Challenges MSPs face in supporting rural healthcare IT infrastructure

Rural healthcare is where the stakes are highest and the margins are smallest. Small clinics, community hospitals, and standalone practices are lifelines for their communities, but they’re also some of the hardest places to deliver modern, secure, reliable IT. Managed Service Providers (MSPs) that take on rural healthcare clients face a unique combination of technical, operational, regulatory, and human-centered challenges. It is important for these healthcare organizations and MSPs to understand the obstacles they may encounter, explain why they matter, and offer practical approaches MSPs can use to mitigate each one.

Limited and unreliable broadband connectivity

At the top of the problem list is connectivity. The study, Disparities in Technology and Broadband Internet Access across Rurality: Implications for Health and Education, states that “Inadequate broadband infrastructure is a critical barrier to provision of telehealth services and remote learning in rural areas, particularly for approaches that involve synchronous video communication between provider and recipient. Inadequate broadband infrastructure is a critical barrier to provision of telehealth services and remote learning in rural areas, particularly for approaches that involve synchronous video communication between provider and recipient.” This indicates that many rural communities still lack affordable, high-speed internet, or they have networks with inconsistent bandwidth and high latency. For services that rely on telehealth video, real-time medical device telemetry, or cloud-hosted electronic health records (EHRs), inconsistent connectivity breaks workflows and degrades patient care.

Why it matters

In the study The State of Telehealth Before and After the COVID-19 Pandemic, Julia Shaver notes that “telemedicine, or receiving one’s medical care remotely via synchronous, asynchronous, or store-and-forward technology, had been on a steady increase for the last decade, but the overall growth had remained slow until March 6, 2020. In response to the SARS-CoV-2 pandemic crisis, the US Congress toppled a multitude of telemedicine regulations, and telemedicine expanded rapidly.” This indicates how telehealth and remote monitoring are now core parts of rural care delivery; however, without reliable broadband, these services may fail to deliver value. 

MSPs can design for lower bandwidth and manage expectations while advocating for long-term connectivity improvements. 

Practical steps

• Offer hybrid solutions that gracefully switch between local caching and cloud sync.
• Implement bandwidth prioritization for clinical applications.
• Deploy resilience patterns: local EHR failover, asynchronous data upload, and adaptive video codecs.
• Help clients pursue broadband grants and public funding targeted at rural connectivity.

Tight budgets and constrained funding cycles

Rural providers often operate with thin margins and limited capital for IT modernization. This is supported in the study Financial performance of rural hospitals persistently lacking or having telehealth technology, which found that “access to financial capital, along with hospital and community factors, may influence capital investment decisions made by rural hospitals. Unfortunately, rural hospitals facing financial difficulty may be unable to commit the monetary resources to telehealth adoption.” This makes it hard for MSPs to implement robust cybersecurity stacks, buy redundant internet links, or refresh aging hardware.

Why it matters 

Deferred software updates translate into higher long-term costs and security risks. MSPs can reconcile best-practice recommendations with what a client can realistically afford. 

Practical steps

• Propose modular, phased projects that deliver high-impact wins first (e.g., multi-factor authentication (MFA) + email security).
• Identify and assist with grant funding, regional healthcare programs, or vendor financing.
• Show ROI in clinical terms (reduced no-shows with telehealth, fewer transfers, improved billing accuracy).

Workforce shortages and limited local IT skills

The study Reflections of rural primary care physicians on the impact of the COVID-19 pandemic: a qualitative study found that rural clinics had fewer resources, including limitations in staff, compared to urban clinics. These restrictions affected the ability to implement telehealth, for example, because of limited internet access and bandwidth. This leaves MSPs responsible for a lot more than monitoring; they must handle onboarding, training, troubleshooting, and act as a strategic IT partner.

Why it matters

Limited local IT capacity increases mean time to resolution and puts more pressure on remote support channels. It also raises security risk if patching and backups aren’t consistently handled. 

Practical steps

• Build training packages tailored to non-technical staff: short, role-specific modules and on-demand microlearning.
• Use managed automation for routine tasks (patching, backups, and endpoint hygiene) to reduce dependency on local staff.
• Shadow clinical workflows to design support processes that minimize disruption during busy care days.

Aging infrastructure and fragmented systems

Many rural facilities run legacy EHRs, outdated workstations, and clinical devices still on old operating systems. As demonstrated in the study The hazard of software updates to clinical workstations: a natural experiment, “Older operating systems and web browsers may not be well supported by their own developers or clinical application vendors.” This indicates that interoperability is often poor; multiple point solutions don't talk to each other, meaning staff resort to manual workarounds (paper, fax, spreadsheets).

Why it matters

Legacy systems hamper data-driven care, complicate compliance, and increase the risk of outages and breaches. Case studies and reviews have repeatedly shown that rural providers struggle with outdated systems and interoperability barriers. 

Practical steps

• Conduct an asset and dependency map: identify critical systems and single points of failure.
• Prioritise interoperability fixes that reduce staff workload (lab interfaces, e-prescribing, scheduling).
• Use secure middleware and API gateways to bridge legacy systems where replacement isn’t immediately feasible.
• Offer lifecycle planning, like a 3–5 year roadmap with clear milestones and budget estimates.

Read more: How legacy systems disrupt patient care

Regulatory compliance and cybersecurity pressures

Healthcare is highly regulated. Rural providers must meet HIPAA (and local equivalents), secure PHI, and show evidence of risk assessments, policies, and staff training. Yet many lack dedicated compliance teams and struggle to keep pace with evolving guidance and threats. In fact, a Paubox report found that “8 out of 10 [healthcare IT leaders] privately worry about their HIPAA compliance. At the same time, cyberattacks increasingly target healthcare organizations, including smaller rural clinics.

Why it matters

Paubox reports that 73% of rural healthcare organizations state that they struggle to maintain HIPAA compliance due to staffing and funding gaps.

Non-compliance risks HIPAA violation fines and reputational damage; successful breaches can seriously disrupt clinical operations and patient safety.

Practical steps

• Provide compliance-as-a-service: templates, evidence collection, regular audits, and remediation roadmaps.
• Bundle essential security controls into managed packages: endpoint protection, centralized logging, MFA, and secure email.
• Run practical exercises for ransomware and breach response tailored to small-staff environments.
• Create a clear, short incident-response plan that non-technical staff can follow in a crisis.

Telehealth reimbursement, licensing, and policy complexity

The Rural Health Information Hub notes that licensure requirements are a major challenge for delivering telehealth services in rural areas.

Telehealth is transformational for rural care, but policy and reimbursement rules (which vary by jurisdiction and change frequently) create uncertainty. Issues include whether telehealth visits are reimbursable, cross-state licensure for providers, and documentation requirements. MSPs must support not just tech but also workflows that align with these policies.

Why it matters

If telehealth workflows aren’t configured to capture the right documentation or the provider lacks licensure, the visit may not be billable, undermining the financial case for telehealth investments. National rural health policy briefs indicate the regulatory complexity around telehealth and its uneven policy landscape. 

Practical steps

• Build telehealth templates into the EHR that capture necessary billing and clinical metadata.
• Help clients track policy changes and provide checklists for cross-state practice and tele-prescribing rules.
• Integrate scheduling and consent workflows so administrative staff can easily verify eligibility for telehealth reimbursement before appointments.

Device and IoT management (medical and non-medical)

Rural hospitals increasingly use networked medical devices (monitors, infusion pumps) and consumer IoT in clinical spaces. Many of these devices have long life cycles and limited built-in security. MSPs must manage device segmentation, lifecycle updates, and maintain medical device vendor relationships.

Why it matters

Insecure devices can act as a major attack vector and can threaten patient safety. Device outages also have immediate clinical consequences.

Practical steps

• Implement strict network segmentation for clinical devices, with monitoring and anomaly detection for device traffic.
• Maintain an inventory of device firmware versions and coordinate patching with clinical teams and vendors.
• Standardize data collection and apply security layers.
• Educate procurement teams to include cybersecurity and patching in device purchase contracts.

Cultural and change management challenges

Technology projects can fail not because the tech is bad, but because people don’t adopt it. As stated by the Rural Health Information Hub, “Some patients may have concerns about the quality of services they receive via telehealth. In addition, it can be difficult for patients and providers to build trust and rapport when communicating virtually. Patients may also have concerns about the security of information that is transmitted via telehealth.” MSPs must be change managers as much as technologists.

Why it matters

Poor adoption negates expected clinical and financial benefits. A well-implemented telehealth system that clinicians [and patients] don’t trust or use is an expensive shelf ornament.

Practical steps

• Co-design solutions with clinicians and administrative staff to get end users involved early.
• Deliver empathy-driven training: short, practical sessions tied to daily tasks, plus clear channels for immediate help.
• Measure adoption with simple KPIs (telehealth sessions completed, time to document, staff satisfaction) and iterate.

Measuring impact and justifying investments

MSPs can help translate technical improvements into clinical and operational metrics, leading to reduced transfer rates, improved chronic disease control, fewer missed appointments, or faster billing cycles.Without measurable impact, funding and future IT investment may be jeopardized.

Practical steps

• Co-develop KPIs tied to clinical priorities (e.g., telehealth no-show reduction, lab turnaround).
• Use small pilots with clear success criteria before wide rollouts.
• Provide accessible dashboards and short monthly reports that show operational improvements, not just uptime percentages.

See also: HIPAA Compliant Email: The Definitive Guide (2025 Update)

FAQS

Who is responsible for HIPAA compliance in an organization?

In any healthcare organization, HIPAA compliance is a shared responsibility. A Privacy Officer oversees policies and patient privacy, while a Security Officer manages safeguards for electronic PHI. Executives provide oversight and resources, but all staff must follow HIPAA rules in daily operations.

Read also: Who is responsible for HIPAA compliance?

How does the lack of a dedicated compliance team affect HIPAA readiness?

Without specialized oversight, rural providers may struggle with risk assessments, policy updates, staff training, and incident response. This can increase vulnerability to data breaches and regulatory penalties.