Critical Access Hospitals Report Challenges, Yet Forge Ahead with Advanced Health IT Capabilities

Critical Access Hospitals (CAHs), some with a census of fewer than 10 patients, are the smallest of the small rural hospitals. In some regions, such as frontier areas, a CAH may be the only local health care provider serving an area the width of the state of Rhode Island! CAHs are small, geographically isolated and have limited resources.

CAHs are found in every region of the country, and represent roughly 30 percent of hospitals nationwide. Often serving as the focal point for all health care services in a rural area, CAHs often own and run the local rural health clinics and skilled nursing facilities. They may also be responsible for public health and emergency medical system services. These hospitals extend services to places where they wouldn’t otherwise be available. And those are the reasons why it is important for CAHs to have access to health IT systems and capabilities.

In an article in the July issue of Health Affairs, we report on the progress and challenges CAHs are seeing as they adopt electronic health record (EHR) technology and advanced health IT capabilities.  This study builds on a Data Brief posted in September, 2013 that provided a first look at the adoption of health IT and EHRs by CAHS.

  • As of 2013, 89 percent of CAHs had an EHR in place; 62 percent of CAHs with an EHR had a fully electronic health record system, and 27 percent had a health record system that was part electronic and part paper.
  • Most CAHs adopted (as of 2013) or planned to adopt (by the end of 2014) the health IT capabilities evaluated in this study (i.e., telehealth, teleradiology, care coordination and health information exchange with other providers and patients).
  • As of 2013, CAHs reported the highest rates of adoption for teleradiology (70 percent) and telehealth (59 percent) capabilities. Fewer CAHs reported other capabilities related to electronic exchange of key clinical information with other providers. Even fewer (15 percent) of CAHs reported patient engagement capabilities (i.e., offer patients ability to view, download and transmit their health information).
  • Among the challenges to health IT adoption among CAHs, financing and workforce related challenges were most commonly reported.
  • CAHs that pooled resources with other hospitals were more likely to have EHR and capabilities related to health information exchange and care coordination, compared to those that did not pool resources or engage in group purchasing.
  • CAHs with faster internet upload speeds were more likely to have the capability to provide patients with the option to view, download, and transmit their health information compared to those with slower upload speeds.

ONC and its partners are helping

ONC and other federal agencies are partnering with others non-governmental organizations to help CAHs identify and apply to financial assistance programs. We are also helping them determine their eligibility for these programs. As of September 30, 2013, ONC and USDA piloted a public-private collaborative funding initiative that successfully generated over $32 Million in funding to critical access and rural hospitals across four states. To date, along with other partners, including  local philanthropies, the Appalachian Regional Commission, the Delta Regional Authority, Health IT Regional Extension Centers, State Offices of Rural Health, Telehealth Resource Centers, ONC and USDA have launched similar initiatives in eleven states: Iowa, Kansas, Texas, Illinois, Mississippi, Georgia, Michigan, Minnesota, Tennessee, Montana and Missouri.


  1. Gina M. Wilson says:

    Independent HIT consultants can empower CAHs to utilize technology to strengthen their organization mission by bringing a breadth of experience, knowledge and talent to these organizations. Please feel free to contact me if you would like to discuss the opportunity for engagement.

    Gina M. Wilson

  2. Dave Newman says:


    I’m so glad to have found your posts on rural health. This is really a fascinating concept to see Healthcare IT making a difference in these locations. I think that HIEs will play a big part.

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