For a small hospital, staying independent now comes with a technology bill. Federal survey data shows the hospitals least able to trade records with the rest of healthcare share one trait more than any other. They stand alone. Independent hospitals routinely send, receive, look up and use outside patient records at less than half the rate of hospitals inside a system. Geography matters less than affiliation does.
Money alone doesn’t close that gap. A modern EHR costs millions to put in, and running one takes a team most small hospitals can’t hire. The federal Rural Health Transformation Program is sending states billions for rural care, but it caps spending on replacing an EHR at 5% of each state’s yearly award. The money can connect old systems. It mostly can’t buy new ones.
So small hospitals rent. Epic’s Community Connect lets a larger system host a smaller hospital on its own instance, and Oracle Health and MEDITECH sell their own routes to a modern record. For many hospitals that arrangement is a lifeline: current software and real support at a price they can manage, with their own board still in place. It also puts order sets, upgrade schedules and the patient’s history inside someone else’s system. Chris Boyer and Reed Smith leave one question open. When a hosted hospital’s future changes and a different system acquires it, who keeps the patient relationship? The portal login, the contact preferences and the consent records all sit with the host.
Allen Cooper wants small hospitals to stay independent, and he sees software as part of how they get there. His company, Ancilla Ventures, builds for systems with a dozen hospitals and for single critical access hospitals, so he sees the gap from both sides. His test for any tool is plain. If the digital version takes a patient longer than the paper did, it didn’t help. He also asks the question interoperability keeps running into: who pays for it?
If your hospital rents its record from a neighbor, what happens to your patients when the lease ends?
MENTIONS FROM THE SHOW
- Healthcare’s Long Walk Toward the Patient, the free eBook marking 500 episodes, plugged in the open: https://www.touchpointpodcastbook.com
- Allen Cooper on LinkedIn: https://www.linkedin.com/in/allen-c00per/
- Ancilla Ventures: https://ancillaventures.com/
- MN Community Measurement: https://mncm.org/
- ASTP Health IT Data Brief 71, “Interoperable Exchange of Patient Health Information Among U.S. Hospitals: 2023,”: https://www.ncbi.nlm.nih.gov/books/NBK606033/
- ASTPs: https://www.healthit.gov/data/quickstats/electronic-health-information-exchange-hospitals
- ASTP: https://www.healthit.gov/sites/default/files/2025-01/A-Decade-of-Data-Examined-The-Evolution-of-Health_508.pdf
- Chartis, “2026 Rural Health State of the State,” February 2026: https://www.chartis.com/insights/2026-rural-health-state-state
- KFF Health News, “Can a federal lifeline keep rural hospitals open?,” August 3: 2026https://civicmedia.us/news/2026/08/03/can-a-federal-lifeline-keep-rural-hospitals-open
- CMS, Rural Emergency Hospitals: https://www.cms.gov/medicare/health-safety-standards/certification-compliance/rural-emergency-hospitals
- Flex Monitoring Team, “Trends in Inpatient Revenue and Volume Among Critical Access Hospitals,” April 2026: https://www.flexmonitoring.org/publication/trends-inpatient-revenue-and-volume-among-critical-access-hospitals
- CMS, Rural Health Transformation Program awards: https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states
- Bipartisan Policy Center: https://bipartisanpolicy.org/explainer/rural-health-transformation-program-notice-of-funding-opportunity/
- Paul Keckley, The Keckley Report, “It’s March Madness for Hospitals,” March 22 2026: https://paulkeckley.com/the-keckley-report/2026/3/22/its-march-madness-for-hospitals/
- Becker’s, “Epic Community Connect, explained,” June 11 2026: https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/epic-community-connect-explained-what-small-hospitals-get/
- Becker’s, “Which EHRs do small hospitals prefer?,” October 31 2024l: https://www.beckershospitalreview.com/ehrs/what-ehrs-do-small-hospitals-prefer/
- Oracle: https://www.oracle.com/news/announcement/critical-access-hospitals-select-oracle-health-communityworks-to-enhance-clinical-and-financial-operations-2024-09-24/
- MEDITECH, “MEDITECH Signs 100th Expanse MaaS Customer,” January 2024. MEDITECH as a Service is a cloud subscription MEDITECH runs itself: https://ehr.meditech.com/news/meditech-signs-100th-expanse-maas-customer
- Gunnison Valley Health, “Gunnison Valley Health Adopts Epic,” January 2025, on joining UCHealth’s Community Connect program: https://www.gunnisonvalleyhealth.org/news/2025/january/gunnison-valley-health-adopts-epic-the-gold-stan/
- Gunnison Valley Health, EHR transition page, May 2025 go-live and legacy portals kept for past records: https://www.gunnisonvalleyhealth.org/patient-resources/gvh-electronic-health-record-transition/
- Becker’s, “‘No way we could afford it alone’: How a rural hospital is implementing Epic,” February 2025: https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/no-way-we-could-afford-it-alone-how-a-rural-hospital-is-implementing-epic/
- Definitive Healthcare, largest health systems in Colorado, 2024: https://www.definitivehc.com/resources/healthcare-insights/largest-idns-colorado
- Becker’s, “Mississippi hospital hires 60 new employees for Epic switch,” January 2025: https://beckershospitalreview.com/ehrs/mississippi-hospital-hires-60-new-employees-for-epic-switch.html
- George Washington University, Health Information & the Law, “Who Owns Medical Records: 50 State Comparison,” last updated 2015: https://www.healthinfolaw.org/comparative-analysis/who-owns-medical-records-50-state-comparison
- Reed Smith on LinkedIn: https://www.linkedin.com/in/reedtsmith/
- Chris Boyer on LinkedIn: https://www.linkedin.com/in/chrisboyer/
- Chris Boyer website: http://www.christopherboyer.com/
- Chris Boyer on BlueSky: https://bsky.app/profile/chrisboyer.bsky.social
- Reed Smith on BlueSky: https://bsky.app/profile/reedsmith.bsky.social
Recommendations from this episode:
- Chris: A History of the World in 100 Objects: https://bbc.in/2u4Wae6 and https://99percentinvisible.org/100-objects/
- Reed: Tulsa King: https://www.advanced-television.com/2026/09/02/tulsa-king-season-4-premires-on-paramount-this-october/
