Lenox Hill Medical Group in Manhattan enjoys tremendous IT support from its service provider, ITelagen, says Lenox Hill's IT administrator, Drew Nietert. "The neat thing is when someone calls the ITelagen help desk, more than 80 percent of time they get a live body, and if it is not a hardware issue, they remote in and fix the problem or talk the person through fixing it. The response on hardware issues is 24 to 36 hours for replacements."

And ITelagen provides this level of service for about the cost of one full-time employee. The secret, says Nietert, is that "ITelagen monitors everything they can remotely over the network: fan speeds, CPU temperatures, smart technology on the hard drives. They come out and fix things before they fail."

This actually costs them less than the normal 'fire brigade' support model of responding when users call in problems. Of course it can't catch everything; equipment still fails without warning sometimes, and when that happens, the provider responds. But the key to the savings that the boutique medical provider passes on to its clients is its intense use of advanced, network-based technology to monitor everything in its clients' shops and, as much as possible, anticipate problems.

It was not always that way at Lenox Hill, however. Until late in 2006, Lenox Hill Community Physicians was associated closely with Manhattan's Lenox Hill Hospital, which supplied all its IT support. This consisted of an old green screen, dumb terminal system. "It took two weeks to get anything -- a toner cartridge, a broken terminal -- fixed or replaced," Nietert says.

When the physicians group, which consists of about 70 doctors covering family practice and multiple specialities, decided for business reasons to break away from the hospital in the fall of 2006, it did so with no IT staff or assets. "Not a single person," Nietert says.

To fill that gap, it hired the JHD Group, a US national medical practice support organisation that was already providing infrastructure support, including IT, to a similar medical organisation, the Manhattan Physician Group. This was how Nietert, who works for JHD and acts as Lenox Hill's head of IT, became associated with Lenox Hill.

JHD and Nietert walked into a mess. Lenox Hill had about two months to replace what it was using. And those systems were so antiquated that there was no question of simply duplicating the existing system.

"No one knew how the software worked or even where the server was. Nothing was documented," he says.

Nietert had to manage a full forklift replacement and move Lenox Hill's support staff from about vintage 1981 to 2007. While most of the doctors had PCs in their offices, some of the support staff had to be trained in using a mouse. Given the short time frame JHD had to create a modern infrastructure, outsourcing was the logical strategy, and JHD turned to ITelagen, a provider with which it had experience.

"It was fun, it was challenging .... It was two months of seven-day weeks," Nietert says. "ITelagen did all the hard work very well."

ITelagen worked from green screen to green screen, inventorying the applications the staff used and identifying what did and did not need to be transferred. It found the one person in Lenox Hill Hospital's IT staff who knew where the server running the medical group's applications was and created a network map. As part of the forklift, the medical group decided to move to modern electronic medical record and practice management systems, and ITelagen inspected all the printers on the system and replaced those that lacked sufficient paper drawers to support these new systems. It managed installation of new wiring and did the quality assurance. It did all this on a flat-fee contract, based on its unusual business model that provides a menu of flat-fee services from which customers order.

"We connected everyone to the new stuff and then back to the old systems," Nietert says. And they did meet the deadline for moving everyone onto the new infrastructure.

Today, the software upgrade is still going forward. "We have everyone trained on the practice management part now," Nietert says. "We plan to roll out the rest of the new [electronic medical record system] in July."

Overall, Nietert says, "everything has gone smoothly. When we started the biggest problem was that Lenox Hill had no IT staff whatsoever. Our goal was to reduce response time for service to 24 hours. Today, it has a full support staff and help desk for the cost of one FTE, and one person could not handle the volume of calls we are getting as we move to the new EMR."

Response time meets the goal, and ITelagen's proactive strategy fixes many problems before they happen, reducing hardware issues significantly. "I get CIO support from the founder, who was a CIO for 10 years before founding ITelagen, which helps me greatly," Nietert says. "They support our WAN connectivity and, of course, Office. They support 200 PCs at Lenox Hill, plus we avoided putting in a server farm and hiring staff for that. This really is a buy for us and our client. And we have no regulatory compliance issues."