About 8 years ago or so, our practice decided to move from paper records to electronic records. The decision was helped along by the fact that we were literally running out of space for our paper charts. I had been looking at electronic medical records systems (EMRs) for years prior to this but could not justify the cost to my partners – apart from the “gee-whiz” factor – until we were up against the wall, so to speak. Our administrator had previously worked in a non-profit where he met an individual who was doing contract information technology (IT) work and recommended we hire him to help us achieve our goal of having a paperless practice.

Fast forward to today. We implemented EMR in our practice at the end of 2008 and performed a gradual rollout to minimize the impact on the clinics and thus the bottom line. We were able to start adding new patients with no significant effect on our efficiency and have subsequently added other patient types to the mix. Our IT Director, who spear-headed this project, commuted from almost an hour away the eight years that he was with us; alas, this eventually took its toll and he decided to leave us and take a position closer to home.

Since we are approaching the deadline for meaningful use of EMR, we felt this was a critical position to fill – and soon. In a practice our size, the IT Director is the next most important person after the Administrator and the Chief Operating Office or Assistant Administrator. And since we were already running on EMR, though not yet at 100%, time was of the essence. Fortunately, we had two other IT employees who could keep things running during our search.

As physicians and medical practice administrators we feel pretty comfortable with the thought of having to recruit, interview, and hire a new medical associate. There are professional head-hunter firms that can throw resumes your way and even help vet potential candidates. We know what questions to ask, what skills are important, and we know how to tell whether or not an applicant is the real deal. The problem with trying to hire an IT director is that we don’t know what questions to ask, what skills are important, and we probably can’t easily identify someone passing himself off as an expert when he’s not (this position was open to applicants from both genders, though 99% happened to be male).

Our next step was to consult with our extended family of experts: my brother, who oversaw an IT department, and the spouse of one of our partners, who works for a major software company. We all decided that any potential candidates would need to be vetted by someone who was in the IT industry even before our experienced management team performed any interviews. It is difficult to verify the credentials of people in this field – MNS, ACE, ACTP, CCNA, CCNP, MCP, CNX, LPIC, LCSE, OCP, WAN-ACE, CSTE, to name but a very few.

After our conference call, we had our plan of action.

1. Create a job description. Do you already have a good idea what this person will do for you? Great. If you don’t, get some assistance. You can either ask the Director of IT for a practice in your area or the local hospital to help you come up with a very specific job description. This should include the certifications required for the job and the expected hours as well as duties – for some people, squeezing through crawlspaces to run network wire is a deal-breaker. You’ll also want to ask your expert what the expected range of salaries would be in your particular market, given your specified skillsets. Even in this economy, people in the IT industry with experience can command some decent pay.
2. Post the ad. Do you live in a small town? Then you might want to think locally. It might be difficult to recruit someone away from a major metropolitan area and your salary offer might be less than they are accustomed to. Apart from placing the ad in your local newspaper, you should post it on a major job listing site like Monster.com. One advantage of using a site like that is that the resumes are stored in an electronic format which makes going through the information much easier (see number 3). It also makes it easier for potential candidates to search for the appropriate job.
3. Start vetting the candidates. Rather than using a head-hunter (more on this later) we opted to go with a consultant, Mike Sellers of CVPSite.com, a credential-verification company. They offer a free service to employers that verifies the credentials claimed on the resume of a potential IT candidate (they charge the applicants a fee for going through their certification process, thereby giving them their seal of approval and making them more attractive a prospect). Based on our job description and some other specific criteria, Mike ran the resumes through their proprietary system to rate the candidates. He then took the top sixteen of these and interviewed them by phone in order to ascertain whether their listed qualifications were genuine – he could usually tell after just a few questions if the applicant truly had the experience and credentials that they listed. In one instance, the candidate gave up early and readily admitted that his credentials were bogus. When the process was complete, we were handed a spreadsheet with all of the applicants and their ratings on a multitude of specific criteria, ranked top to bottom, with the finalists clearly identified.
4. Considering using predictive testing. Recent research is showing that personality or IQ tests are less predictive of an employee’s success in a particular job than what is known as conative testing. This describes a person’s modus operandi or M.O. – how are they likely to act in a particular situation. The most well-known of these is called Kolbe Testing. The practice administrator and/or direct supervisor of the applicant take one test to determine their own Kolbe ‘profile’, then take another test to determine the profile of the ideal employee. Last, the job applicants take another Kolbe test to see if they would be a good ‘fit’ for the practice.  Obviously this should be just part of your overall assessment (we have just started using this tool, so the jury is still out). Another type of assessment tool to consider is Predictive Index testing  from PI Worldwide .
5. Final interviews. After going through the process above, you should have four to six finalists for your face-to-face interviews. Since your expert has already vetted their credentials and assessed their technical skillsets, your finalists are all on a level playing field. Now all you have to do is subject them to the same rigorous evaluation process as you do for any other (highly-compensated) employees and make sure that you feel that person is a good fit for your practice. You know they are highly skilled, but do they also have good people skills? It is critical for the person in this position to act as a liaison between the technical world and the real world. You might also want to consider involving a subordinate in the evaluation process – a person who works in the same technical field can have valuable input.

Why didn’t we just retain the services of a head-hunter like we do when hiring a medical associate? Like a listing agent in real estate, the head-hunter doesn’t necessarily represent the buyer – in this case, our practice. Their main job is to place their clients, the job applicant, i.e. the ‘seller’. Sure, their reputation is at stake and they want to make sure you are satisfied so they can count on you for more business. But they will make their fee, regardless of who is placed in your practice. And although most reputable head-hunter firms have some sort of guarantee if the prospect doesn’t work out, this is not something we wanted to waste a lot of time on. For this reason, and for reasons I listed above, we decided to go with a ‘broker’: an expert who performs a formal candidate analysis.

Peter J Polack is an ophthalmologist who blogs on medical practice management and electronic medical records implementation on Medical Practice Trends.

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