Once a new information system is installed though, finding someone to maintain it can become especially problematic. Recruiting and retaining talented IT staff is difficult for all hospitals, and harder still for lower-paying small hospitals outside of metropolitan areas.

Outsourcing can help, to some extent. “But beware: There are vendors who say they’ll be there shoulder to shoulder with you to service that information system, but once you’ve installed that, their accessibility becomes very difficult,” says the AHA’s Supplitt. “ 'Doing your homework’ doesn’t even begin to convey the degree to which small and rural hospitals have to research these vendors and these systems.”

In-house IT staffers in rural settings need to be extra sharp because they may be called on to fill three or four different roles or to maintain all the hospital’s systems, whereas their metropolitan peers may be able to narrow their focus. Signing bonuses and human resources consultants might help recruiting efforts, but they’re expensive.

Savvy hospitals can make their rural setting a selling point by emphasizing the quality of life and advantages for raising a family. But there are risks to the strategy. “You have to be really careful when you’re recruiting someone from the outside,” says Brewer of Colleton Medical Center, who notes that her facility is within an hour of Charleston, S.C., and not too far from some other vibrant metro areas. “If you recruit someone from those areas, odds are that they’ll leave you sooner rather than later because they get a better offer from closer to home.”

Some rural hospitals prefer to look for IT workers locally and help develop them into the job. “I hired a couple of local individuals who were very advanced out of high school in computer technology,” says Mullins of Boone Memorial. “If they’re from your back yard in the first place, they’ll be more likely to stay with you.”

New hires aren’t the only option. “We identified two people who had an interest in computers, and we supported them to go back to school,” Brewer says. “When you’re a small hospital, you have to take a different approach—you find people who are interested in certain things, then invest in them and ‘grow your own.’”

The consortium or system approach adds another clear advantage to members, besides simple cost savings: It lessens the need to recruit as many IT staffers because several functions can be centralized.

“We’ve taken on the role of ‘super-user’ for our hospitals, and we do lots of the work that, at a larger facility, would be done by your own staff,” says Kenneth Abendshien, director of information systems at the Midwest Health Systems Data Center. Abendshien notes that 16 of his 26 facilities don’t even have a network administrator on staff, and that one of his employees travels from hospital to hospital to do troubleshooting, maintenance and upgrades.

Serb, Chris. “Small and Rural IT Challenges.” Hospitals & Health Networks. August, 2006.  16 Jan. 2007
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