HIT Outsourcing in Rural Hospitals

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Rural hospitals often struggle to stay financially viable while attempting to meet the standard of care set forth by their much larger counterparts. Health IT (HIT) is often seen as an elegant solution to both of these problems, as it is viewed as a money-saving endeavor while keeping healthcare quality at a maximum. However, rural hospitals struggle to implement HIT due to lack of resources, both financial and personnel. A study published by Johnson, et. al [1] details a survey regarding attitudes on HIT outsourcing at these rural hospitals as a solution to these barriers of HIT implementation. This survey is based off a paper by Reddy, et. al [2] proposing a model of hospital-to-hospital partnerships where rural hospitals partner with a larger hospital for HIT resources.

Previous Studies

The survey done by Johnson, et. al [1] was based on a prior study done by Reddy, et. al [2] where a single example of a hospital-to-hospital HIT partnership was studied in detail.

In 2008 Reddy, et. al [2] published a study of 3 rural hospitals, from 9 to 83 beds, all of whom outsourced their HIT needs through the same larger regional hospital with 411 beds. The regional hospital provided hardware, software, customer support and housed the data center.

  • Benefits of the arrangement:
    • Financial Savings
    • Shared IT Staff
  • Challenges:
    • Customer Service
    • Interdependence

The rural hospitals listed the benefits of significant financial savings and having access to hardware and software that would otherwise be generally out of their price range. As well the rural hospitals noted access to IT staff that would also be unsustainable in their smaller environments. Contrarily, the rural hospitals felt that one challenge with this model was the customer service relationship, where the rural hospitals were both customers and partners, and did not always get the service they felt was appropriate to their role. Also, with housing the data and hardware at the regional hospitals, the rural hospitals became dependent on the regional hospital in ways that were both expected and unexpected. Over time, this interdependence grows as the systems become more enmeshed and would be more and more difficult to separate.

This study coined the term hospital-to-hospital HIT partnership (HHP).


Johnson, et. al in 2012 [1] distributed a written survey to rural hospitals. In this study, a rural hospital was defined as any non-metropolitan hospital. 61 rural hospitals responded.


  • Current Barriers to HIT Adoption
    • 72% believed there is lack of acceptance from end-users
    • 68% believed there was not well-trained IT staff
    • 62% cited privacy concerns
    • 62% were concerned about loss of productivity during the transition
    • 60% were concerned about data security
    • 60% believed it was difficult to qualify for financial IT benefits
    • 53% cited concerns for lack of interoperability
    • 27% cited difficulty finding the right software for their needs
    • 15% cited lack of management support
  • Hospital Types
    • 72% Standalone
    • 23% Part of a multi-hospital system
    • 5% Some other formal relationship with other hospitals
  • Current Viewpoints on HIT
    • 98% believed it could increase compliance with regulatory/accrediting bodies
    • 93% believed it could decrease medical errors
    • 76% believed it could improve patient satisfaction
    • 68% believed it could increase productivity
    • 60% believed it could increase patient care revenue
    • 22% believed it could reduce hospital staff

Currently, 37% of rural hospitals surveyed were outsourcing for HIT needs whereas 63% were not. Those who were comfortable outsourcing HIT needs preferred to outsource data infrastructure, telemedicine, EMRs and electronic record applications. They were also comfortable housing their data offsite.

Despite hypothetical concerns, hospital administrators were not seen by rural hospitals as a resistance point to HIT adoption. On the other hand, funding of HIT adoption is a significant concern for rural hospitals which run on much smaller budgets than their larger counterparts. It was found that the HITECH Act (ARRA), although a source of funding through the meaningful use dollars, may not be enough on it's own. For rural hospitals the cost of HIT is prohibitive both to initiate implementation and to sustain over the long term with HITECH funding solely.

In conclusion, "HHPs were an appealing solution to those willing to outsource" [1]


  1. 1.0 1.1 1.2 1.3 Johnson N, Murphy A, McNeese N, Reddy M, Purao S. "A Survey of Rural Hospitals' Perspectives on Health Information Technology Outsourcing" AMIA Annual Symposium Proceedings/AMIA Symposium. 2013:732-41, 2013
  2. 2.0 2.1 2.2 Reddy M, Purao S, Kelly M. "Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships" JAMIA. 2008;15:554-558.

Submitted by Sarah Laiosa, DO