Specializing in Orthopedic Surgery since the 1980’s, Fresno Surgical Hospital (FSH) was the first healthcare facility in the nation to supply elective surgery and post-surgical care in a non-hospital setting. From a focus on premium patient experience, to recognition as the Joint Commission Gold Seal of Approval since 2005, FSH has earned a reputation for being the best in care.

In 2021, while Fresno Surgical Hospital was at all-time highs with patient satisfaction, behind the scenes, FSH was struggling to manage IT. An aging infrastructure meant that FSH was operating in an unreliable environment, with chronic network and system outages, open attack vectors, and limited support options. FSH required a more robust support matrix to reduce exposure to downtime, security threats and degraded patient care.

Following a critical network outage, ProMedical IT held an emergency consultation with FSH leadership and coordinated overnight fixes, while allowing time to implement more permanent improvements. First, by completing a full-scale network & systems overhaul to ensure operable systems supported by the latest security fabrics. Then, by implementing a support matrix for FSH to offload end user requests and service to ProMedical IT. And finally, by crafting and enacting a long-term strategy for FSH’s technological infrastructure to enable stability in the continuum of care.

Since 2021, with the help of ProMedical IT, FSH has:

  • Reduced technical debt
  • Increased both patient and staff satisfaction
  • Increased network reliability and availability to 99.999%
  • Increased system reliability and availability to 99.999%
  • Enhanced security for all network enabled devices

The implementation of ProMedical IT’s solutions for FSH took place in four steps:

  1. Overnight Hotfix
  2. Analysis and Roadmaps
  3. Network, Systems and Compliance Overhaul
  4. External Support Implementation


When Fresno Surgical Hospital first reached out to ProMedical IT, a crippling network outage occurred after-hours, and FSH did not have internal knowledge equity to bring them back online. With no options, FSH’s management company, Tenant-United Surgical Partners International (USPI), recommended calling ProMedical IT.

Service Note: ProMedical IT provides 24x7x365 service availability.

Unbeknownst to FSH, there was something seriously wrong in their networking setup: A main networking switch had been unintentionally looped. This was causing a severe degradation to the performance of both that switch and of the entire network. It eventually created such a strain on the equipment that a failure occurred after hours. When ProMedical IT was looped in to assist FSH it was already 9PM local time for the members of our team who would then go on to work through the night to locate and commit a hot-fix before FSH was to begin seeing scheduled patients the next day.

Our Chief Solutions Architect and a high-ranking Service Delivery Engineer went to work as soon as they were made aware of the issue and ran tests across the entire network’s infrastructure to pinpoint the cause of the outage. Once the switches were identified as having abnormal power consumption, ProMedical IT began testing each switch and each port within until the offending port was identified. That switch was temporarily taken offline to ensure the stability of the hot-fix and was later correctly set up and brought online as part of a larger scale networking and compliance overhaul.

Before a professional relationship was ever formally created, ProMedical IT worked through the night to ensure FSH was online and able to serve patients, because we are dedicated foremost to the patients. We take great pride in the part we play in facilitating the care they receive from their providers.

Finding: FSH reduced its network downtime by 91% following ProMedical IT’s remediation.

Service Note: ProMedical IT prides itself on providing white-glove service to its clients, and overnight emergency response is an example of these standards.


Following initial analysis of FSH’s IT environment for the purposes of instituting a stop gap solution, FSH required a comprehensive gap analysis and audit.

Finding: ProMedical ‘s audit revealed out of date PC’s and operating systems, lack of enterprise grade security fabrics, external access vulnerabilities, non-redundant infrastructure and a desperate BCDR topology. The situation required swift and immediate action.

ProMedical IT evaluated the findings with FSH’s leadership. Together, ProMedical IT and FSH created a roadmap to stabilize operations as quickly as possible, while considering FSH’s capital expenditures. First remediating essential items, like security and infrastructure stability. Then, spreading other critical initiatives over multiple fiscal periods.

Service Note: ProMedical IT acts as a Virtual CIO/CTO, to supply leadership and insight for reliable IT operations and sustained future growth beyond IT Service Management (ITSM) basics.

Network, Systems and Compliance Overhaul:

After thorough collaboration with FSH and ProMedical IT, the decision to upgrade hardware, security and compliance was made. In larger organizations such as FSH, ProMedical IT employs a phased approach to infrastructure remediation.

Finding: FSH’s systems were outdated. Core networking infrastructure, edge systems, and end user devices were reaching or already reached the end of serviceable life.

FSH’s networking equipment was reaching the end of life and support, meaning the devices would no longer receive software or security updates from the manufacturer. By updating the environment to a more stable, secure, and integrated network fabric from Cisco Meraki, FSH could guarantee the premium level of care its patients have come to expect. Additionally, ProMedical IT revamped all MDF and IDF rooms to provide improved physical access to wiring and equipment during troubleshooting periods. Once ProMedical IT stabilized network connectivity, it focused next on security and software compliance.

Compliance plays a key role for any technology enabled healthcare organization and non-compliance results in drastic security and operational gaps. ProMedical IT removed technical compliance from FSH’s internal workload and focused its initial efforts on Patch Management.

Many compliance issues had to be ironed out before FSH’s situation could truly be considered stable. There were critical infrastructure components on every floor of the hospital that needed to be rectified immediately. Like the improper network configuration explored in the Overnight Hotfix section, inactive service contracts against in-use hardware, and hardware with out-of-date security patches and policy setups. These deficiencies created both lapses in productivity and significant security vulnerabilities.

With the most vital components stabilized and a stable baseline established, ProMedical IT jumped into the rest of FSH’s compliance gaps. Replacing end-of-life equipment throughout the hospital, consolidating and further securing FSH’s MS Exchange, reactivating warranties on certain devices, and configuring a bespoke data permission for the file sharing infrastructure.

FSH was finally able to operate without interruptions and new threats daily. Focus could shift from outages and issues, back to its mission “[of providing] high quality of care through compassion to all [they] serve…”

Service Note: ProMedical IT handles IT Compliance concerns giving providers and executives the confidence and freedom to perform their daily operations without uncertainty.

“ProMedical IT is as concerned with patient care as the providers we serve. We know that what we do helps patients seek critical care, and nothing is more important.

Daniel Livschutz, CEO of ProMedical IT


While 100% uptime may be unrealistic, PMIT takes pride in exceeding customer expectations, from single-office facilities to the most sophisticated hospital environments in the U.S., North America, and overseas.

Finding: FSH has enjoyed a 94% boost to network stability since joining the ProMedical IT family. Our service delivery team solved 88% of issues remotely, 72% in under an hour, and performed on-site maintenance as required.

ProMedical IT stipulates explicit maximum response times to tickets of varying severities in each SLA, taking the guesswork out of IT support and ensuring that supported offices can focus on their core business.

Service Note: ProMedical IT’s resources span North America, Canada, and the U.K. and can provide immediate in-person support. ProMedical IT classifies support engineers, ensuring each service delivery ticket is assigned to a subject matter expert — whether an EMR is malfunctioning, a printer is offline, or Microsoft Windows simply requires an update.


FSH chose to take a difficult path and implement extensive technological overhaul following years of neglect and mounting technical debt. ProMedical IT has supported the facility in partnership with its internal IT group and because of this collaboration, Fresno Surgical Hospital continues providing exceptional and reliable service to its patients.

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Milestone Projects Completed by ProMedical IT

Phase 1 – IT Audit and Roadmap Creation
IT Managed Services
MDF Access RACK Overhaul (Main Building)
MDF Core Network Overhaul
Server Rack Overhaul (Replace Switches & External Firewall)
Wi-fi Network Overhaul
Exchange Consolidation Project
Business Continuity Disaster Recovery Plan Refresh
IDF Refresh 1-8 (Main Building & External IT Closet Refresh)
FSH – Catalyst to Meraki Switch Replacement
Fresno Mnet Citrix Custom Remote Access Setup
Server Replacement (Labor)
Updating Server Security Patches & Applying Correct Access Policies
VOIP Vendor Assessment