Denis Tanguay, chief information officer for Central Maine Healthcare, says his workload has "probably quadrupled," in the past few years.

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The rigors of getting ready for Stage 2 meaningful use attestation, along with the tall order of transitioning to ICD-10, have him and his 70-person IT staff "buckling under the pressure," says Tanguay. "We're working very hard."

In the years since HITECH, the to-do list has grown considerably. "We went from planning upgrades that probably happened once or twice a year, to several times a year, with a lot of rigorous testing involved in between," he says.

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On top of all that, Central Maine's "challenges are a little bit out of the norm," says Tanguay of the system, which comprises three hospitals, two long-term care facilities and 85 physician practices.

"We are not only upgrading all of our systems for meaningful use and ICD-10, but we decided to consolidate and change some product lines at the same time," he says. "We moved from some McKesson products on the financial side to Lawson; we moved from McKesson billing to Cerner billing, and then we moved a non-Cerner module to Cerner, as part of our consolidation efforts to move more toward a single vendor platform."

The combination of regulatory requirements and infrastructure upgrades – to say nothing of foot-dragging vendors – mean Tanguay and his team are "sweating it out," he says. "We're scrambling on both fronts. I'd love to hear that ICD-10 is going to be delayed a little bit because Stage 2 is a handful."

In short, anything that could take some work off their plates is much welcomed.

For the past several years, Tanguay has worked with Troy, Mich.-based CareTech Solutions, which offers IT outsourcing services for smaller, rural and community based providers like those that make up Central Maine Healthcare.

"CareTech helps us with not having to worry about the big iron stuff: our Cerner system, the Centricity and the Lawson," says Tanguay. "CareTech has full-time folks that are paying attention to that. I don't have to worry about the Oracle guy on my staff or a midrange systems guy on my staff. Those are higher-cost resources."

By offering skills like those to its customers, CareTech saves the expense of having to employ folks whose skill sets don't necessarily match the needs of a smaller facility.

"When you hire a midrange guy or an Oracle guy, they're (often) sitting idle," says Tanguay. "Managing one or two of those systems is not a full-time job."

More critically, it "allows me to focus," he says. "My CEO has a line: 'We're not in the IT business; we're in the healthcare business.' This allows me to focus more on making sure that we're focused on the hospital."

Tanguay says the flexibility and scalability afforded by this set up has been a boon, enabling easier software upgrades, quicker response time and greater system stability. Data security and disaster recovery procedures are other benefits.

"We use CareTech essentially as an insurance policy," says Tanguay. "They have already blazed those trails and made sure that whatever we're going to be using has already been tested, what versions of firmware and software work well."

Central Maine Healthcare makes use of the service in several ways, from "field engineers that help us deal with some of the user calls that are coming in to new service requests: PCs, keyboards, software installations. They help us with that but they also have folks back in the shared data center that manage our big-iron equipment," he says.

"We have a lot of systems, don't get me wrong: We still have 400 servers in our location; we have our PACS and several other systems that exist locally," says Tanguay. "But CareTech's outsourcing "allows us to focus on those little systems, keep those running and focus on your core business: providing healthcare."

And, of course, meeting meaningful use requirements and prepping for ICD-10.

So far, MU readiness is "going pretty well," says Tanguay, who, when we spoke back in February, was just getting ready to upgrade the Cerner system for Stage 2. There's been foot-dragging on the part of other vendors, however: "GE Centricity is lagging, they haven't released their version yet that's Stage 2 ready, so we're sweating it out a bit."

"We're planning on attesting in July," he says. "Most of our vendors have released updates for Stage 2 and ICD-10. One vendor has not and that's got us a little worried right now. It could hold up our attestation and cost us some dollars. That's worrisome."

In the meantime, "having good projects managers is key," says Tanguay. "My CEO asked me the other day which of my directors was my first lieutenant. It's the project managers. They're the ones making sure that I'm getting the projects done. I've got a full-time person focused on making sure that everything it happening."

Compliance with the rules of Stages 1 and 2 is challenging enough, he says. Then there are surprise "intermediary rules," like the 2015 edition EHR certification criteria proposed by ONC in February. "It's challenging; just when you think you know what the goal is, they move it a little bit."

It's not easy, but it's necessary work.

"I think the pace is a little challenging, we're trying to get all of this done at once," says Tanguay, "but I think it's stuff that needs to happen. This is good for us."