February 17, 2026
Access to timely, high-quality health care is essential for managing risk factors and preventing adverse outcomes. For people in rural communities—who often face higher risks for chronic conditions such as heart disease, hypertension and diabetes compared to urban residents—specialty care is critical. Yet access is often compromised because these people encounter barriers that make completing an in-person specialist visit difficult, even when referred by a primary care provider.
OCHIN is advancing research and adoption of electronic consultations, or eConsults, in rural clinics to help our members connect their patients with specialty expertise. eConsults offer primary care providers an easy way to get specialist input quickly and virtually, ensuring patients receive the care they need no matter where they live.
Why people in rural communities face steep barriers to care
People in rural communities face significant challenges, including:
Provider shortages
A nationwide specialist shortage and rising demand have led to long wait times, a problem that is exacerbated in rural areas:
- Over 46% of U.S. counties—and 86% of rural counties—have no practicing cardiologists.
- A 2025 OCHIN network analysis found the average wait to see a specialist is 58 days, and only 40% of significantly delayed referrals are completed.
- Hospital closures have also worsened access: Since 2005, 112 rural hospitals have closed, 84 converted to outpatient or urgent care, and 314 are at immediate risk.
Insurance coverage limitations
According to a recent analysis, people in rural communities:
- Are more likely to be uninsured— 8.4% compared with 7.8% in urban areas.
- More often rely on public insurance such as Medicaid or Medicare, at 45.2% versus 36.1%, which can restrict access to specialists.
Geographic isolation
Long distances to care facilities and limited transportation options hinder appointment attendance:
- An estimated 3.6 million people in the United States delay or forego health care because they lack transportation.
These challenges contribute to higher rates of preventable hospitalizations and increased age-adjusted mortality in rural areas compared to urban counterparts.
How eConsults bridge the rural specialty care gap
Community-based health care organizations serving rural and lower-resourced patients often lack the clinical capacity, tools or resources to provide specialized care. Ideally, these providers could refer patients to a specialist, but many specialists do not accept patients who are uninsured or use Medicaid. Even when referrals occur, completion rates are low due to long distances or appointment wait times.
eConsults offer a promising strategy for addressing gaps in specialty care access for people in rural communities by connecting primary care providers with specialists for support. By enabling primary care providers to virtually consult with a specialist about a patients’ condition, eConsults help reduce the need for in-person specialist visits. Initially developed for community care providers, eConsults help reduce unnecessary referrals and delays in specialty care input, improving early detection and management of life-changing illnesses.
Specific benefits include:
- Reduced care delays and improved follow-up while keeping patients in their local communities.
- Expanded access for patients covered through Medicaid or those without health insurance, supported by platform-contracted or volunteer specialists.
- Early detection and improved patient health outcomes.
- Enhanced clinician knowledge and support for chronic disease management, allowing primary care providers to practice at the full extent of their training.
- Improved documentation and reimbursement for specialist input.
- Reduced cost to the health care system at large.
In community health organizations, eConsults have been associated with improved diabetes outcomes, better understanding of specialty guidelines, reduced financial and transportation barriers, and improved scheduling for necessary follow-up visits.
What OCHIN’s research reveals about eConsult adoption
Despite their promise, eConsults remain underused in rural community health organizations. A team of researchers at OCHIN recently examined eConsult requests within OCHIN clinics and found that:
- Just 50% of rural community health organizations requested eConsults compared with 67.6% of urban community health organizations.
- Only 10% of all community-based providers requested an eConsult at least once from 2022 to 2024.
- Among all providers requesting eConsults, 73% did so fewer than 10 times over three years.
OCHIN’s next steps: Driving access through digital health
Most existing studies on eConsults in community health organizations have focused on single clinics or urban health systems, limiting their ability to address the needs of rural communities.
OCHIN is changing that by advancing research and developing best-practice guidelines for eConsult use in rural clinics. These guidelines will help members use eConsults more effectively, ensuring patients—regardless of geography or insurance status—receive the specialty care support they need.
By creating practical guidelines and providing technical assistance for eConsult adoption and use, OCHIN is giving rural providers a pathway to improve patient access to the specialty care they need, helping drive better health outcomes for rural communities.
