Building a minimum viable digital foundation for rural health

Why telehealth, interoperability and cybersecurity matter more than shiny tools

In brief

• Rural health transformation efforts will stall if states chase shiny tech instead of building digital basics that actually scale.
• Telehealth, interoperability and cybersecurity are the minimum bar for modernizing rural health infrastructure.
• If technology can’t support outcomes reporting, coordination and accountability, it increases risk instead of accelerating the impact.

Technology is often the most visible — and most misunderstood — aspect of rural health transformation. With significant federal funding now available, states face pressure to invest quickly in digital tools that promise innovation and modernization. As a result, new and established technology vendors are “coming out of the woodwork” with the next greatest “shiny object” solution — unfortunately, most of these solutions are not aligned with the state’s Rural Health Transformation Program (RHTP) initiatives and delivery commitments made in the grant application. 

The real risk is not underinvesting in technology. It is investing in too much, too fast or in the wrong order without a clear line of sight to long-term value, adoption and impact for rural health stakeholders. 

Interoperability turns access into continuity

Expanding access alone is not enough to transform rural health and care. Without data interoperability  and bidirectional data use agreements between health ecosystem stakeholders, virtual and in person care, along with critical safety net programs, services will remain fragmented and inefficient. 

Modernizing the rural health data infrastructure will require a coordinated, cross-stakeholder approach to encourage the adoption of standards-based fast healthcare interoperability resources application programming interfaces (FHIR APIs). FHIR APIs enable a more efficient, secure and seamless exchange of an individual’s health information between electronic health records (EHRs) at large hospital systems, rural clinics, local health departments, community health centers, pharmacies and primary care offices. 

Beyond that, more ubiquitous adoption of FHIR API standards would enable whole-person health insights by integrating data from medical devices, wearables and mobile health apps, as well as community-based organizations (CBOs), that address many of the social determinants of health (SDoH) factors that impact health outcomes. 

Interoperability is another foundational baseline infrastructure for rural health transformation. It enables the promise and potential of predictive data analytics, coordinated care management and artificial intelligence (AI)-based care navigation. More importantly, interoperability is critical to sustainable economic models for rural health by improving the health outcomes analytics required to support value-based payment models. 

The RHTP requires states to support secure, interoperable data sharing systems aligned with the CMS Interoperability Framework. These capabilities enable:

• Coordination across rural hospitals, clinics and community providers
• Integration of physical health, behavioral health and social services
• Population level analytics to track outcomes
• Consistent reporting across initiatives and regions

Interoperability translates expanded access into continuity of care and improved outcomes  — and allows states to demonstrate that investments are producing results, not just activity.

Cybersecurity is foundational, not optional

As states expand digital access points, they also expand cybersecurity risk.

States are encouraged to invest in cybersecurity with the goal of protecting patient data, ensuring system reliability and maintaining trust across rural communities. For rural providers with limited IT resources and insufficient data infrastructure, RHTP supported investments in cybersecurity improvements are essential to participation in modern care delivery.

One of the most overlooked roles of technology under the RHTP is its impact on compliance and performance reporting.

Technology systems can help states:

• Collect and validate data consistently across partners
• Monitor initiative progress in near real time
• Support timely, accurate submission of required reports
• Track subrecipient performance and outcomes

States that build reporting and performance management into their technology architecture reduce the administrative burden and improve the confidence in their results. States that do not often find themselves scrambling to assemble data at reporting deadlines.

Cybersecurity is a foundational baseline infrastructure for rural health transformation. Cybersecurity investments will directly support state RHTP initiative success by:

• Mitigating the risk of data breaches and ransomware attacks
• Protecting health information and personally identifiable information
• Reducing the risk of service disruptions and class action lawsuits
• Maintaining community trust and managing reputational risk 

In the RHTP performance based funding environment, data breaches and service disruptions are not just IT issues — they are significant risks that must be managed.

What this means for states

To transform rural health, states must invest in building the foundational digital infrastructure for telehealth, interoperability and cybersecurity. This will require a thoughtful long-term strategic roadmap of prioritized and sequenced technology initiatives to build capabilities over time. 

The RHTP goal is to improve access, care coordination and health outcomes in counties and communities across rural America. Achieving this goal and continuing to increase the state’s RHTP funding award in each year will require a modernized technology stack that empowers patients and clinicians through remote access; enables data interoperability and trusted, bidirectional data sharing; and ensures secure protection of sensitive information. States should be careful to avoid the urge to invest in shiny object technologies that do not result in a digital foundation for the future.

Before funding new technology and tools through the RHTP grant, states should ask:

• Does this technology accelerate the delivery of existing RHTP initiatives?
• Does this technology expand access in a meaningful way for patients and providers?
• Does this technology enable data interoperability and care coordination?
• Does this technology create new cybersecurity challenges and risks? 
• Will rural patients and providers realistically adopt and sustain it?

If the answer to any of these questions is no, state agency leaders should explore whether the technology investment increases RHTP delivery risk and complexity rather than improving the constituent experience and accelerating the impact.

What to do next

A practical approach to evaluating digital investments under the RHTP includes:

1. Define the desired end-to-end constituent experience for each initiative proposed in the state’s RHTP application and project narratives.
2. Align technology capabilities and requirements with RHTP initiatives, performance measures and reporting requirements, not just service delivery.
3. Define an integrated, cross-initiative statewide strategy and roadmap for building a minimum viable digital foundation for telehealth, data interoperability and cybersecurity.

Rural health transformation depends on technology modernization and investment — but only when that technology is built to support execution, accountability and outcomes of existing RHTP initiatives while building the digital foundation for future sustainability.

The views reflected in this article are the views of the author and do not necessarily reflect the views of Ernst & Young LLP or other members of the global EY organization.