Bob Segert is Chairman and Chief Executive Officer of athenahealth.
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In many rural communities across the U.S., clinicians are the most reliable point of care patients have. Clinicians often run small practices or community health centers with limited staff, aging infrastructure and little margin for error, often while carrying responsibilities that extend far beyond medicine itself.
I hear it directly from doctors caring for patients while also managing billing, regulatory requirements and the operations that keep their doors open. Access in those communities depends on more than whether a clinic is nearby. It also depends on whether patients can get an appointment, afford care and whether the practice itself can stay open. The work is deeply personal and essential, but for many, it has become difficult to sustain.
That is why federal action matters. The Rural Health Transformation (RHT) Program represents a $50 billion investment across five fiscal years beginning in 2026 to expand access to care in rural communities and modernize the infrastructure that small practices, rural health clinics and community health centers depend on. After years of financial pressure, workforce shortages and limited ability to adopt technology suited for small practices, this funding offers something rural clinicians have not had in a long time: a chance to stabilize and invest more deliberately in how care is delivered. It also shifts the burden of success. With policy and funding now in place, the question is no longer whether support exists—it is whether the technology ecosystem follows through.
But funding alone will not determine whether rural care remains viable. What matters now is whether that investment translates into real, day-to-day relief for clinicians and patients. Technology has a central role to play, and healthcare technology companies carry a responsibility to meet this moment with solutions that reflect the realities of rural care. For those of us building healthcare platforms, this is a test of leadership.
Too often, healthcare innovation is designed with large hospital systems in mind—organizations with the scale and resources to absorb complex and costly implementations. When technology requires extensive training, customization or administrative effort, it compounds the problem rather than solving it. In rural settings, complexity is not neutral; it actively undermines access and sustainability.
As the leader of a healthcare technology company that serves federally qualified health centers nationwide, I spend a great deal of time listening to rural clinicians describe what actually helps. The message is consistent. They need tools that help them care for more patients without adding more work. Technology must reduce administrative burden and improve how information moves across systems so clinicians are not forced to chase data during patient care. This is especially true for independent practices, rural health clinics and community health centers, which need the same timely access to patient information as large health systems. In rural care, interoperability is not just a technical goal—it is a clinical and operational necessity. For technology leaders, success is measured less by feature velocity and more by whether day-to-day work becomes manageable.
The urgency of this moment is hard to overstate. A JAMA research letter found that current RHT Program allocations may not align closely with rural health and access needs, reinforcing how important it is for this funding to translate into operational support where it is needed most.
Regulatory volatility, stagnant reimbursement rates and limited access to usable data have pushed many rural practices to the edge. Since 2010, over 180 hospitals have closed or discontinued inpatient service, and nearly 50% of rural hospitals operate on negative financial margins. Independent practices continue to consolidate with large health systems because many lack the operational support to survive on their own.
Workforce shortages deepen that pressure. While roughly 20% of Americans live in rural areas, only about 9% of the nation’s physicians practice in those regions. One clinician described the reality quite plainly, noting they wish someone had told them: “I was hired as a clinician, but since then I have also become a grant writer, an administrator, coder, biller, maintenance, receptionist, social worker, pharmacist, and everything.” That load is unsustainable, and it pulls clinicians further away from the reason they entered medicine in the first place.
Even before the RHT Program, many rural practices began looking for ways to reduce administrative work that pulls clinicians away from patient care, with AI emerging as a promising tool. Some adopted AI to reduce after-hours charting, increase face-to-face time with patients and catch revenue-cycle errors before claims were submitted. These efforts provided incremental relief, but they were often constrained by outdated systems and fragmented data. The RHT Program creates an opportunity to address those limitations, but only if technology companies prioritize integration over novelty.
With this level of federal investment, the goal should extend beyond administrative efficiency. Rural practices need a stronger digital foundation—systems that bring patient information together in a single, usable view. Without that foundation, more advanced capabilities, including AI, cannot function reliably. Documentation support and revenue-cycle automation deliver value only when embedded into everyday work, without pulling clinicians away from patient care.
That kind of follow-through requires discipline. Technology has to be integrated into existing workflows, not layered on in ways that create more steps or more work for clinicians. Support should be built into documentation, orders, billing and follow-up work, so staff do not have to toggle between systems or do the same work twice. Technology leaders should also test early in independent and rural care settings, where lean staffing makes every extra click and handoff more visible. If a tool adds friction, shifts work onto already stretched teams or extends the day, it is not delivering the relief clinicians need.
Federal funding has created a window for rural healthcare to stabilize and for many practices to begin investing more deliberately in how care is delivered. Whether that window stays open will depend on what technology leaders do next. The technologies that endure will be the ones that respect clinicians’ time, fit the realities of small practices, keep independent care models viable and help patients get the care they need.
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