhaps hard drives, microcode, etc. Next, you have to determine which hardware is underutilized and which is running hot. Then the jigsaw puzzle begins as you take all of these pieces and determine the best fit.

Here’s where you need to rely on key members of your staff. It takes a lot of energy to collate all of the data and create a plan of action…and a lot of patience as you work your way through the multiple managers/directors who must sign off on testing before the migrations can take place. After the migrations, you need to keep track of performance and utilization to ensure the migration has not degraded clinical or business performance and to ensure the capacity of the hardware is not saturated or bottlenecking in new places.

Prognosis: Discovering and redeploying old, underused equipment may seem like a daunting task, but it might be a realistic solution for a budget-strapped IT department staffed by creative problem solvers.