Rural hospitals preparing to deploy federal Rural Health Transformation Program funding say workforce stability, cybersecurity and technology modernization are top early priorities, even as many continue to struggle with health IT tools designed for larger urban systems, according to a new survey.
Black Book Research on Jan. 16 released the “Rural Health Transformation Program Awards & Implementation Playbook 2026,” a publication intended to help rural hospitals, states and regional collaboratives move from funding awards to auditable execution. The playbook aligns implementation guidance with rural transformation funding spanning fiscal years 2026 through 2030, according to a Jan. 16 news release.
The playbook draws on findings from a broader Black Book Research survey of 205 rural hospitals and critical access hospital stakeholders, including IT professionals, clinicians and financial users. The survey assessed whether technology vendors are addressing rural-specific challenges or simply adapting solutions designed for large health systems.
Here are six key findings from the survey:
- Workforce recruitment and retention emerged as a leading first-year priority for Rural Health Transformation Program investments, with 74% of respondents ranking it among their top two concerns. Cybersecurity and health IT modernization are also expected to receive early funding attention, with 69% of respondents identifying them as initial investment areas.
- Telehealth and connectivity remain front of mind for funding recipients. Sixty-three percent of respondents are prioritizing telehealth and remote monitoring expansion under the transformation program, while 52% said broadband and last-mile connectivity limitations continue to hinder progress.
- Technology fit and implementation challenges remain significant for rural providers. Nearly 90% of respondents said vendors often market products as “rural-ready” even though the tools appear repackaged from urban system designs.
- Workflow strain was widely reported, with 82% of respondents indicating their organizations are more often forced to adapt workflows to technology rather than implement technology designed for rural staffing and operations.
- Implementation complexity is contributing to unplanned costs. Nearly 70% of respondents said at least one recent technology purchase required unexpected third-party consulting or external services for implementation, optimization or stabilization.
- Despite these challenges, collaborative models are gaining traction. Three-quarters of respondents said they are participating in, evaluating or planning to join a Rural Health Transformation Collaborative. While 71% said collaboratives improve negotiating leverage with vendors, only 22% said vendors meaningfully incorporate collaborative or rural-provider input into product roadmaps and delivery models.
Black Book Research said the playbook is designed to help rural providers navigate such gaps by clarifying governance structures, reporting expectations and execution risks. More than half of respondents cited procurement timelines and contracting complexity as the greatest execution risks during the first year of transformation efforts.
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