Rural Hospitals Could Benefit From IT Outsourcing
Main Category: IT / Internet / E-mailAlso Included In: Public Health; Medical Devices / Diagnostics
Article Date: 24 Oct 2008 - 8:00 PDT
Patients expect the most up-to-date equipment and technology at hospitals, regardless of the institution's size or budget. Providing that technology, however, can be difficult for small, rural hospitals that often lack the budget and staffing to make it possible.
A case study conducted by researchers in Penn State's College of Information Sciences and Technology (IST) shows that smaller hospitals may be able to benefit by sharing an IT infrastructure with larger hospitals in the same geographic area.
Madhu Reddy, assistant professor of IST, Sandeep Purao, associate professor of IST, and Mary Kelly, a graduate student, conducted interviews with administrators at a regional hospital and three small, rural hospitals in central Pennsylvania. The three smaller hospitals relied on the regional hospital to manage such things as software, laboratory information and technical support.
The researchers found that the smaller hospitals saw financial savings from the partnership and also benefitted from the shared IT staff and its experience. The group reported their results of the study in a recent issue of the Journal of the American Medical Informatics Association.
"The most prominent financial benefit for the rural hospitals was the ability to afford a comprehensive IT infrastructure at a relatively low price," Reddy said. "For instance, the rural hospitals only pay a percentage of the hardware dedicated to their needs … if the regional hospital buys a new hard drive, the rural hospitals will only be charged for the percentage of the hard drive they use."
The regional hospital did not profit from sharing its services, but the smaller hospitals did take on costs involved with the partnership and helped pay for the additional staffing required to make the relationship possible.
One of the challenges to this outsourcing system, the researchers found, was a perception among the small hospitals that their customer service requests were sometimes not a high priority for the regional hospital's IT staff.
"They believed a traditional vendor would want to meet their needs in order to retain their business, but that was not always the case in the partnership," Reddy said. "However, as the partnership evolved over time, they were able to overcome this challenge."
Reddy said he hopes to continue this research by organizing a larger case study examining rural/regional hospital IT relationships throughout Pennsylvania to determine whether this type of relationship can have long-term benefits for rural hospitals across the state and the country.
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Source: A'ndrea Elyse Messer
Penn State
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Rural Hospital / Regional Hospital Shared Services - Other Concerns
posted by Spencer Hamons on 2 Jan 2012 at 3:24 pmAfter reading your article about the potential benefits for rural hospitals partnering with larger, regional hospitals, I thought it prudent to add a couple of additional thoughts to your article.
I agree that there are significant benefits from the arrangement that you describe, but don't forget to consider the risks for pursuing such an arrangement. First is leadership. Both the rural hospital's administrative team and the regional facilities senior technology (and potentially others on the senior leadership team) need to evaluate readiness for engaging in such a venture. Many hospitals, regardless of size, view technology strictly as a cost-center, a "break-fix" group responsible for processing some data at midnight and replacing a computer at a nursing station. On the other end of the spectrum (and my personal preference) is the Technology group that serves as a catalyst for organizational change, and the servers, software, and applications that support that change are tools. In the case of potential partnering, but group's need to step back and realistically consider what camp each facility is currently engaged in, and whether this viewpoint is congruent. A lack of congruence on this one issue can create problems in the relationship, especially with the rural hospital expects innovation, but the larger regional facility is overly concerned about cost control. One example of many that I can share involves a small facility engaging with a larger regional facility, and the larger facility being extremely conscious of costs. When the small facility added 10 additional personnel, the regional facility avoided buying extra terminal server and Citrix licenses, thinking that their current agreements were sufficient. When the new staff started, personnel at both facilities started receiving license errors and were unable to even log into the system. Seems like a simple solution to a simple problem...but in reality, the problem should have never occurred.
Another risk, especially when working with rural facilities is connectivity. Rural areas often have poorer communications infrastructures, with many rural areas not even having tier I telecommunications providers serving the area. Remote hosting solutions, such as the ones described in your article, rely on 100% uptime links between the two facilities. While this can be done just about anywhere, in rural areas, multiple links still often go through the same central office (CO), often on the same utility poles. One accident that affects that physical connectivity will bring down both links, effectively severing the facility from the host. Of course, this can be mitigated with planning, but some systems require expensive hardware and/or licensing to take advantage of fault-tolerance features. Telephone (whether PBX or VoIP) are a good example of systems vulnerable to communication loss, and can be expensive to make fault-tolerant.
Finally (I will get off my soap box now), is cost. In a situation described like the one in your article, cost benefits can be found. However, as with any business decision, hidden costs can kill you. One cost often underestimated is the cost of connectivity. Rural rates for telecommunications links are often higher than urban telecommunications rates, some times 10 - 15 times higher. There are programs available to subsidize these high-cost links, but obtaining the required quotes and adherence to the mandated processes is required to receive these subsidies (if this is of interest to you, I did a podcast recently about the Universal Service Funds USAC program for healthcare...you can find that podcast at itpodcast.org/blog/2011/07/29/usac-funding-for-rural-healthcare-telecommunications/ ).
Thanks for the article. I am a big fan of using "shared-services" to provide advanced health IT capabilities to rural facilities. I just want to caution, as with any business decision, that there are risks that must be considered in addition to the potential benefits. Remember, these are people that we are dealing with...people we are trying to care for, people who are providing the care, and people that are making the decisions. Too often, those of us leading technology initiatives forget that.
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