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Rural Implementation Steps

Step 1: Assess Your Organization Readiness

The assessment phase is foundational to all other electronic health record (EHR) implementation steps, and involves determining if your organization is ready to make the change from paper records to EHRs, or to upgrade your current system to a new certified version.

Benefits of EHRs

The benefits of electronic health records are well documented, and critical access hospitals and small rural hospitals are well positioned to benefit from the use of EHRs. Health IT will transform how rural health care organizations collect, manage, store, use, and share health information. Health IT also helps rural health care organizations access and coordinate care, improve disease surveillance, target health education, and compile regional data – all activities aimed at improving health care quality and patient outcomes. An EHR also creates a mechanism for completing specialty referrals, which is valuable in rural communities where access to specialists is often limited.

Additionally, by using EHR technology, critical access hospitals (CAHs) and rural hospitals can access to up-to-date lab results, new medication information, and medication interaction and allergy safeguards that would not be readily available otherwise. Because many rural areas typically have a lower per capita income, additional EHR efficiencies may help to control rural health care costs to help offset lower than average reimbursement levels. Many of these EHR mechanisms and enhancements can be used to improve rural health care gaps and challenges.

Assess Your Current Organization

Your readiness assessment should provide a good understanding of the current state of your organization and help identify key goals for improvement.  Consider the following components as parts of your readiness assessment:

  • Assess your organizational leadership for:
    • Readiness and aptitude
    • Willingness to undertake the project
    • Understanding of the impact of the project
    • Commitment to the human capital investment and deep clinical involvement
  • Review your organization’s external technical environment
  • Assess organizational financial readiness and investment needs
  • Inventory your current IT environment before you determine what new items need to be added to support your EHR or Health IT implementation
  • Identify Strengths, Weaknesses, Opportunities and Threats (SWOT)

Assess Staff Readiness

EHR implementation should move at an appropriate pace for your staff. You should assess the necessary competencies and resources that are in place before proceeding with EHR implementation.

  • Inventory the IT staff to plan for what type of staff and skills you need to support your EHR implementation.
  • Understand the attitudes and readiness of your clinical and administrative staff.


The following resources are examples of tools that are used in the field today, and are recommended by subject matter experts for the use by others who have made the commitment to implement or upgrade to certified EHR systems.

Namesort ascending Details
Strengths, Weaknesses, Opportunities and Threats: Sample SWOT Analysis View
Rural Health Resource Center's HIT Network Case Studies View
Lessons Learned from Electronic Health Record Implementation at Three North Dakota Critical Access Hospitals View
Critical Access Hospital Goal Setting View

The material in these guides and tools represents the collective EHR implementation experiences and knowledge gained directly from the field of ONC’s outreach programs (REC, Beacon, State HIE) and through the Health Information Technology Research Center (HITRC) Communities of Practice (CoPs) in their performance of technical support and EHR implementation assistance to primary care providers. The information contained in these resources is not intended to serve as legal advice nor should it substitute for legal counsel. The resource list is not exhaustive, and readers are encouraged to seek additional detailed technical guidance to supplement the information contained herein.

Reference in this web site to any specific resources, tools, products, process, service, manufacturer, or company does not constitute its endorsement or recommendation by the U.S. Government or the U.S. Department of Health and Human Services.

Additional Resources

Creative Solutions to Expand Iowa’s Rural Health IT Funding

Read about how the ONC and USDA brought together key stakeholders in Iowa to discuss and overcome the challenges of implementing EHR systems, which include leveraging partnerships to expand rural health IT funding.

HealthIT is an Opportunity for Job Creation in Rural Communities

A survey of CAHs and small, rural hospitals in Mississippi reveals challenges in achieving meaningful use. Learn about how challenges present new career development opportunities for rural Health IT stakeholders.

Stratis Health Toolkit

Stratis Health has developed a health IT tool kit that provides resources and guidance to Critical Access and Small Hospitals. The following tools have been identified to help you with this step of EHR implementation:

See Step 2 >