Inside a Critical Access Hospital's IT Decision-Making Process

Kelley, however, acknowledges a major downside to remote hosting: The risk of a catastrophe that would lead to an interruption in the fiber optic communication lines.

"The way the system is set up, the working data is stored locally and is swapped back and forth with Nashville," he says. "We would be able to operate fairly seamlessly for a few days…if there was a prolonged disaster that disrupted those communication lines, that could be a problem."

Users wouldn't be able to access data that's been archived away from their local systems. But Kelley doesn't seem too worried about that.

"Nothing works in a vacuum…it's very few systems that are completely independent of everybody else," he says. "There's nothing you can do that can fully insulate yourself from an event like that."

Kelley expects to get 70% of the money back when Ellenville attests to stage one meaningful use, which it hopes to do by October, a plan he acknowledges is "aggressive." But when efficiency is the mantra, what else can you expect?