Now more than ever, surgical facilities rely heavily on computers and the information technology that links everything together - from the scheduling computer to the arthroscopic imaging equipment. Beyond desktops and laptops, there's much for you to consider: from servers, routers and cables, to cable drops, specialized software and a dedicated computer room. Plus, you must adhere to the new HIPAA security regulations.

Fortunately, you don't have to be an IT expert to get your facility into the computer age (although it may be a good idea to hire an IT general contractor or a network consultant to steer you along the information highway). Here are 10 tips for getting IT right the first time.

1 Plan the work, work the plan.
It's ideal to seriously start thinking about IT six months to nine months before opening your surgical center - after they've poured the concrete but before the walls go up. "You have to think long and hard about what you want where," says Marcia Boresen, RN, CNOR, administrator of the Ambulatory Surgical Center of New Jersey in Edison, N.J.

The process also involves getting the software vendors and the hardware people together to coordinate who needs what. For example, the information management software Sue Hayes chose when she helped open the Rocky Mountain Surgery Center in Denver, Colo., last January required two servers. "You have to put it all together like a puzzle," says Ms. Hayes. Using a systematic approach to add up all you need, perhaps in a spreadsheet, you can get all your IT ducks in a row.

2 Show me your computer room.
Oh, wait, you or your architect may not have drawn one into your new facility. After all, it's a surgery center, not Silicon Valley. Still, it's a mistake that Marion Jenkins, PhD, of QSE Technologies, a technology consulting firm in Centennial, Colo., has seen time and time again. "Unfortunately, in most cases, we see that the computer room has not been properly designed, and in some cases, not included at all," says Mr. Jenkins. "When we get plans for a surgery center, the first thing we look at is the location of the computer room, and ensure the room has adequate power and ventilation," continues Mr. Jenkins. "Today's servers generate a lot of heat and the internal cooling fans generate a lot of noise. Protected power is needed to ensure maximum uptime for the servers and data storage systems."

You can no longer cram a server under the billing person's desk or tuck it into a supply closet. The new HIPAA security regulations won't even allow it, but we'll explain more about that later.

Make sure your computer room is centrally located because it'll be the heart of the facility. Most of the other rooms will be wired from it, and the longer the cables run, the weaker the transmission signals will get. Virtually every room in the center will be computerized in some shape or form.

For instance, the OR will have imaging equipment, booms, printers and monitors. There's also a workstation for dictation, front desk for check-in and scheduling, nurse's station, procedure room, business office to handle billing and materials management and med gas room, which will have monitors connected to alarms in case of a leak. Even the staff lounge will likely have a telephone that uses digital technology.

Another option is to have your servers located at an off-site facility, which is one of the services that SevenD & Associates in Effingham, Ill., offers. "All the clients are doing is connecting with us. We do the maintenance and troubleshooting for day-to-day IT operations," says Ann Deters, CPA, MBA, the CEO of SevenD. The surgical center accesses their information systems via DSL or cable modem, but the computers within the center should be hard wired.

3 Cable drops here, there and everywhere.
Most of the equipment gets connected with cable. "I've never seen so much wire," says Ms. Hayes. To be on the safe side, it's smart to put cable drops on every wall, and then some for future upgrades. Dr. Jenkins, who did the IT work for Rocky Mountain Surgery Center, likens cable drops to electrical outlets: You can never have enough drops, and no one ever asks you to take them out.

Many people assume that you can just use Wi-Fi (a wireless local area network) and not install data cabling in a facility. Wi-Fi is too slow to use as the primary network, and there is usually so much metal in the building that you can't get a strong signal. Cabling is relatively cheap during construction but incredibly expensive after the center is open, say our experts. They recommend planning for future growth by putting multiple cable drops in areas of anticipated need, including within the surgery suites themselves and their ceilings. It may cost a few hundred dollars extra at construction time, but later on it may cost tens of thousands of dollars to shut down the rooms and go through the whole sterilization process after adding a few cable drops.

David Carter, RN, BSN, the director of nursing at Sheridan Surgical Center in Wyoming, also recommends making hardware, like printers, as multifunctional as possible. He likes the versatility of being able to "send a signal anywhere" in order to toggle printers. "It's worth a bit of expenditure in the construction phase," he says, since it's much harder to do a retrofit or forklift upgrade, a process in which everything has to be taken out and replaced.

4 Remember, it's all about the data.
Data is the backbone of the operation at a surgical facility, whether it's billing, scheduling or utilizing PACS to transfer radiology film. Even surgeons' preference cards can be stored in a software program.

"Our view of information technology as it relates to surgery centers is that it is all about the data, and the data is all about managing for profitability - giving the owners the ?knobs and dials' to understand, control and maximize that profitability," says Dr. Jenkins. The key operational requirements, he says, are capture, storage and delivery.

Since data drives your center, make sure the data is backed up with a redundant data storage system.

5 Invest in robust, scalable server platforms.
Make sure your server platform more than meets the minimum requirements of the software systems. "On a properly-designed platform, you can easily double or even triple the capacity of a server system, in terms of memory or hard drive space, with very little incremental cost," says Dr. Jenkins.

The minimum hardware requirements of most software vendors are, in most cases, based on their software only. It's simple: If you use other applications, then you'll need additional horsepower.

Another tip: Always separate the requirements of security and authentication - critical requirements of the HIPAA security rule - and the software applications. This means a separate, dedicated server for login, security, data backup and authentication, and additional servers as needed for the specific software application(s).

6 What if you want to work from home?
Communication isn't limited to the confines of the surgical center. These days, people don't necessarily want to stay at the office for 12 hours, so they're bringing their work home. Or, if there's a snowstorm or hurricane and you have to cancel appointments, you need remote access.

That's one thing Ms. Boresen of Ambulatory Surgical Center of New Jersey had wished she'd done from the start. Even taking a printout of the next day's schedule home can be a HIPAA violation.

An IT expert comes in handy for these matters. In order to allow access to specific systems for certain people, the system's firewall has to allow for a VPN (virtual private network), which requires secure authentication. This keeps your center compliant with HIPAA security guidelines.

7 Speaking of HIPAA security.
Last April, the federal government extended HIPAA regulations to cover electronic medical information, falling right under the umbrella of wiring IT for new surgical centers. There are a plethora of rules governing medical facilities now but the good news is none of them are draconian.

There are a few basic ones:

• the computer room has to be locked;
• passwords for log-ons can no longer be shared and they have to be a combination of letters and numbers; and
• it's a violation to have an out-of-date operating system such as Windows 98 (which is no longer updating security patches) on your desktop.

"HIPAA security must prevent unauthorized access in case of theft or loss," says Mr. Jenkins. "It really just makes your business more secure." Unfortunately for the sake of the patients' privacy, Mr. Jenkins believes very few practices have complied adequately with HIPAA security.

Another security note: With always-on broadband Internet access, new productivity gadgets such as PDAs and Wi-Fi, and a host of other features and factors, the risk of data loss and system attack has never been greater.

8 Take a system-wide view of IT infrastructure.
Most people look at the hardware infrastructure only with a single application in mind - usually the scheduling and billing system. They think in terms of a single application server and some workstations. However, there are many other factors that come into play, and those need to be designed from day one. In addition to billing and scheduling, there are many other critical needs, such as imaging, case documentation, inventory management, reporting and metrics, remote access, transcription, and access to and from the outpatient surgery center to hospitals and the physicians' offices. Set up your system in a modular, scalable form so you can implement future needs and applications without a total do-over.

9 Don't skimp on training.
So once your fancy IT system is in place, who's going to use it? Everyone, basically. And that means training everyone to get up to speed by the time the center opens. In this tech-savvy world, even the patients have come to expect a certain level of computerization.

Ms. Hayes believes start-up training is critical to the surgery center operation. "If you don't train the staff correctly up front, you have to go back and redo," she warns. "We did a second round of training for the admissions people when we started seeing patients. You almost need two or three training sessions."

10 Invest in maintenance contracts.
Be sure you have someone in place to continue to maintain your IT system. Ms. Boresen has a vendor coming in quarterly to check on the hardware. Mr. Jenkins offers a service contract along with his services as an IT general contractor. Ms. Deters at maintains the servers easily because they're located in her own facility.

The need for more and better data The need for good management data has never been greater. Metrics that help drill down to costs and profitability per procedure mean that the technology needs to be properly set up to record, store, protect and deliver that data. It also means that multiple software applications will ultimately be used within the center, not just a single scheduling and billing module. So modularity is critical for proper system design.

With a properly designed IT system, the doctor can do the surgery, go back to the dictation room, code and send the records back to his office. Says Ms. Hayes, "We can drop a bill even before the patient leaves."