Case Study: Surgery Center in New Hampshire (Podcast)

Dave Hodgdon from PCG talks with John Maher about PCG’s work for a surgery center in New Hampshire. He explains why the client reached out to PCG, and then, he details the past and current ways PCG has supported this client and improved their technology.

Portsmouth Computer Group · Case Study: Surgery Center in New Hampshire

John Maher: Hi, I’m John Maher. I’m here today with Dave Hodgdon, CEO and founder of PCG, a managed services and security provider, with headquarters in Portsmouth, New Hampshire. Today we’re doing a case study on a surgery center in New Hampshire. Welcome, Dave.

Dave Hodgdon: Good afternoon, John. How are we doing today?

What Does This Client Do?

John: Good, thanks. So, tell me a little bit Dave, about this surgery center and what they do and how many employees they have.

Dave: It’s a medical surgery center. A lot of surgery centers are owned by the hospital, but this is owned by various doctors. They have 25 employees. We have been doing business with them for about seven years now. We originally met up with them due to two or three key problem areas that they were having with their technology and the network was aging.

There was not a plan in place to keep up with the dramatic changes in the medical world, John. And how do you expect to do the patient treatment if you don’t have wireless? This whole thing of the tablets coming around to bedside, getting the information necessary in the surgery center rooms as well as the care rooms for the patients.

They start their surgeries very early in the morning, and they weren’t getting help desk services at the right time. Because sometimes, a lot of times, there are problems first thing in the morning, and they just wanted some better guidance. So, we met with their leadership team and we kind of went over some of our options and we came up with some specific tasks for them to do.

Bringing the Client’s Technology Up to Speed

John: Right. So, tell me a little bit more about the strategy and what was involved in bringing them up to speed.

Dave: Anytime you hear the phrase “aging network” that kind of concerns us. So, we want to see firsthand exactly what it was. What’s the infrastructure? I always talk about that. Like the foundation of your house, what’s happening with the plumbing, the electrical? Is the foundation that your house sits on in good shape?

So, the network was aging. It was an older switch. It was an aging firewall. The wiring wasn’t labeled. So that was the problem one. We knew why they were complaining because the server had probably been there for six, seven years. It was at the end of its lifespan.  And you can tell that when a user was trying to access the database on the server, the response time was four, five, six, or seven seconds every time they tried to access something.  In the medical world, you want things quick. So, we knew there was an issue with the server performance.

And we also noticed, John, that the PCs were getting a little bit old too. So, just like anything, it’s just not one specific location. You could have a great server and lousy workstation that kind of stinks, or you can have a lousy server and a great workstation. You must have both sides of the bridge to join together and have a good experience.

The Network Assessment

John: So, I know that one of the first things that you do is a network assessment. What did you find when you took a look at their network?

Dave: We have an engineering process that is pretty much a blueprint of certain stuff that we look at. They do their discovery of those items. They try to find out the specific hardware, any warranties, the age of the computers, the processing, the memory… Is it the right version of Windows? Then, they get a list of the client’s key line of business applications, a copy of the internet bills to see if the problem could be the ISP… Comcast, FirstLight, what’s coming into the building?

And where we get some of our most important information is by talking to the users and trying to find out what’s working, what’s not, how can technology help make things a little bit better? What’s missing? We get that feedback from them. And that’s good feedback to go back to the ownership team.

Tactics to Improve the Client’s Technology

John: And what were the tactics that were involved in implementing some changes to make things better for them?

Dave: Well, part of the strategy is coming back to them with some guidance, and after we did that, John, we determined that they didn’t have the right wireless. Of course, they had one access point. It was like a 6,000 square foot area, and with a single access point, you’re not going to get the coverage that you need. A lot of these rooms are heavy concrete with a lot of equipment. And your signal needs to broadcast pretty well. So, they were definitely short on the wireless signal.

Issues With the Client’s Wireless Access

John: Were they just using like a home router or something like that, that you would use in your house?

Dave: It was just one sending off the signal. And it was probably covering about one third of the facility, but it’s kind of like you are driving with your cell phone, you have some good coverage, but then, you go down a hill, you kind of lose it. With wireless the big word is density. Just because you have good wireless in theory doesn’t mean it can support your needs. If you get four, five, six, seven, or eight people on there,  plus people’s cell phones, you have now sucked up the bandwidth and you can’t get access. I don’t know if a lot of people know that at the beach in the summer, if it’s early and late, you can typically get your cell phone on. But as you get into the busy parts of the summer, there’s too many people trying to get on that signal and you just can’t get on.

John: Right. It’s not even so much that the signal isn’t available, it’s that the bandwidth isn’t available.

Dave: Exactly. And it only can handle so many people making the connection. It’s just not there. And if you show up at the end of the day, you might wonder, why is it working now? So, there’s a reason why that doesn’t work.

Planning and Roadmap for Success

Dave: We also noticed that as we spoke to the users, John, they weren’t that satisfied with the line of business application running the practice. So that was the other thing to bring to their attention. And so, we found out many things. And any time you’re in the medical field, you must follow the HIPAA guidelines. So, we wanted to confirm the security gaps. And when it was all said and done, there was quite a heavy roadmap of things to do. So, we prioritize and come back with a plan of what we need to do, and we work through each of those steps, not doing everything at once… the budget wasn’t ready for that. Instead, we just chip away at everything, and we plan a roadmap to get success.

Improving the Client’s Infrastructure

John: Yeah. So, tell me a little bit more about some of those tactics that you implemented in order to really fix those issues for them and get them back where they needed to be.

Dave: Once you start developing a plan, you need to come back to them and speak in English so that they can understand things. Once we were able to tell them about the infrastructure, and again, we talked about plumbing and electrical so that they would understand that until you fix the infrastructure, they’re always going to be problems.

So, we had to change the switch. We had to change the firewall, which helped the security. The wireless was a huge bottleneck, and we knew that was a big thing of what they wanted to do to support the way they offer their service to the patients. Improving the wireless was also important for the guests who were in there waiting. From the surgery, to all the rooms, the wireless just had to be better. That was a no brainer.

And then also cleaning up the wiring. It was kind of like a hodgepodge of what we inherited, and our job is like anything, let’s clean up the wiring that’s there. Let’s label it. Let’s neaten it up. Let’s label each of the devices. If there is a problem, first thing in the morning, you can tell the user, please reset the cable modem, or please reset the switch. But if they don’t know what it is or if it’s not labeled, they don’t know what you’re asking for.

So again, the first thing was to improve the infrastructure. We knew that many of the machines were aging. So, we had to come up with a plan for the server and for the workstations, because you could change the server, but the workstations were still a problem.

The second major project was to get the server updated with a more current operating system, which again was at the end of its life and had no support. Then, we wanted to work with their current line of business application to get that migrated from the old server to the new server.

That always takes time. And downtime in a medical facility is not accepted. So, we had to plan that after hours. When you make a change it affects the client’s access to data, and it doesn’t work to be doing surgeries when we’re in the middle of a technology migration. So that we did not disrupt them, we planned the migration after hours instead of during business hours.

By doing all these things, we slowly started chipping at the list. There are so many things on the list to do. The next thing on the list for us… they were on an old email system, they weren’t meeting the compliance requirements, and their emails weren’t being backed up. So, we moved them to the 365. I think in 2015, they were all on old POP accounts.

And since 2015, John, as you know, security has changed dramatically. So, security was important to them at the firewall level of the PCs. But we’ll talk about that in a little bit. In the last few years, the tactic has really been to address the security.

But since we made these changes, the server was up and functioning, the PC started having a better experience, the help desk was able to support them outside of the normal business hours. They pretty much lean on us for everything related to IT from a webcam to a new printer, to doing wiring for the phones. They ask us, “where can we get guidance?” And that’s the ultimate goal, John. We don’t want to be known as a repair shop, even though we do repair machines. It’s really the big picture. How can we make technology work better in that environment? So, what they’re investing in is allowing them to realize the benefits ultimately of having a better user experience and making money, just not spending it.

Technology to Support HIPAA Requirements

John: Right. Can you tell me a little bit more about the HIPAA requirements and do you help them to sort of lead the charge and make sure that they’re being compliant with HIPAA? Or are they kind of relaying to you what they need to be fixed and upgraded?

Dave: That was the biggest issue when we first took them on, but over the last five or six years, risk assessments have come a long way, John, not only in the manufacturing environment or in the medical field. We do have the ability to do the risk assessment and help with that HIPAA guideline to make sure they’re meeting X, X, and X. And that is important for them to do because they are a medical surgery center. Being compliant is critical to them. And not only for the insurance claims, but also for the work they’re doing for the patients, for doing credit card payments, for the guests coming into the facility. Meeting HIPAA requirements is critical for the safety of their patients and for the safety of their data.

Results of Working With PCG

John: And how long have you been working with them now and what have been the results and outcomes of the project?

Dave: I think again, we’d probably been with them about seven plus years now, and originally it started off with the server project, getting the workstations, getting the infrastructure in place, but some of the best outcomes that they love is having a proactive visit. So, they get to see the same engineer once a month for the proactive visit.

They love having the help desk out of hours, because they do start early in the morning, five, six, seven in the morning. When we first started, we didn’t offer that to them, but now we do because they don’t want to wait around those two or three hours.

As we got wireless going, they had to change out the tablets. So, we moved away from the older Androids that weren’t as reliable. They needed a more robust tablet with the protective case. And many nurses use these tablets. So, we implemented a tablet solution with the protective cases, and we made sure all of those could get onto the wireless and access the line of business application.

One thing they didn’t like about the original server setup was the software. So, we helped them and guided them toward a new cloud-based application that they can move to. So just recently this summer, we migrated from the on-premises server to a cloud-based application to run their medical software. That was a big change for them. We did have to increase the internet bandwidth, John, and the next big thing as we’ve been promoting with other clients, you can’t have just one internet when you rely on the internet to run your line of business applications. Similar to your house all winter long, without having a generator in place to have power, that can be a problem. You hope you don’t lose power, but the internet will go down and you can’t afford downtime when you’re in the middle of a major surgery or stuff and you don’t have access to information. Based on that, we’re proposing a backup internet line for them in Q1.

We did move them to 365. Then we added the necessary email encryption and additional security features into 365. The most recent push has been on their security. Where’s their security posture at? What’s the baseline of where they feel at risk not only for themselves but for their patients? And what gaps are in place? And that’s always a big thing, especially with your cyber insurance. So, we’ve been working with them recently on getting the right security services in place to minimize those risks. They do have their quarterly, as we call the VCIO meeting. That’s the bigger picture of having that dedicated individual as your trusted advisor, similar to why you have an accountant or attorney. You’re leaning on this person for IT advice and giving them the roadmap of services needed. It’s a huge improvement when the client embraces that, because that’s the biggest part of how IT can help them.

We don’t want clients to see IT as an expense, we want to see it as an investment into them providing better service to their clients, their patients, but also that they can make money. So, our goal with them is always to help them understand anything they’re spending money on… what it’s for and how it can help their business, whether that’s through better productivity, through a better software product, through securing their data. With the whole COVID thing, even though they’re doing surgery, certain people still could work remotely. They were in place to do that. So, we helped them with the remote workforce last year when COVID hit.

How Backup Internet Works

John: Okay. And in regard to the backup internet that you mentioned, is that a wireless solution and does that automatically switch on if their internet goes down?

Dave: Great question. The backup could be Comcast, the backup could be FirstLight, it could be Consolidated, but a big thing recently is going to a company like Verizon or AT&T so that the backup would be a wireless signal. A lot of times, if there’s an issue on the wire, it could be power, or they hit the same pole. So even though the service is coming from different providers, if somebody hit that pole, both services would be down. Our ambition and goal for our clients is to have the backup internet in place because I always tell them, it’s like having the donut tire in your car, John. You’re not going to drive 90 miles an hour, but you’re going to be able to get to where you need to, to get by.

Usually, with most major carriers, the internet won’t be down long. And the goal is for this backup service to run and keep you functioning until the main service comes back. And if that fee is 50, 75 bucks a month, that’s a lot better than spending another 500 a month that you might never use. So, I think going the Verizon route is a great option for many companies and it is a very inexpensive option and it’s there if you need it. It’s like having insurance.

Contact PCG to Talk About Your IT Needs Today

John: All right. Well, that’s really good information, Dave. Thanks again for speaking with me today.

Dave: My pleasure.

John: And for more information, you can visit the PCG website at or call (603) 431-4121.