Health information technology (HIT) is an important tool to improve the quality, safety, effectiveness, and
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
Telemonitoring applications that allow patients to transmit vitals or diagnostic
information to providers remotely
Confidential and secure patient health portals for patients to access their personal health
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
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 a Health IT
Playbook that acts as a guidebook for healthcare professionals on using HIT. It includes a section
on Rural Health Resources that
provides 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.
The 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.
The Agency for Healthcare Research and Quality (AHRQ) maintains an online Tools and Resources section, as
part of their Digital Healthcare Research section, that provides resources for planning, implementing, and
The 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 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.
A 2018 article, Health Information Technology Continues to
Show Positive Effect on Medical Outcomes: Systematic Review, found over 80% of the reviewed literature
shows positive effects of HIT on the efficiency and effectiveness of medical outcomes.
HIT allows patients the opportunity to engage in the provision of their healthcare by tracking health
conditions, accessing provider visit notes, and test results. However, broadband access for rural residents can
be a barrier to engaging with their health records. The Federal Communication Commission’s (FCC) 2020
Broadband Deployment Report notes that in 2018, approximately 22.3% of rural residents and 27.7% of
Americans in tribal areas did not have access to fixed broadband services that met the FCC’s minimum speed
benchmark. 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.
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 electronic health record (EHR) data to address population health issues.
Kentucky's White House Clinics, for example, used their EHR to identify an increase in cancer screening rates
after the implementation of a new intervention program.
Quality data tracked and reported with HIT is an important component of value-based payment models such as
Accountable Care Organizations (ACOs), Medicare Shared Savings, and the Quality Payment Program (QPP) as well as
state Medicaid programs. 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
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. Section 1 of the ONC Health IT
Playbook includes information and resources and highlights EHR adoption and implementation steps:
- Selecting a vendor
- Contracting with a vendor
- Implementing and adopting an EHR
- Using your EHR
- Optimizing or replacing your EHR
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.
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
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, health administration, and public
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,
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 expenses 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 sponsoring 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 firstname.lastname@example.org
to request a list of funding opportunities specific to your project and location.
To what extent have rural hospitals adopted EHR systems?
Although nearly all rural hospitals have adopted EHR systems, according to the ONC's Health Information
Technology Data Brief 42, Variation in
Interoperability among U.S. Non-federal Acute Care Hospitals in 2017, only 27% of rural hospitals and
CAHs were able to participate in all four domains of EHR interoperability—sending, receiving, finding, and
integrating summary of care records—compared to 41% of all hospitals nationwide. In 2018, the national
average rose to 48%. Additionally, the percentage of rural hospitals that indicated they lacked the
technical ability to exchange patient health information to outside providers or organizations, experienced a
cumbersome workflow to send EHR information, or had challenges exchanging information across different EHR
platforms, was significantly higher than the national average.
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, a self-assessment tool for healthcare leaders
interested in forming a HIT network.
The Rural Health Information Technology Network Development (RHITND) Program, a three
year pilot program funded by the Federal Office of Rural Health Policy from 2011 to 2013, helped to develop
rural health networks
that support the adoption of EHRs and HIT. Recipients of RHITND Program grants included the Health Care
Coalition of Rural Missouri, which established electronic medical and prescription records, telemedicine
capabilities, and HIT training for providers in rural West Central Missouri. The RHITND
Sourcebook provides an overview of every RHITND Program grantee.
Rural Health Innovation's 2018 Network
Spotlight: Northeast Kentucky Regional Health Information Organization 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?
HIE as sharing electronic health information that “allows health care professionals and patients
appropriately access and securely share a patient's medical information electronically.” ONC describes 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.
In July 2019, the Centers for Medicare and Medicaid Services (CMS) announced Data
Point of Care, a pilot API (application programming interface) program designed to provide physicians
with historic claims data to fill in gaps in patient histories. Data Point of Care expands MyHealthEData,
government-wide initiative announced in 2018. MyHealthEData is a digital patient health information platform
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 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 achieved in
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, EHR, or media, such as a USB memory stick. Information
initially communicated through mail or fax can be shared via a HIE or EHR as a PDF or in a structured data file
through Direct Secure Messaging.
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
(virtual private network)
point-to-point connection. With advances in broadband connectivity in rural areas, images or test results can be
sent much faster, which 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:
A 2017 Rural Monitor article, Cybersecurity: How a
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'
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,
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 fewer 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,
Secure Electronic Messaging to Support Patient and Family Engagement, lists many benefits secure
electronic messaging can have for both patients and providers.
Two final rules were issued in 2020 to improve interoperability and provide patient access to their personal
health data. The ONC Cures
Act final rule implements the interoperability provisions of the 21st Century Cures
Act to promote transparency in healthcare and patient control over their own health information. The Interoperability
and Patient Access final rule establishes policies to allow patients to better access their health
information and increase the exchange of healthcare data between providers, patients, and payers.
However, it is important for rural providers to be aware of challenges their patients might encounter in
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
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 a 2019 Congressional Research
Services report, 73.6% of Americans living in 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. Government Accountability
Office (GAO) reports published in 2018, Broadband Internet:
FCC's Data Overstate Access on Tribal Lands, Tribal
Broadband: FCC Should Undertake Efforts to Better Promote Tribal Access to Spectrum, and Tribal Broadband: FCC Should Undertake Efforts to Better
Promote Tribal Access to Spectrum, share 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
use 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
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
- Telecommunications Program offers healthcare providers a discount on
telecommunication expenses based on the urban and rural price differences in your area.
The USDA also provides information and resources on
investments in rural broadband and e-connectivity, and offers many funding opportunities to expand
telecommunication and broadband services, including:
Rural eConnectivity Broadband Loan and Grant Program (ReConnect) offers loans,
grants, and loan/grant combinations to support broadband expansion in areas without sufficient access to
Rural Broadband Access Loan and Loan Guarantee Program furnishes loans and loan
guarantees for the costs of construction, improvement, or acquisition of facilities and equipment needed to
provide broadband services.
Community Connect Broadband Grant Program provides funding to support the
development of broadband services in rural communities.
Telecommunications Infrastructure Loans and Loan Guarantees provides financing
for the construction, maintenance, improvement, and expansion of telephone and broadband services in rural
Distance Learning and Telemedicine Program Grants provide funding to promote
and improve telemedicine and distance learning services in rural areas using telecommunications, computer
networks, and related advanced technologies. Grant funds can be used to purchase equipment and capital
assets, including broadband transmission facilities.
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