As healthcare organizations navigate rapid technological change, rural hospitals continue to face unique challenges that often go overlooked, Nitin Agarwal, CIO of Wayne Memorial Hospital in Honesdale, Pa., told Becker’s.
“Rural organizations are doing a heck of a lot more with a heck of a lot less,” he said. “We work on a shoestring budget, yet many times are serving some of the biggest populations.”
Mr. Agarwal, who joined the 90-bed acute care hospital in 2025 after working primarily with midsized and large health systems, said the transition has given him a new perspective on the disparities between rural and larger healthcare organizations.
“It’s a David-and-Goliath situation,” he said.
Large health systems often have greater influence with technology vendors and more resources to invest in innovation, while rural organizations must work harder to secure the same level of support, according to Mr. Agarwal.
“Rural hospitals are often told to accept what’s offered to them, whether that’s a contract, pricing structure or level of support,” he said. “But that’s not acceptable. Rural organizations deserve to feel valued as customers and partners.”
He emphasized that many rural hospitals serve patients who travel long distances for care and rely on their local hospital as a primary healthcare access point. That reality makes technology investment decisions particularly important. Mr. Agarwal said his team prioritizes initiatives based on their ability to solve meaningful problems for patients and staff while maximizing limited resources.
“Projects that solve genuine problems rise to the top,” Mr. Agarwal said.
One of the hospital’s biggest technology initiatives is implementing a new PACS, RIS and cardiology platform. With PACS and RIS being the first phase.
Previously, Wayne Memorial Hospital had several disparate systems operating independently, requiring providers and staff to move between multiple applications to access information. The hospital recently partnered with a vendor to implement an integrated solution that brings those systems together on a single platform.
“It will provide our clinical teams with much better visibility into patient information and streamline workflows,” Mr. Agarwal said. “That’s something I’m very excited about.”
While rural hospitals face unique challenges, Mr. Agarwal said healthcare organizations across the country often share many of the same struggles — and could benefit from working together more closely.
“Healthcare organizations number among the thousands and thousands throughout this country, and we’re all fighting these battles independently,” he said. “I think we need to remember that as a community, we have a lot more power than us as individuals.”
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