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

 |  By Alexandra Wilson Pecci  
   January 18, 2012

Steven L. Kelley, president and CEO of Ellenville Regional Hospital in Ellenville, NY, admits that he's a bit "fanatical" when it comes to efficiency. To show just how efficient things are at Ellenville, Kelley offered this little fact: In 2011, the average length of stay in the 25-bed, rural critical access hospital's ED was 93 minutes.

So perhaps it's no surprise that when it came to choosing an EHR vendor, Kelley wanted to find the "best opportunity for getting to meaningful use in the shortest amount of time," he says.

For him, that meant remote hosting.

"I did not want to look at any vendors that did not have a remote hosting model," he tells HealthLeaders Media. That's because Kelley says his business is healthcare, not IT.

"I did not want to be in the computer business," he says, so he quickly nixed the idea of onsite hosting. "I felt it would be much more expensive and the kind of system that we would be able to afford would require a lot more staff."

Indeed, Kelley says he looked around at hospitals in the surrounding communities and saw relatively large IT staffs; at least they were larger than Ellenville's previous IT staff of one (it's now doubled to two).

Plus, he rattles off all of the functions he did not want his staff having to work on: "hardware, operating systems, application software, and all of the responsibilities of the endless updates to the operating system, the application updates, the hardware updates, the backups, the recoveries."

"I wanted to engage some vendor to do all of that for us," he says.

After interviewing several vendors, Ellenville chose the Nashville-based Healthcare Management Systems, which provides cloud-based, hosted and managed IT to hospitals and healthcare systems across the country. Kelley says because hundreds of hospitals are hosted on the same system, the costs are spread out, too, which is important to a small critical access hospital.

"I just think there's huge economy of scale," Kelley says. "It doesn't cost that much more to add another hospital's worth of data. And if they're updating the operating system, they're updating for all the hospitals at once."

Avoiding the upfront costs of onsite implementation also allowed Ellenville Regional Hospital to pay for the solution using existing capital. Kelley says the hospital hasn't borrowed any money for the venture and has been planning for it for a very long time.

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?

Alexandra Wilson Pecci is an editor for HealthLeaders.

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