Defeating the Health IT Hurdles in Rural Healthcare


The good news for the 67 million Americans in rural communities is that nearly all rural and small hospitals have adopted electronic health record (EHR) systems. This move has helped enable about half of these providers to have information from outside sources available at the point of care. However, rural healthcare still lags larger and more urban providers where more than 70 percent have these same, or better, options. As health IT continues to play an ever-increasing role in all healthcare delivery and patient outcomes, rural healthcare providers face three primary IT hurdles: Lack of broadband access, telehealth availability and overall system cost constraints.

Rural Health organizations can benefit from data archiving

The state of rural healthcare

In the U.S., 97 percent of the country’s land mass is rural, with about 20 percent of the population living in the small, frontier towns. Conversely, urban areas make up only 3 percent of the entire land area but are home to more than 80 percent of the population.

In 2023, a report that surveyed more than 100 rural healthcare organizations across 25 states found that there is a cautious optimism among many. While financial pressures continue to drive decisions and there is pressure to cope with regulatory challenges, 23 percent report their level of financial stability is much higher compared to five years ago.

That said, many surveyed also report there is a long road ahead.

With financial pressures at the forefront, 69% stated they are most interested in considering the Rural Emergency Hospital (REH) Model. The REH designation is given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS) and is in response to the loss of essential healthcare services in rural areas due to hospital closures. There are 140 rural hospital closures reported between Jan 2010 – Sept. 2022, with an additional 453 that are financially vulnerable.

Rural Emergency Hospital (REH) designation provides new options to struggling hospitals. The Department of Health and Human Services (HHS) has grants to provide direct health services and expand infrastructure, another $16 million to provide technical assistance to rural hospitals facing financial distress and $161 million in awards for Emergency Rural Health Care grants.

What does this say about the state of rural healthcare that makes up 35% of the nation’s hospitals?

Perhaps it is that rural healthcare is not out of the woods.

 How does health IT impact rural healthcare delivery?

As of 2021, more than 6 in 10 hospitals nationwide engaged in key aspects of interoperability (send, receive, query) and integrating summary of care records into electronic health record (EHR) systems. For rural and small hospitals progress has been made, with 48% having bedside information available as of 2021. On a positive note, usage of information received electronically from outside sources by rural and small hospitals increased twice the rate of hospitals nationally (over 40% vs. over 20%). Yet, these less resourced hospitals are still not on par with their counterparts, indicating the need to continue addressing challenges in having full access to electronic information from external sources.

For all healthcare providers a key goal is to improve in the four domains of interoperability: send, receive, query, and integrate. For rural healthcare, these goals can seem mountainous.

What are the steps forward for rural healthcare to improve their health IT posture?

Overcoming the three information technology hurdles for rural hospitals

  1. Broadband access. There is a digital divide in the United States with about 24 percent of Americans in rural areas that lack high-speed internet service. This includes 8.5 million unserved and 3.6 million underserved according to the Federal Communications Commission data.Moving forward. There are some grant and funding programs from the FCC, USDA and Universal Service Administration Company (USAC) rural healthcare facilities may be able to use to expand broadband access in their areas.
  2. Telehealth availability. Lack of access to healthcare is a serious disparity for people who live and work in rural and frontier areas. Rural residents are more likely to die from chronic conditions (heart disease, cancer, chronic respiratory disease, and stroke) due to lack of available/ongoing care. Further, the lack of technological infrastructure has also limited the rollout of telehealth services to rural populations. Without this service model, rural patients have less access to virtual consultations, remote monitoring and other digital solutions that support improved healthcare delivery.Moving forward. The Rural Telehealth Toolkit includes seven modules to support organizations in implementing telehealth programs. There is a large focus on telehealth visits within rural healthcare. Of those surveyed in the report listed above, 77 percent say they’ve developed/implemented some form of telehealth offering.
  3. Cost constraints. While not limited to rural healthcare, there are numerous cost pressures that weigh heavily on rural health providers. This impacts their ability to make IT investments. As such, rural health providers may not have the resources to upgrade the EHR on their own.Moving forward. Some rural and smaller health providers are taking advantage of the programs offered by industry leaders Oracle and Epic. Oracle Health CommunityWorks and Epic’s Community Connect allows rural healthcare providers to continue to provide local care with state-of-the-art technology. The cloud-based EHR systems enable clinicians to share and access an integrated digital record across the care continuum. The smaller partner can access the EHR but isn’t burdened by the cost of a complete installation and all the associated costs for the overall system.

There is an effort at the federal level to support healthcare improvements for rural Americans. The Department of Health and Human Services (HHS) has extended several grant opportunities to support rural communities, including $28 million to provide direct health services and expand infrastructure, $16 million to provide technical assistance to rural hospitals facing financial distress, and $161 million in awards for Emergency Rural Health Care grants – to help maintain access to health care services within rural communities. Further efforts include the Rural Development Broadband ReConnect Program that includes $274 million to expand access to high-speed internet for more than 300,000 people living in eight states, primarily in the southwest U.S.

As the landscape for rural health care delivery continues to be rocky and filled with uncertainty, the focus on improving broadband access and interoperability is critical for the one in five Americans who call rural communities their home.

Case Study: Technology is key for rural healthcare success at Singing River Health System in Mississippi

Our team at Harmony Healthcare IT supports our rural healthcare clients with a range of cost-saving, interoperability-focused health IT solutions. We are proud of the work we’ve done with Singing River Health System, which spans the Mississippi Gulf Coast. Together, we consolidated, stored, and protected health information and business records to reduce paper records by 90 percent and achieve more than $2 million in savings.

See our blog for the complete story.

We can help your rural hospital or acute center create a systemized plan to ensure the long-term access, secure storage, and interoperability of your clinical, financial, and business records. Our Midwest team has the core values and the depth of experience to serve rural health providers with a commitment of the highest customer service and innovative solutions that will strengthen care delivery.

Please reach out to schedule a call.

Nov 16 2023

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