The Hidden Cost of Upgrading

The Hidden Cost of Upgrading Before you trade in your old PC for a sleek new model, consider the many hidden costs of upgrading your office with a fleet of computers, as described here. journalArticle computor,computers, technology and medicine,computer systems Bryan Bergeron, MD Bryan Bergeron, MD, faculty, Health Sciences and Technology, Harvard Medical School and MIT, Boston, Massachusetts. Dr. Bergeron also practices medical informatics at Massachusetts General Hospital, Boston, and is the author of several hundred articles on applied technology and healthcare. His latest book on the topic discussed here, Business Expectations: Are You Using Technology to Its Fullest?, is available from <a href="http://www.wiley.com/WileyCDA/Section/id-WILEY_SEARCH_RESULT.html?queryText=bryan+bergeron&field=author" target="_blank">John Wiley & Sons</a> Medscape Medscape General Medicine 02/09/2004 6 1 <H3>Introduction</H3>With the price of personal computers dropping below $500, it's tempting to toss out "old" putty-colored sub-GHz computers with their bulky CRT monitors in favor of sleek, two-tone models with fast processors and flat-panel displays. But before you do, consider the many hidden costs of upgrading your office with a fleet of computers, as described here.<h3>Price, Cost, and Return on Investment</h3>In a clinical practice, time is money. If it takes your office manager 2 minutes to fill out an insurance form, and he or she spends half of that time waiting for the computer to update a database, then cutting out that waiting time may be worth the investment in a new PC. This is especially true if it means cutting overtime hours for the manager or obviates the need to hire additional help.Let's say you purchased 3 or 4 PCs for your practice 5 years ago. Back then, the minimum price of a PC capable of running a suite of office applications was about $1000, and the cost of ownership in a small practice was about $10,000 per year.[1] Today, the equation has changed somewhat, in that the initial cost of equipment has dropped by more than 50%, but the cost of ownership, which includes expenses such as software upgrades, ongoing support, training, and supplies, hasn't dropped appreciably.Even if you have a teenager who is willing to install your new system in exchange for his or her weekly allowance, at some point, it doesn't make sense to replace sticky keyboards and worn mice, add RAM, a larger hard drive, new video card, or flat monitor, or install a new operating system in an old clunker. Still, before you upgrade to a late-model PC, it's important to understand the resources, in terms of time and money, involved in making the move.<H3>Hidden Upgrade Costs</H3>Thanks to the advent of mass, online customization of PCs, popularized by Dell and now followed by the other top desktop vendors -- IBM, Hewlett-Packard, and Gateway,[2] as well as Apple -- it's easy to determine the upfront price of computers and peripherals. If you go to Dell's Web site, for example, the prices for extra RAM, an ergonomic keyboard, or a larger hard drive are clearly defined. Because you can do the same with HP, IBM, Gateway, and the "white box" brands, computers are low-margin, commodity items. With the exception of the Apple line of computers, it's easy to compare computers, feature by feature, dollar for dollar. What are not available are the hidden costs of upgrading your office with a new computer, outlined below.New software. The biggest economic shock when upgrading from, say, a Windows 98 machine to a new PC running Windows XP is the investment in new software. Prior to XP, it was possible -- albeit not legal -- to share one copy of Microsoft Office and any number of third-party software packages. No more. XP effectively quashes any attempt to get around the one PC, one license limitation.In addition, not all vendors offer products that are compatible with the new operating system without an upgrade. Sometimes the upgrade isn't available, requiring that you either purchase a substitute product or keep an old machine around so that you can run the old package. Sometimes purchasing an upgrade means signing up for an expensive "maintenance contract" that can cost up to 30% of the original cost of the software package -- per year. For a $30,000 clinical office package, the maintenance cost may be prohibitive.Even if there are no compatibility or license issues, there is still the need to load software from the original CD-ROM or floppy disks. There is the time required to locate the disks and instructions, time to find the original installation codes, and time on the phone with vendors. Several products also require a phone call to the vendor to activate the software. For example, if your office runs on Intuit's QuickBooks Pro, then your office manager will have to call Intuit for a new code -- or spend time online filling out online forms.Increased complexity. Like the latest cars, the newest PCs are simple to operate, but don't even think about looking under the hood. The latest PCs are much more complex than their predecessors. Much of this complexity lies in the operating system, which hides most of what's going on behind a colorful veneer. But this complexity means it's often difficult for someone with a little knowledge to perform even simple tasks, such as uninstalling programs completely.For other, savvy users, the increased complexity is an invitation to hunt for back doors to drop in viruses and do other mischief to unsuspecting PC users. To guard against this, you'll need to install the latest versions of firewall and antivirus software -- and keep these updated as well. If you don't have an Internet connection, then you'll need to get one, just to automatically keep up with the updates.Part of the increased complexity is due the interdependence of system software. If your PCs are connected to the Internet, then it's a simple matter to keep current with the latest software updates from Apple and Microsoft. Both vendors provide automatic downloads of updates. However, accepting these automatic upgrades can have a cascading effect, requiring additional upgrades of software packages that rely on the old components. For example, I recently upgraded several packages from Apple online. When I was finished, one of my commercial packages gave an error message and required that I purchase a later version so that I could be compatible with the latest version of the operating system. The free system upgrades translated to an inoperative piece of software. Expect more of this in the future, as automatic operating system upgrades become commonplace.Training. Moving from Windows 98 or 2000 to XP requires some time to get used to, and perhaps some training for your staff. This translates to decreased productivity for the first few weeks as you and your staff discover the nuances of the new interface.Lost downloaded installations. Especially problematic are programs and utilities downloaded from the Internet. Since there is no CD-ROM to work with, you'll have to hope that the original vendor is still in business and that you have your login ID and pass code to download the application again. For example, I have several extensions to Microsoft Word that allow me to add graphics within the text, but no disk to reinstall the extensions in my new machine.Network infrastructure. The latest versions of PCs and Macs don't support many of the network cards and applications that ran on previous versions. The cables and connectors are different, and many of the software drivers don't work with the latest versions of the operating system. For example, when I tried to install my wireless network software, I received a message from Windows XP that the software wasn't certified to work with XP and that I'd be installing the software at my own peril. The vendor's Web site didn't have an upgrade to XP available, so I was forced to buy a new wireless router (about $150).Peripheral interfaces. The reason I recently upgraded my office PC from a 500 MHz Pentium 3 model to a 2.8 GHz Pentium 4 was primarily because of an external hard drive. The old machine has a USB 1.1 port, which, at 12 Mbps, is painfully slow, despite my external hard drive that I use for backups, which supports both USB 2 (480 Mbps) and FireWire -- also known as IEEE 1394 and i.Link -- at 400 Mbps. As a result, I can now back up an entire day's work in less than 5 seconds, compared with 2 minutes before.The initial downside was that there was no serial connector for my BlackBerry's cradle. I had to purchase a USB to serial adapter for about $30. (I purchased one advertised on Amazon.com made by IOGEAR, but adapters are available from other vendors as well.) After installing the software, my printer stopped working and my monitor froze. A visit to the IOGEAR Web site, using another PC, gave me a workaround. Then when it came time to syncing my BlackBerry, it turned out that my software didn't recognize Microsoft Outlook 3000. So I upgraded my BlackBerry software, via the Web, to the latest version, which consistently crashed. After spending 2 hours on the project, I went to Amazon.com and ordered a $100 Palm Pilot -- complete with USB-compatible cradle.Although there may be drivers and cables available for the Blackberry that actually work out of the box, the point is that I invested 2 hours that I didn't have trying to get it working. If you have other peripherals, such as a dedicated label printer, you may run into the cable and software incompatibility issues as well. This brings up another hidden cost -- consulting.Consulting. Whether it's reconfiguring a new or updated wireless network, installing PDAs and label printers, or working with the computer manufacturer's technical support staff over the phone, it usually makes sense to hire a consultant to oversee the upgrade -- especially if your entire office is affected. Otherwise, you and your staff may be free to work with the scheduling and billing system down for a day or more.Media transfer. Many of the new desktop computers don't support floppy drives, but may have only a CD-ROM drive and/or a Zip disk drive. Although it takes time, media transfer usually isn't a problem with data files. However, if you still have applications on 3 1/2 inch disks, then transferring their contents to another medium may not be workable. This is because the applications may transfer, but when the program installer runs, it may request a specific floppy disk. One workaround is to contact the vendor and request a CD-ROM or downloadable version of the application. The other is to invest in an external floppy drive.Debugging time. It takes time to work the bugs out of any new installation -- from new printer setup routines to new versions of core programs and new firewall and antivirus setup options. Allow about a month for the system to settle down.<H3>Hidden Returns</H3>There are hidden returns as well as costs associated with upgrading to a new desktop computer. For example, if you upgrade to a system with a new ergonomic keyboard and mouse and flat screens with less flicker and glare, then your employees may be less likely to suffer from repetitive stress injuries and eyestrain. The resulting increase in job satisfaction for your office managers and staff may be difficult to quantify up front, but may likely result in enhanced performance from your staff.Another hidden return is the ease of hardware and software maintenance. Unlike earlier PCs, with large, metal enclosures held together by dozens of machine screws, the latest models are slim affairs with pop-open sides that allow anyone to add RAM or a card in seconds, not hours. This translates to less service time, less down time, and lower maintenance cost.Similarly, Windows XP and Mac OS X support automatic incremental software upgrades over the Internet. There is no need for your staff to wait for a technician to make the rounds with "service pack" CDs from Microsoft for the latest patches to the operating system. Your staff may be able to update their application software with a click of a mouse button.Finally, there's your image to consider. If your patients walk up to your receptionist and he or she is hidden behind a large, dusty CRT monitor, clicking away on an old keyboard, and printing out patient information on a dot-matrix printer, it presents a certain "image" to your patients. Some more technically savvy patients may infer that your practice hasn't kept up with the latest medical technologies, for example.<H3>Take Away</H3>There a numerous hidden costs involved in upgrading to a new, often inexpensive fleet of desktop computers for your practice. Knowing these upfront can help you decide on your actual budget for the program, and whether the benefits outweigh the initial expense, up-front costs, and hidden costs.<H3>Related Links</H3><a href="http://www.apple.com/" target="_blank">Apple Computer</a><a href="http://www.ibm.com/" target="_blank">IBM</a><a href="http://www.iogear.com" target="_blank">IOGEAR</a><a href="http://www.dell.com/" target="_blank">Dell Computer</a><a href="http://www.gateway.com/index.shtml" target="_blank">Gateway Computer</a><a href="http://www.hp.com/" target="_blank">Hewlett-Packard</a> <ol><li>Bergeron BP, Bergeron RA. The return on investment for information technology. J Med Pract Manage. 1998;14:43-50. <a href="http://intapp.medscape.com/px/medlineapp/getdoc?pmi=10623406&cid=med">Abstract</a></li><li>Greenemeir L. Analyzing the PC vendors. Information Week. 2003;Dec 1:34-53.</li></ol>