Getty Images

Top rural health IT challenges for healthcare organizations

With constrained budgets, hospitals are tackling rural health IT hurdles through cloud-based EHRs, workforce training, grants and free cybersecurity resources.

Rural healthcare providers have long faced challenges surrounding their geographical isolation and limited financial resources. However, the digital health transformation has ushered in a new set of rural health IT challenges.

While federal legislation successfully promoted EHR adoption across rural and urban organizations alike, having an EHR system in place is just one aspect of an organization's health IT strategy.

Rural healthcare organizations face a host of health IT barriers, including infrastructure limitations, interoperability challenges, limited resources, workforce shortages and data security concerns.

Limited access to broadband

Broadband is imperative for the use of health IT. However, a stark disparity in broadband access exists between rural and urban regions.

According to a report by the Federal Communications Commission (FCC), about 96% of the United States population had access to broadband at the FCC's established minimum speed benchmark in 2019, compared to 73.6% of rural Americans.

A lack of broadband infrastructure in rural regions impacts rural organizations' ability to use a variety of IT features that can improve care delivery, like electronic health information exchange (HIE) and virtual care.

While HIE and virtual care benefit all healthcare organizations, rural facilities disproportionately rely on them to fill in gaps unique to their organizations.

For example, HIE is important for sharing data across smaller ambulatory organizations and bigger academic medical centers, and telehealth helps rural clinicians consult with specialists at more urban health centers.

Additionally, telehealth has emerged as a tool to meet patients where they are, which can be particularly helpful in rural areas where patients must travel long distances for care. However, without broadband access, these services are infeasible.

While disparities in broadband persist, the rural-urban divide has grown smaller in recent years. Since 2016, the number of people living in rural areas without access to 25/3 Mbps service has fallen by more than 46%, according to FCC data published in 2021.

Several programs aim to expand broadband access in rural areas, including the FCC's Rural Health Care Program, administered by the Universal Service Administrative Company (USAC). The USDA also provides resources and funding to develop telecommunication and broadband services in rural regions.

Interoperability barriers

Rates of HIE across the country are on the rise. However, rural healthcare organizations lag urban providers in interoperability capabilities, according to a 2023 GAO report.

Analysis of 2021 American Hospital Association survey data revealed that rural hospitals were less likely to participate in national HIE networks and regional HIEs than medium/large hospitals.

According to interviews with healthcare stakeholders, rural providers were less likely to have the economic and technological resources to participate in electronic HIE networks, leaving them to rely on manual data exchange, such as fax or mail.

The GAO report also found that rural healthcare providers were less likely to participate in EHR vendor networks for data exchange.

That tracks, as a qualitative study published in 2020 found that rural organizations often do not share systems from the same vendors as other settings in their area, complicating health data exchange.

Federal efforts like TEFCA could help address interoperability barriers via a network of networks approach that allows organizations to participate in various HIEs through a single connection.

However, participation in the network is voluntary and does not address barriers like IT staffing shortages and gaps in broadband access that limit interoperability for rural providers, the GAO report emphasized.

Financial constraints

Rural hospitals often operate with thin profit margins due to lower patient volumes and higher rates of uninsured or underinsured patients. Declining reimbursements from Medicare and Medicaid have further strained rural hospitals' finances.

According to KFF, median operating margins were 1.5% among rural hospitals, compared to 5.2% among other hospitals in 2019.

With razor-thin margins, rural healthcare organizations often do not have the budgets for advanced health IT adoption, as well as the training and maintenance these systems require.

Many small rural hospitals are turning to cloud-based EHR platforms as a more affordable health IT option.

Cloud-based EHR systems eliminate significant upfront hardware and infrastructure investments. Instead, healthcare organizations pay a monthly subscription fee, which reduces initial costs. Some cloud-based EHR systems allow organizations to pay a subscription fee as low as $100 per month.

Workforce challenges

The country is struggling with shortages of healthcare staff across all regions, and the deficiency is not limited to clinicians; health IT specialists are also lacking. An uneven distribution of workers means that shortages are often more common in rural areas, according to the Rural Health Information Hub.

A shortage of skilled IT staff can hinder the adoption and effective use of health IT in rural regions. On its website, ONC provides several strategies to help overcome health IT workforce shortages in rural settings, including cross-training multiple staff members in health IT.

"When several staff members can perform multiple health IT functions, staff turnover will have fewer negative effects on your organization's health IT capabilities," the website pointed out.

Providing opportunities for additional health IT training can also help rural organizations address workforce shortages, ONC suggests. For instance, healthcare organizations can offer tuition reimbursement or other incentives to clinical staff who show an interest in IT to obtain additional skills.

Certain healthcare networks are using grants to address the health IT worker shortage. For example, OCHIN, a nonprofit research and innovation network, received a $15 million grant from the California Department of Health Care Access for a workforce development program.

Through the four-year grant, OCHIN will train 275 learners in one of three key health IT fields: medical billing and coding, health information management and EHR analysis. The program is virtual, which aims to meet learners where they are, whether rural or urban.

However, limited broadband access can prevent individuals living in rural regions from participating in virtual programs, underscoring the need for broadband expansion.

Data security concerns

Healthcare data breaches are on the rise, with a 256% increase in large healthcare data breaches reported to the Office for Civil Rights (OCR) over the past five years.

Due to constrained budgets, rural healthcare organizations often lack the resources and staff to implement robust data security measures, leaving them susceptible to cyber threats and data breaches.

When a healthcare organization faces a cyberattack, they often divert patients to other medical facilities. However, in rural communities, where patients must travel an average of 10.5 miles to the nearest hospital, trekking to the next-closest facility can be a care access barrier.

Luckily, there has been increased government focus on the challenges of rural healthcare cybersecurity.

In May 2023, lawmakers introduced the Rural Hospital Cybersecurity Enhancement Act. The legislation would require the Cybersecurity and Infrastructure Security Agency (CISA) director to create a "comprehensive rural hospital cybersecurity workforce development strategy."

Additionally, the act would require the CISA director to develop educational materials to assist rural hospitals in training staff on important cybersecurity measures.

In the meantime, rural healthcare organizations can reference free resources like the Health Industry Cybersecurity Practices (HICP) publication to inform their cybersecurity strategies. The HICP includes a volume specifically for small organizations, covering implementation guidance for cybersecurity tools, including vulnerability management and email protection systems.

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.

Dig Deeper on Health IT infrastructure

Cloud Computing
Mobile Computing