Rural healthcare leaders are turning resource limits into a sharper lens for technology investment.
As federal initiatives like the $50 billion Rural Health Transformation Program infuse rural health systems with new capital, the organizations seeing the most impact are not spending the most — they’re spending most intentionally. Innovation is judged less by novelty than by results: whether a tool can extend clinical capacity, improve access and health outcomes, or support financial sustainability.
“There’s a real desire to measure the gain that you’re going to get,” said Kat Smith, executive director of customer success at athenahealth, who specializes in FQHC and community health center technology adoption. “Right now, organizations can’t afford to implement a technology and not have it drive impact.”
This article, the second in a four-part series, “Rural healthcare excellence in 2026: 26 lessons in making less do more,” examines seven ways rural healthcare organizations are approaching innovation under constraint, drawing on executive insights into how priorities are set and tools are evaluated.
1. Go all-in on virtual infrastructure
Telehealth has matured from a pandemic-era stopgap into a core care delivery strategy. In West Virginia, where 50 of 55 counties are federally designated mental health professional shortage areas, Morgantown-based WVU Medicine has made virtual care central to behavioral health, with more than half of adult visits conducted virtually and roughly one-third of pediatric appointments via telehealth — reducing no-shows and improving access.
At UCHealth Yampa Valley Medical Center in Steamboat Springs, Colo., all specialties are capable of providing telehealth, with physicians and other clinicians blending virtual and in-person care based on clinical judgment. UCHealth’s Virtual Health Center adds a “layered” approach: a bedside team backed by remote specialists monitoring patients in real time.
Olivia (Minn.) Hospital & Clinic uses primary care virtualist programs, e-consults and video visits to give rural patients personalized, same-day access to clinicians — bypassing hours of travel for specialty opinions.
“By giving every patient a personalized digital experience, we’re empowering them to take charge of their health, and we’re delivering more proactive, connected and efficient care,” Jen Macik, MSN, RN, chief nursing officer for Olivia, told Becker’s.
2. Harness shared technology infrastructure to expand collective capacity
With 81% of rural providers citing financial limitations as the primary barrier to IT modernization, few organizations can afford to build sophisticated infrastructure independently. Rural Health Transformation funds and collaborative models are filling that gap, as three-quarters of rural hospitals report participating in, evaluating or planning to join a Rural Health Transformation Collaborative — though in ambulatory settings, the picture differs. athenahealth’s research found that 68.6% of rural clinicians are unfamiliar with the RHT Program, suggesting participation remains more aspirational than active, Ms. Smith said.
Among the collaborative models already in motion, Opelousas (La.) General Health System has emerged as a regional anchor, extending its centralized infrastructure — network operations, security, data centers, EHR management — to partner hospitals at comparable cost, with three systems already joined and a fourth in preparation. “The goal was that hospitals could pay roughly what they’re paying today but receive higher-qualified personnel, stronger security and more IT services,” Lance Armentor, Opelousas’ president and CEO, told Becker’s.
Ms. Smith has observed similar patterns. “We are seeing states rely on each other very differently, not just for group purchasing power and shared resourcing, but around what’s working philosophically and structurally,” she said.
That ethos is also built into athenaOne®, which connects health centers to a shared national infrastructure — standardized data inputs, pre-built integrations and HIE connectivity — giving under-resourced organizations access to capabilities they couldn’t build independently. “Your inputs will be the same as every other health center around you,” Ms. Smith said. “When you look at that data, you can really compare apples to apples.”
3. Extend care beyond the care center — and meet patients where they are
Eleven states have outlined plans to address post-acute care coordination as part of the Rural Health Transformation Program, incorporating hospital-at-home models, EMS treat-in-place care and mobile-integrated healthcare teams serving rural communities directly.
Cloud-based technology is enabling these models wherever patients can be reached. Ms. Smith has observed health centers using cloud-based tools to support compliant, community-based outreach — from mobile or pop-up services to partnerships with trusted local organizations like social clubs and libraries — helping teams reach patients who may face transportation, broadband or clinic access barriers.
“Part of it is cloud-based technology giving care teams the flexibility to support appropriate, community-based outreach beyond the four walls of the clinic. But the larger point is meeting patients where access already exists,” she said.
Kristen Toth, vice president of women’s services at Orlando-based AdventHealth for Women — which is employing telemedicine, phone calls, mobile health units and community visits to reach rural patients — echoed this sentiment: “If we truly want to serve rural communities, we can’t expect families to come to us,” she told Becker’s. “So we need to think about mobility — how do we go beyond our brick-and-mortar buildings and bring care to them?”
4. Put AI and automation to work where the need is greatest
AI adoption in rural healthcare remains nascent — just 8% of critical access and rural community hospitals have implemented AI-driven analytics for predictive healthcare — but organizations that have moved deliberately are seeing tangible results.
At Lewistown-based Central Montana Medical Center, a 25-bed critical access hospital, ambient AI scribing reduced after-hours charting demands so significantly that some physicians said they would consider leaving if the tool were taken away. Sioux Falls, S.D.-based Sanford Health raised appointment connect rates from 40% to 56% with an AI-powered outreach tool, while a virtual care program supported by AI infrastructure helped more than 12,000 patients access mental health services for the first time.
Zeshan Anwar, MD, associate chief medical officer at The Guthrie Clinic (Sayre, Pa.), told the “Becker’s Healthcare Podcast” that patient mobility detection is among AI’s strongest rural use cases; his organization is using it to reduce falls and prevent pressure injuries.
“As leaders, we should aggressively pursue federal funding to advance digital and workforce innovation, reinforce financial sustainability and protect access to essential services,” Dr. Anwar said.
5. Build AI governance structures that keep pace with adoption
While 88% of health systems report using AI internally, only 17% have a mature governance structure and a fully formed AI strategy. ECRI flagged the “AI diagnostic dilemma” as 2026’s top patient safety concern, citing risks of diagnostic errors and automation bias when AI operates without proper oversight.
Ms. Smith noted this challenge is especially acute at rural organizations, where IT teams often amount to one person. Successful deployment, she has observed, requires governance frameworks built before implementation — defining appropriate use cases, building in bias checks and establishing expectations for human oversight. Grant timelines and funding pressures can push deployment before those frameworks exist, making the discipline harder but more essential.
“It’s not enough to just say, ‘I’m going to activate this new tool,'” she said. “It’s having structure around how to deploy it, how to get it to patients and how to make sure all staff are using it consistently.”
6. Measure what matters: let financial returns lead your tech strategy
In constrained environments, there is no margin for technology that cannot prove its worth — and rural leaders increasingly demand that proof in financial terms.
At Parkview Health, AI-assisted evaluation and management coding tools helped clinicians accurately capture service complexity, improving reimbursement accuracy. Generative AI applied to discharge summaries and revenue cycle workflows created further efficiencies.
“Finding those key AI functionalities where you can absolutely see a financial ROI is key to getting things started,” Dr. Mabus said. “And then those help pay for some of the other functionalities that may have more of that ‘soft ROI’ based more on efficiency and time savings.”
Parkview has also embedded an AI review into its vendor intake process — requiring teams to document the clinical need and confirm existing vendors don’t already offer comparable capability before any new solution is approved.
James Wellman, vice president and CIO of Nathan Littauer Hospital & Nursing Home in Gloversville, N.Y., is prioritizing revenue cycle management as the highest-return AI use case. “Rural health is under amazing pressures we’ve never seen before,” he told Becker’s. “I really think the appropriate use of AI is something that can make a difference — making sure we’re getting fully reimbursed for the work we’re doing.”
7. Choose partners that bring more than a product
When nearly 90% of rural providers say vendors promote tools as “rural-ready” that appear repackaged from urban designs — and more than half cite procurement complexity as their greatest execution risk — selecting the right partner has become as consequential as selecting the right technology.
Typically understaffed in IT, governance and training, rural organizations are seeking vendors that supplement that deficit rather than simply sell into it. “We are a rural health organization, and the broad, generalized, built-in solutions may not fit our needs,” Mr. Wellman told Becker’s. “Third-party vendors are working for us every day to keep our trust.”
Ms. Smith at athenahealth shares that view. “The entire role of our team is to help make sure organizations are not just implementing technology, but realizing the operational and patient-access outcomes they expected,” she said. “That service layer matters because many rural health centers do not have deep implementation, governance or training infrastructure internally — so the partnership has to bring more than the product.”
Turning constraint into a ‘silent accelerator’
Across the country, rural leaders are demonstrating that constraint has sharpened their capacity for innovation, marked by disciplined governance, selective partnerships and a patient-centered philosophy that treats technology as a means of extending scarce clinical capacity and earning trust.
The most effective technology, in Ms. Smith’s words, functions as a “silent accelerator” — enabling clinical efficiency without creating friction between clinicians and patients.
“The less we ask providers to put technology between themselves and the patient, the more we preserve the trust that keeps patients coming back,” she said.
To access the first article in the series, visit: https://www.beckershospitalreview.com/digital-health/closing-the-access-gap/
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