A Rural Healthcare CIO's Approach to AI, Infrastructure, and Leadership at Nathan Littauer

James Wellman, VP and CIO at Nathan Littauer Hospital and Nursing Home in Gloversville, New York, joined Phil Sobol on The CereCore Podcast to share how his organization is approaching technology modernization in a rural healthcare setting. With more than three decades of healthcare IT experience across academic medical centers, regional health systems, and community hospitals, Wellman brings a practical, operations-focused perspective to the challenges rural organizations face every day. 

The conversation covers Nathan Littauer's four-pillar AI strategy, cloud infrastructure modernization, what it means to function as an operational CIO, and how Wellman thinks about building and developing teams for the long term. 

Read on for highlights from the conversation, and stream the full episode for more »

  • 48 min

Leading IT in Rural Health: Lessons from Nathan Littauer CIO James Wellman

The CereCore Podcast

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Define the problem before pursuing AI

Nathan Littauer had attempted an AI initiative before Wellman arrived in 2023. When he asked what organizational problem it was designed to solve, there was no clear answer. That experience shaped the team's approach going forward. 

Wellman deliberately held off on new AI initiatives until 2026, using that time to build the infrastructure and operational foundation needed to support them. When the organization was ready, they launched what he calls a four-pillar approach, each pillar tied to a specific need at Nathan Littauer. 

The first pillar is an agentic AI agent handling inbound calls, scheduling, and patient information. Previously, each clinic operated its own call process without a centralized structure. The AI solution is now deployed with a goal of handling the majority of call volume by end of year. 

The second is ambient documentation, rolling out across the ED, hospitalist team, and ambulatory settings using two separate platforms suited to the workflow differences in each care environment. 

The third is search and summarization to support chart preparation. As a rural facility, Nathan Littauer regularly receives patients returning from larger health systems after oncology or cardiology treatment, often with extensive outside records. "Before I arrived here, they were just directly scanning all those into our EHR, which is never a good idea," said James. 

The fourth pillar is an AI-powered revenue cycle management partnership currently in final stages, designed to track patients from registration through final payment. 

Across all four, Wellman is clear that the goal is not to reduce headcount; "We approached AI as a tool set. It's not a replacement. We're not getting rid of people. We're augmenting the people that we have."

Infrastructure investment as a strategic priority 

Alongside AI, Wellman has prioritized moving Nathan Littauer's infrastructure toward a cloud-based model. His team is currently transitioning MEDITECH hosting to Google Cloud Platform, part of a longer effort to shift IT spending from unpredictable capital outlays to consistent operational costs. 

Wellman's cloud-first thinking developed earlier in his career while leading IT in Southwest Oklahoma, where the risk of severe weather made redundant physical data centers impractical. He found that restoring communications was far more manageable than rebuilding physical infrastructure, and cloud hosting offered a level of resilience that local data centers could not. 

In a rural hospital where capital dollars compete against clinical equipment investments, he sees predictable IT costs as a leadership responsibility. "I like to call myself an operational CIO, because I want to know what IT costs. What's it cost to fund me? I don't want to be the black hole," said James. 

He also emphasized that infrastructure investment goes beyond servers and networks. Nathan Littauer is actively working on surgical robotics as a workforce solution, recognizing that recruiting surgeons to a rural setting is increasingly dependent on having the technology that supports modern surgical practice. 

James told listeners, "If you don't invest in it, just like if you don't invest in your physical infrastructure, and your buildings, and your generators, and your power, you'll cease to exist."

The operational CIO and understanding the business of healthcare 

Wellman's perspective on the CIO role is shaped by experience across very different types of organizations. His consistent view is that effective healthcare IT leadership requires understanding the operations of the organization, not just the technology. 

James emphasized, "You must understand the business of healthcare as a CIO. I felt so much more invested when I took the time to learn the operations, and see how we made a difference." 

He puts that into practice by keeping his team present and visible throughout the hospital. Technicians attend early morning surgery starts, walk the floors, and check in regularly with clinical and administrative departments. His view is that IT staff are often the most visible face of the IT organization to frontline employees, and that visibility matters. "Our techs are the face of our organization, and in many organizations, depending on how you answer the help desk, they're the voice."

How CereCore supported Nathan Littauer's modernization work 

 After spending his first hundred days at Nathan Littauer listening and observing, Wellman engaged CereCore to conduct an assessment of the organization's current technology environment. The goal was to get an honest, outside view of where gaps existed and where opportunities for improvement had been missed. 

That engagement marked the beginning of an ongoing partnership as Nathan Littauer continues its technology modernization work. For Wellman, the value of an external partner in a rural setting comes down to the ability to identify what an internal team, no matter how capable, may not be able to see on its own.

Developing people for the long term 

Wellman devoted a significant portion of the conversation to leadership development and what it means to build a team that can grow beyond its current roles. He is an active mentor in the TechLX program, one of the leading IT leadership development programs in the country, and he carries that same commitment into his own organization. 

He was candid about his own development as a leader, describing a 360 review early in his career that made clear his management approach was not working. Rather than minimize the feedback, he used it as a turning point. 

"Their perception was my reality, and that was hindering me as a person and in my career. I looked at myself and said, I don't like myself as a manager. I'm not very good. And that was a really hard, hard thing to do," said James.  

That experience informs how he now supports others. His standing practice with his own team is to actively encourage career growth.

More resources:

• Follow and subscribe to The CereCore Podcast.
• Need an outsider’s perspective on big technology decisions? Start with a healthcare IT assessment.
• Learn more about CereCore’s MEDITECH services.