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Health Information Technology in Rural Healthcare

Health information technology (HIT) has the ability to improve the quality, safety, effectiveness, and delivery of healthcare services in rural communities. HIT can connect rural patients and providers in remote locations to specialists in urban areas. Implementing, maintaining, updating, and optimizing HIT can be an ongoing challenge for rural facilities and providers with limited resources and expertise.

HIT uses technology to store, secure, retrieve, and transfer protected health information electronically within healthcare systems and community settings. Key components of HIT can include:

  • Electronic health records (EHR) for patients, instead of paper records
  • Secure digital networks to send and deliver up-to-date records whenever and wherever the patient or clinician may need them
  • Electronic transmittal of medical test results
  • Telehealth applications to increase access to providers
  • Confidential and secure patient health portals for patients to access their personal health information online
  • Electronic communication between healthcare providers, as well as patients
  • Electronic prescribing and ordering to help avoid medical errors
  • Decision support systems to provide clinicians with information on best practices and treatment options to improve quality of care
  • Mobile devices and tablets to update patient records in real time and document at the point of care

Frequently Asked Questions

Are there HIT resources specific to rural facilities?

Yes, there are many rural specific HIT resources available, including:

  • The Office of the National Coordinator for Health Information Technology (ONC), within the U.S. Department of Health and Human Services, provides HIT Rural Health Resources that include information on the benefits of HIT in rural areas, barriers to HIT adoption and implementation resources, and tools and resources for Critical Access Hospitals (CAHs) and other rural hospitals. ONC also updates and maintains a Health IT Playbook that acts as a guidebook for healthcare professionals on using HIT and it includes a section on HIT in rural settings.
  • National Rural Health Resource Center (NRHRC) provides an online HIT section of their Resource Library that lists upcoming events and a searchable list of HIT resources.
  • Agency for Healthcare Research and Quality (AHRQ) maintains an online Tools and Resources section, as part of their Health IT Portfolio, that provides resources for planning, implementing, and evaluating HIT.
  • National Rural Health Association (NRHA) maintains a listing of HIT resources that provide information and connections for HIT implementation, use, and support for rural areas.

The Federal Office of Rural Health Policy's Rural HIT Workforce Program grantees developed rural HIT workforce curriculum resources. These courses can be used by rural-serving community, vocational, and technical colleges in preparation for HIT certifications and to provide guidance for instructors. Educators are welcome to adapt and build on these training materials. The grantees' training programs were designed so that others can adapt and build on these training materials to fit their program's needs.

For more rural project examples that have demonstrated success, see RHIhub's Models and Innovations under the topic of HIT.

How can HIT improve healthcare delivery and the quality of care in rural facilities?

HIT works to ensure efficient, coordinated, and secure healthcare information exchange for patients who receive healthcare services from multiple providers or in multiple locations.

The 2011 Health Affairs article, The Benefits of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results, completes a meta-analysis of HIT literature and found 92% of recent HIT articles found HIT was associated with improvement in one or more aspects of healthcare. A 2018 article, Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review, found a strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes.

HIT helps ensure healthcare professionals have the most up-to-date health information for their patients. HIT allows patients the opportunity to engage in the provision of their healthcare by tracking health conditions, accessing provider visit notes, and test results. The 2018 Journal of Rural Health article, Differences in Access to and Use of Electronic Personal Health Information Between Rural and Urban Residents in the United States, reported rural residents had less regular access to the internet and were less likely to manage personal health information online or email healthcare providers.

RHIhub's Rural Healthcare Quality topic guide discusses quality and quality measures for rural healthcare facilities and provides additional resources and funding opportunities to address rural healthcare quality.

What are considerations for rural facilities when implementing and upgrading EHR systems, including working with vendors?

The Health Information Technology Toolkit for Critical Access and Small Hospitals stresses the importance of strategic planning and defining a vision:

Your hospital needs to develop a plan that describes its long range goals for acquiring and achieving effective use of HIT. Without a guiding roadmap, you are in a reactive position, responding to what a vendor offers or what appears to be a regulatory requirement. Getting true value from HIT comes from setting your own course, communicating expectations, engaging all stakeholders, and celebrating success.

Considerable planning is necessary to ensure a good fit and optimal use of an EHR system. There are many considerations for rural facilities when selecting and implementing EHRs. The ONC Health IT Playbook Section 1 includes information and resources and highlights EHR adoption and implementation steps:

  • Planning
  • Selecting a vendor
  • Contracting with a vendor
  • Implementing and adopting an EHR
  • Using your EHR
  • Optimizing or replacing your EHR

ONC describes barriers rural hospitals experience related to EHR implementation that are unique to providing healthcare in a rural setting paired with related rural-specific HIT resources.

The Rural Monitor article, Making the EHR Work: Rural Healthcare Organizations Use Data Extraction to Improve Patient Care, discusses how rural organizations are using their EHR data to address population health issues.

What is the relationship between HIT and telehealth?

HIT and telehealth are related and complementary activities. Both use technology to improve efficiency and the delivery of healthcare services in a healthcare system in different ways. ONC defines HIT as a broad term encompassing a compilation of technologies and programs to analyze, house, and share health information. Examples of HIT include electronic health records (EHRs), personal health records (PHRs), e-prescribing, online communities, and online patient and provider communications. The Health Resources and Services Administration (HRSA) Office of the Advancement of Telehealth (OAT) defines telehealth as:

using electronic information and telecommunications technologies to support and promote long-distance clinical healthcare, patient and professional health-related education, public health, and health administration.

 For more information on telehealth, review RHIhub's Telehealth Use in Rural Healthcare topic guide.

What are some HIT funding opportunities for rural providers?

Funding specifically aimed to assist with HIT is limited, but many grant and loan programs focus on issues and initiatives that interplay with HIT, such as healthcare quality, access to healthcare, healthcare workforce, improving efficiency, broadband access, capacity building, and network development. Some funding opportunities may be able to pay for HIT as part of a bigger initiative.

Several federal organizations and agencies offer grant opportunities that support HIT:

The U.S. Department of Agriculture (USDA) has loan and grant programs that will fund HIT initiatives, including:

Other funding opportunities supporting rural providers and HIT exist. For example, the Universal Service Administration Company (USAC) Healthcare Connect Fund provides assistance to healthcare providers for eligible expense related to broadband connectivity at a flat discounted rate of 65%. For more information on broadband funding opportunities, see We have limited broadband in our area, what are our options? If you have questions about whether or not a funding opportunity supports HIT, you can contact the agency or organization responsible for listing the funding opportunity or program and ask if the opportunity supports HIT initiatives and expenditures. Some funding opportunities and programs may support HIT efforts with spending restrictions, such as what can and cannot be purchased or what the overall percentage of the budget or allotment can be used for HIT expenditures.

RHIhub maintains a list of federal, state, and foundation funding opportunities for HIT in rural healthcare. You can contact us at 800.270.1898 or to request a list of funding opportunities specific to your project and location.

To what extent have rural hospitals adopted EHR systems?

According to ONC's Health IT Quick-Stat #45 analyzing 2016 data, Hospitals Participating in the CMS EHR Incentive Programs, 98% of Critical Access and small rural hospitals have demonstrated meaningful use of certified health IT.

Percent of Critical Access and Small Rural Hospitals that have Demonstrated Meaningful Use of Certified Health IT | 2016
Source: Hospitals Participating in the CMS EHR Incentive Programs, Health IT Quick-Stat #45, August 2017

What are some HIT workforce issues in rural facilities?

A 2015 article, Health Information Technology Workforce Needs of Rural Primary Care Practices, surveyed rural primary care practices from 13 states to assess their EHR and HIT workforce resource needs. The survey identified the top five major workforce-related barriers to EHR/HIT use as:

  • The prohibitive cost of consultants and vendors who understand the HIT needs of rural facilities
  • Limited resources available for EHR and HIT training (this includes funds and time set aside for training)
  • Difficulty finding and connecting with qualified candidates
  • Trouble retaining qualified staff with EHR and HIT skills and knowledge due to a competitive market
  • HIT career steps are not clear cut, which reduces interest in EHR and HIT training and education

As with any leadership role, succession planning for HIT leaders is an important exercise. Consideration should be given to how HIT activities would continue if HIT staff leave due to retirement or other reasons. Facilities might consider training and career ladder programs to prepare the next wave of HIT leaders or look to outsource some of their HIT management in the event they lose their internal capacity.

The HIT workforce is limited in rural areas and there has been a lack of adequate HIT workforce development in rural communities. A 2015 WWAMI Rural Health Research Center policy brief, Access to Health Information Technology Training Programs at the Community College Level, identified two barriers for recruiting rural students to community college HIT training programs:

  • HIT job opportunities are limited in rural areas
  • Potential rural students find it difficult to relocate or commute to on-campus programs

Rural Health Information Technology Workforce Curriculum Resources provides planning and educational programs to train rural HIT workers, including an inventory of curriculum resources that includes detailed course descriptions and training materials.

How have rural HIT networks contributed to their members' success in implementing HIT?

Networking can help rural hospitals and healthcare facilities manage HIT implementation. Rural HIT networks can provide many benefits, such as shared HIT staff, volume purchasing for software and training, health information exchanges (HIEs), and data analytics services. NRHRC provides a Health Information Technology Network Readiness Assessment and source book for the Rural Health Information Technology Network Development (RHITND) Program, a three year pilot program funded by the Federal Office of Rural Health Policy to develop rural health networks that support the adoption of EHRs and HIT.

Rural Health Innovation's 2016 Network Spotlight: Prairie Health Information Technology Network describes a rural HIT network, highlighting how it supports its members and overcomes challenges in a rural area.

What is HIE and how does it work? defines HIE as sharing electronic health information that allows health care professionals and patients to appropriately access and securely share a patient's medical information electronically. ONC defined three forms of HIE:

  • Directed exchanges utilize secure messaging to send and receive information between known parties, usually healthcare providers or healthcare facilities
  • Query-based exchanges initiated by a question or request of personal health information uses a data repository or record locater to find patient EHRs
  • Consumer-mediated exchanges stem from a patient engaging in the delivery of their healthcare services by communicating pertinent health information

HIE allows providers to discuss, plan, share, and coordinate patient health information and care between multiple healthcare facilities. ONC identifies multiple HIE benefits for both patients and providers. The National Rural Health Resource Center's (NRHRC) HIE Toolkit provides information and resources on guidelines and requirements for HIEs.

MyHealthEData, a government-wide initiative announced in March of 2018, is a digital patient health information platform to allow patients access to their full healthcare records and the ability to control and make decisions on how their healthcare data is used. The MyHealthEData initiative is being led by the White House Office of American Innovation in coordination with multiple divisions of the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare & Medicaid Services (CMS), ONC, National Institutes of Health (NIH), and the U.S. Department of Veterans Affairs (VA).

How do rural providers exchange information with other providers?

The electronic exchange of protected health information between providers is being achieved in a number of ways. Traditionally, information that was carried or couriered in a paper or film format can now be sent to another provider in a digital format via HIE or media, such as a USB memory stick. Information that was mailed or faxed can be sent via Direct Secure Messaging and attached as either a PDF or in a structured data file. Just like in the paper-based process, all parties involved in the exchange of protected health information need to agree on the method and format of the data being sent and received.

Some rural hospitals contract out specialty services or other healthcare services not available at their facility. In these instances, imaging or other patient health information is exchanged electronically via a VPN point-to-point connection. With advances in broadband connectivity in rural areas, images or test results can be sent much faster that results in a faster turnaround time, ultimately improving patient care and safety.

How do we ensure the security and privacy of our electronic information?

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created regulations to provide a minimum standard for compliance with privacy and security of health information. One of the requirements of the HIPAA Security Rule is to perform an annual risk assessment. This risk assessment should look at all of the administrative, physical, and technological risks your organization faces. It recommends a third-party be involved in the risk assessment to act as another set of eyes to identify any risks. Many agencies and organizations provide information and resources for providers, hospitals, and others to provide guidance on conducting security and privacy assessments:

Cybersecurity: How a Rural Alaska Hospital is Safeguarding Its Patients' Information identifies security and privacy concerns in rural communities and describes how healthcare providers in rural Alaska are protecting their patients' information.

How can providers engage patients in electronic health information?

HIT has significant potential to help patients engage more fully in their own healthcare. A 2019 ONC data brief, Electronic Capabilities for Patient Engagement Among U.S. Non-Federal Acute Care Hospitals: 2013-2017, found 60% of CAHs, 70% of small non-CAH hospitals with less than 100 beds, and 73% of rural non-federal acute care hospitals provide their patients the ability to electronically view, download, and transmit their health information. Patient engagement can happen at every interaction, both inside and outside the point of care. Online patient portals can be used to schedule appointments, review test results and immunization schedules, and request prescription refills. The factsheet, Using Secure Electronic Messaging to Support Patient and Family Engagement, lists many benefits secure electronic messaging can have for both patients and providers.

It is important for rural providers to be aware of challenges their patients might encounter in accessing their information. The NORC briefing paper, Understanding the Impact of Health IT in Underserved Communities and Those with Health Disparities, identifies challenges for underserved populations that are due to community and population-related factors, including:

  • Limited health and technological literacy
  • Language and cultural factors
  • Comfort level in interacting with the healthcare system
  • Access to technology and the internet

ONC's Patient Engagement Playbook is a resource for providers, hospital and practice staff, and others to learn successful strategies and best practices to increase patient engagement.

Why is broadband important for HIT? How can we tell if broadband is available in our community?

A January 2019 Congressional Research Service report, Broadband Internet Access and the Digital Divide: Federal Assistance Programs, defines broadband as high speed internet access, cable, fiber, satellite, mobile and fixed wireless, and other advanced telecommunication connections and services that give users the ability to exchange data at adequate volumes and speeds to support their information technology applications in a variety of fields, including distance education, public safety healthcare, and more.

The Federal Communications Commission (FCC) set a benchmark for a fixed service provider providing advanced telecommunications capability as a download speed of 25 Mbps and an upload speed of 3 Mbps. According to the 2019 Congressional Research Services report, 75.7% of American living rural areas had access to fixed broadband services meeting the FCC minimum speed benchmark of 25 Mbps/3 Mbps in 2017. Broadband is integral in connecting rural healthcare providers using HIT applications to healthcare professionals, patients, and healthcare facilities.

Information on broadband availability in tribal areas is less certain. Recent 2018 Government Accountability Office (GAO) reports, Broadband Internet: FCC’s Data Overstate Access on Tribal Lands and Tribal Broadband: FCC Should Undertake Efforts to Better Promote Tribal Access to Spectrum, shared new insights regarding the actual availability of broadband access in tribal areas.

The FCC map, Residential Fixed Internet Access Service Connections per 1000 Households by Census Tract, shows the number of residential internet service connections per 1,000 households. To determine the availability of fixed 25Mbps/3Mbps broadband deployment and broadband speed in your community, as well as other locations across the country, you can search by city and state, zip code, or a street address in the Residential Fixed 25 Mbps/3 Mbps Broadband Deployment map and the Residential Fixed Broadband By Speed map. Another broadband mapping tool, the Broadband Search Tool, is available from USDA Rural Development.

We have limited broadband in our area. What are our options?

There are a number of programs healthcare facilities or their local telecommunication provider may be able to take advantage of to expand broadband access in rural areas, including:

  • FCC's Rural Health Care Program, administered by the Universal Service Administrative Company (USAC), provides funding to healthcare providers for telecommunications and broadband services for the provision of healthcare services. The purpose of this program is to improve the quality of healthcare for patients in rural communities. Two separate funding opportunities make up the Rural Health Care Program:
    • Healthcare Connect Fund (HCF) Program provides a 65% discount on eligible expenses related to broadband connectivity to individual and consortium rural healthcare providers.
    • Telecommunications Program offers healthcare providers a discount on telecommunication expenses based on the urban and rural price differences in your area.

USDA Broadband also provides information and resources on investments in rural broadband and e-connectivity. A 2018 USDA document, e-Connectivity @ USDA: Broadband Resources for Rural America, a offers resource matrix highlighting 27 programs to serve as a guide for planning, researching, and implementing e-connectivity activities and projects. USDA offers many funding opportunities to expand telecommunication and broadband services, including:

Other funding programs and grants can be found on RHIhub's list of funding opportunities related to broadband, which includes federal, state, and private foundation funding opportunities.

Last Reviewed: 9/14/2018