"Rural is not a smaller version of urban," said Tom Morris, associate administrator for rural health policy at Health Resources and Services Administration, speaking Sunday at the pre-conference symposium, "Health IT and Rural Healthcare: Embracing Opportunities and Overcoming Challenges."

In sparsely populated areas, where 46.2 million Americans live, things are very different from the cities where most health policy is developed. The provider base is different, with a bigger focus on primary care. The payer mix is different, with a heavier reliance on Medicare and Medicaid. Technology infrastructure is more limited. Small hospitals struggle with regulatory burdens, even as they're stretched thin dealing with more prevalent chronic disease.

And, of course, geography – with vast open spaces between care facilities – poses huge challenges for patients and providers alike.

At the Sunday session, billed as the first-ever rural health symposium, stakeholders gathered to learn more about the ways health IT is being deployed to address the unique challenges of rural care delivery

The federal government has a critical role to play, as Federal Communications Commissioner Mignon Clyburn emphasized in her opening address. For instance, by fostering better Internet connectivity (just 50 percent of rural Americans are wired for broadband), the FCC is working toward its goal of "getting all Americans online" and enabling a more robust infrastructure for telehealth, she said.

The EHR incentive program is also a key enabler, said Judy Murphy, RN, deputy national coordinator for programs and policy at the Office of the National Coordinator for Health IT.

"Meaningful use is a means to an end," she said. And with $21 billion in incentives doled out so far, that goal of improved outcomes gets closer each day.

"How is rural doing?" Murphy asked.

Much better in recent years. Rural physicians are participating in MU at roughly the same rate as the national average, and while hospitals are lagging a bit behind the overall trend, more than 60 percent of critical access facilities – more than 1,000 of them – have achieved meaningful use, fast exceeding an "all-hands-on-deck" challenge issued by ONC in 2012.

Even better, there's been an improvement in rural technical infrastructure and, crucially, an increase in the knowledge base of the people putting it to work toward better care.

"We have gotten smarter," said Murphy. "I do believe we have reached a tipping point."