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Original Question

Rewrite Smaller healthcare organizations face significant challenges integrating with RHIOs due to the high costs of IT infrastructure upgrades, staff training, and ongoing maintenance. As Glandon et al. (2020) explain full-scale system transitions often require substantial investment, which many providers, particularly in rural and underserved areas, cannot afford. Even if partial upgrades can be made, fragmented legacy systems limit data sharing and coordination with federal programs such as TEFCA. The 2023 ONC report confirms that many smaller providers still have a limited connection to HINs and HIEs (Office of the National Coordinator for Health Information Technology [ONC], 2024, p. 13).

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