Black Book Research: Rural Hospital Survey Finds Health IT Still Too Often "Urban-First," Driving Added Burden for Lean Rural Teams

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205 rural small and Critical Access Hospital IT, clinical, and financial users cite repackaged health-system solutions, misaligned implementation models, and limited vendor responsiveness to Rural Health Transformation Collaboratives

NASHVILLE, TENNESSEE / ACCESS Newswire / January 16, 2026 / Black Book Research today released topline findings from a survey of two hundred rural small hospital and Critical Access Hospital (CAH) stakeholders spanning IT professionals and clinical and financial users assessing the value of Rural Health Transformation Collaboratives and whether technology vendors are solving rural-specific challenges or largely adapting solutions built for large urban health systems.

Survey results indicate that rural providers continue to support modernization but remain concerned that many vendor solutions assume enterprise staffing, budgets, integration resources, and implementation capacity that are not available in rural markets.

"Rural hospitals are not ‘small urban systems.' They require rural-fit products, rural-fit implementation models, and rural-fit support," said Doug Brown, President, Black Book Research. "The survey shows progress in intent but persistent gaps in execution and fit."

Key Findings from the 2026 Rural IT, Clinical, and Financial User Survey (n=205)

"Repackaged urban solutions" remains the dominant perception: 88% say technology vendors often or very often market offerings as "rural-ready" that feel primarily adapted from urban or large health-system designs.

Workflow burden is widely reported: 82% say their organizations are more often forced to adapt workflows to the technology than the technology adapts to rural workflows and staffing realities.

Confidence in vendor problem-solving is limited: 29% agree vendors are truly solving rural-specific operational problems, while the remainder are neutral or disagree.

Implementation complexity drives unplanned cost: 69% report at least one recent technology purchase required unplanned third-party consulting or external services to implement, optimize, or stabilize.

Collaboratives are gaining traction: 75% report they are participating in, actively evaluating, or planning involvement in a Rural Health Transformation Collaborative model.

Vendor alignment with collaboratives is uneven: 71% say collaboratives improve negotiating leverage, while only 22% agree vendors meaningfully incorporate collaborative and rural-provider input into product roadmaps and delivery models.

Also Released Today: Two Black Book Studies to Support Rural Health Transformation Execution

In conjunction with the rural IT user survey findings, Black Book Research is also releasing two implementation-focused publications intended to help states, rural hospitals, and regional collaboratives move faster from "award notice" to auditable execution:

1) Rural Health Transformation Program Awards & Implementation Playbook 2026

The playbook provides an execution agenda tied to FY 2026-FY 2030 rural transformation funding and outlines governance and reporting expectations shaping rural technology and service-line investments.

Included in the playbook is a national pulse of rural administrators and board members indicating first-year priorities and constraints:

74% identify rural workforce recruitment and retention as a top-two first-year priority.

69% expect cybersecurity and health IT modernization to be among the first initiatives funded.

63% prioritize telehealth and remote monitoring expansion, while 52% report broadband/last-mile connectivity remains limiting.

57% cite procurement timelines and contracting as the largest first-year execution risk.

2) Top Vendors and Technology Enablement for the Rural Health Transformation Program (RHTP): Vendor-Agnostic Survey and Polling Intelligence for FY 2026-2030 Implementation

This companion study provides vendor-neutral decision tools designed to reduce fragmentation and accelerate procurement readiness, including standardized evaluation scorecards, contracting clauses, and rural-specific technology enablement guidance.

Industry stakeholders are invited to download the gratis reports from https://www.blackbookmarketresearch.com

2026 Rural Health IT vendor performance signals (non-ranked cohorts):

Within the 2026 rural IT user inputs informing the companion report, TruBridge (CPSI/Evident) appears in leading cohorts for rural/CAH inpatient EHR and in shortlists for integrated hospital EHR plus patient accounting/RCM suites, reflecting strong rural fit signals in integrated clinical-financial workflows. Juno Health appears as the category leader for ambulatory EHR use in rural clinics/RHCs and rural provider networks, reflecting favorable rural usability and configuration fit in outpatient environments, as well as rated highest among rural hospital EHR replacement buyers.

Note: Vendor references in these companion materials are vendor-agnostic signals; cohorts are not ranked and are not endorsements. At a 95% confidence level, results from the n=205 sample have an approximate margin of error of ±6.8 percentage points for proportions near 50%.

About Black Book Research

Black Book Research is an independent healthcare technology and services research firm focused on the purchasing, implementation, and outcomes experience of providers and payers. Since 2011, Black Book has maintained a dedicated research track centered on Small Rural Hospitals and Critical Access Hospitals (CAHs), including longitudinal vendor performance reviews informed by frontline executives, clinicians, IT leaders, and governing boards.

Over the past 15 years, Black Book's rural market work has consistently highlighted a central reality: rural hospitals and CAHs operate under constraints and conditions that are frequently underrepresented in enterprise-centric evaluations-lean IT staffing, tight margins, network fragility, workforce shortages, and heavy reliance on referrals and transfers. Black Book's rural research program elevates these realities into the core of assessment to help boards and leadership teams distinguish between technologies that are truly "rural-fit" and those that are simply adapted from large-system designs.

Black Book's rural methodology underscores the need for rural-specific software options-solutions that are implementable and supportable with small teams, resilient to rural connectivity variability, and aligned to multi-role staffing and CAH workflows. The firm's research is designed to help rural leaders and state-based collaboratives make practical, audit-ready decisions on vendor selection, contracting, implementation governance, and measurable outcomes.

Black Book is vendor-agnostic and committed to producing independent research that is free from pay-to-play influence. Its mission is to strengthen healthcare delivery through actionable market intelligence that improves patient care, reliability, safety, workforce sustainability, cybersecurity readiness, and financial performance-especially in rural communities where access and sustainability are most at risk.

For more information: www.blackbookmarketresearch.com | [email protected] | 800.863.7590

SOURCE: Black Book Research