Q&A: Delaware Guidance Services’ Todd Capriotti on Building Out IT in Healthcare Nonprofits

Despite being the state’s largest single nonprofit provider of comprehensive psychiatric services for children, just three years ago Delaware Guidance Services had almost no IT footprint. When Todd Capriotti, head of information technology at DGS, joined the organization three years ago, he immediately set about working with CDW to streamline and augment the healthcare provider’s IT structure.

Nonprofits deliver important and often life-saving services to their communities, but notoriously struggle with tighter budgets, which can make it more difficult to build out an efficient IT infrastructure. But by providing a more efficient and secure IT environment, these organizations can also offer more reliable and agile services to the community they serve.

HEALTHTECH: Can you speak to the role technology and connectivity play in providing psychiatric services to patients at DGS?

CAPRIOTTI: The connection between service and IT really comes from our EHR [electronic health record] system, which is Netsmart’s Totally Integrated Electronic Record, or TIER, solution. We’ve had that since 2009. There is another piece in TIER called DrFirst, which allows our doctors and nurse practitioners to prescribe medicine to our patients. With regard to our IT services, TIER and DrFirst are the main things that our doctors and nurse practitioners use.

Technology also plays a role in the increasing accessibility of medical records. By increasing the intersystem communication and communication with the government, we can accurately assess the true effectiveness of our built-in monitoring tools.

Moreover, coming to nonprofit from big retail, I really had to change my mindset. Working here at DGS, has made me a much better IT person, from both a business and financial perspective, because I have to figure out how to do more with less.

In working for a nonprofit, your work becomes a lot more important because you realize that you are helping a lot of people that otherwise would not be getting help. We represent the community and an organization that is here to help that community. If I can help that organization operate more efficiently, it has a domino effect that goes all the way down to the patient level.

HEALTHTECH: When you arrived, what systems were in place and what challenges were you facing?

CAPRIOTTI: When I got here three years ago, we had a lot of systems that weren’t working well together. There was a disconnect. DGS had a Telco provider that delivered  circuits to each location, but it didn’t tie our sites together, leaving them independent from each other. We didn’t have any segmentation in our dashboard, and our virtual infrastructure was unreliable, which created bottlenecks in our server traffic, resulting in server instability and user frustration.

On top of that, the equipment we had for our main site and four corresponding sites were not business class. It was more consumer class.

HEALTHTECH: How did you go about building up the DGS environment with a focus on technology?

CAPRIOTTI: When I came on board, I went through a consulting process: identifying what worked, what didn’t and why.

The first part was strategic: We had to build out a roadmap for our IT department. The second part was technical: We had to rebuild our entire infrastructure.

You usually don’t want to rip out the entire IT infrastructure; it’s ideal just to patch it. But in order to build a foundation, I had to tear down the entire infrastructure and rebuild. To do so was a three-partner project. I shopped around to a lot of different vendors and decided that CDW would be the best partner for DGS going forward. As my main vendor, CDW provided my Cisco ASA Firewalls and Cisco switches — particularly many of the switches I use today in my IDF [independent distribution facility] closets. CDW also provided me with my anti-virus and VMware licenses.

The other two partners, Cisco and Dell, provided me with DGS’ phone system and back-end infrastructure, respectively.

Meanwhile, our EHR was fraught with problems because we had a lot of customizations in it and were doing most of that customization in-house. We have tried very hard over the past few years trying to work with our vendor and make it more of our own. The next logical step is to migrate to a different platform to meet the agency’s changing needs.

The second part was strategic: We had to build out a roadmap for our IT department.

HEALTHTECH: Can you speak to what DGS' IT footprint looks like now?

CAPRIOTTI: There is still work to do, but today all our infrastructure is solid and growing. Our remote sites all tie into our Wilmington, Del., headquarters via MPLS [multiprotocol label switching]. We are using a secure, robust VPN [virtual private network] solution and, thanks to help from CDW, we have Cisco firewalls at all of our sites.

I am working on a security initiative that will secure our environment even more. We have regular penetration tests on our sites to ensure we’re secure. All our data and software have audit trails, so they’re secure whether or not they’re accessed in-house. And we are working hard to secure our data to comply with HIPAA [the Health Insurance Portability and Accountability Act] and state regulations.

Our services are now more reliable, dependable and resilient. All our data is secure and backed up regularly. IT at Delaware Guidance is now agile.

Moreover, I have service contracts on everything, which was previously not the case.

Everything now is considered mission-critical, and we have a more collaborative environment. We do a lot of video conferencing, which will eventually be done through Cisco’s Telepresence, but we are currently using Zoom for further collaboration.

It’s the little things that allow for our environment to function much more efficiently than before. We had been a reactive environment, and now we function as a proactive environment, which is the goal of IT as the service arm of any organization. People can now depend on the systems.

HEALTHTECH: What specific challenges do nonprofits face in looking to build up an IT infrastructure?

CAPRIOTTI: As an IT professional, coming in to take over a department creates a set of challenges. In nonprofits, the challenges are magnified because of budget constraints but also because the approval process is much more in depth. Nonprofits are typically smaller, and the boards are more hands-on. The finance committee is more likely to review major expenditures, and IT changes like the ones we’ve just talked about typically fall in that category. All of these steps make for a longer process to get things done.

HEALTHTECH: Does DGS have plans to help other nonprofits build out their IT infrastructure?

CAPRIOTTI: The issue for any nonprofit is money. Our goal, now that we’ve pushed the edge of IT and gotten to a better state, is to help other nonprofits in Delaware and the local area take advantage of our expertise and build that shared-services model for smaller nonprofits who may not be able to afford an IT staff or pay exorbitant consulting fees. We want to help make things better for nonprofits through our relationship with vendors such as CDW, which can be of tremendous value to them.

Through our DGSIT Shared Services, we can help other nonprofits build an IT strategy and budget plan, as well as manage traffic and help desk services. We can give them a voice that they may not otherwise have because IT is often a mystery to people, and if they don’t understand it, they can be taken advantage of very easily. We’re trying to use our relationships with vendors and our own experience to help put the best interests of nonprofits first and help them move forward on solid footing.