Information Technology in the Rural Setting: Challenges and More Challenges

In this issue, Ohsfeldt and colleagues1 estimate the financial cost that would be incurred by all hospitals in Iowa if they implemented computerized physician order entry (CPOE). Small hospitals (defined as fewer than 200 beds) account for 70% of nonfederal, general, short-term hospitals.2 The estimates of Ohsfeldt et al. add to a growing literature describing the financial and administrative burdens incurred when modernizing the information technology infrastructure of the small hospital.3,4 For many of these institutions, lower revenues, higher costs, and poor access to capital combine to make the necessary investment in information systems unrealistic.The work of Ohsfeldt et al. focuses on the financial burden of implementing CPOE but not the value proposition that motivates the leadership of a hospital to proceed with an implementation. Early adopters of this technology, including community hospitals5 and many other hospitals now poised to make the investment,6 seem convinced that delivering safe and effective care requires information technology to assist clinicians to “do the right thing all of the time.” Nonetheless, even when investments are viewed as important, affordability is a significant barrier, given the many competing demands for capital.Of …