Some modest first steps have been taken to assist providers and communities in investing in ICT. In fiscal year 2001, more than $30 million in federal grants was available to support Indian Health Service and Alaskan health care infrastructure initiatives, including telehealth technologies (IHS, 2000). In fiscal year 2004, Congress appropriated $50 million to help small and rural hospitals invest in ICT (AHRQ, 2003a). In fiscal year 2005, an additional $50 million will be made available to communities to plan and implement local/regional health information infrastructures (AHRQ, 2004b).

Although it is too early to assess the full impact of this and the other developments described above, building the NHII has clearly become an important national priority. Below the committee identifies actions that should be taken to ensure that rural areas have an opportunity to both contribute to and benefit fully from the NHII.


Building the NHII over the coming decade presents both opportunities and challenges for rural communities. As discussed above, all communities stand to derive sizable benefits from the NHII, and these benefits may be even more substantial in rural communities, where the NHII has the potential to greatly enhance residents’ access to providers and services. At the same time, however, rural communities are at risk of being left behind. Some are poorly prepared to participate in the information age, having little or no access to the Internet and populations with minimal ICT experience. Given their limited financial resources (see Chapter 5) and the small scale of rural provider organizations (see Appendix C), most rural health care systems will need financial and technical assistance to establish EHRs and secure platforms for data exchange.

Although there are challenges to be overcome, rural communities also have unique strengths to build upon and may represent excellent sites for community-based ICT demonstrations involving public- and private-sector partnerships. Rural health care systems are less complex than those in urban areas, and the scarcity of resources in rural settings provides strong incentives for collaboration among all stakeholders. Moreover, rural hospitals and nursing homes are far less likely than their urban counterparts to have made major investments in information systems in the past, so they do not confront the challenge of converting from these legacy systems to the NHII.

In this section, the committee lays out a strategy and recommendations

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