David Blumenthal feels your pain.

He knows that the federal standards for meaningful use are "painful and difficult," especially for rural hospitals. But…you knew there was a "but," right? But, "We can't hold back this revolution because it is hard," he said, speaking to a packed room here in Phoenix.

The national coordinator for health information technology was speaking of what he deems "The Meaningful Use Era." That, of course, is a reference to the federal regulations for installing and utilizing electronic health records. But to Blumenthal it is much more than that. The Meaningful Use Era is a time when health information will be recorded, stored, shared and, most importantly, utilized by providers to improve the safety and quality of care.

Blumenthal spent much of his speech highlighting his office's accomplishments: formation of 62 regional extension centers which were established to help physicians and small and rural hospitals meet meaningful use standards, $120 million for workforce development, standards development, more than 300 certified EHR products/modules, and the list goes on.

But for this crowd, Blumenthal had to ease some concerns. Rural hospitals are held to the same standards as their larger counter parts when it comes to meeting meaningful use. That has many of the executives and trustees gathered here concerned. They have both financial and staffing constraints. There are infrastructure limitations in many rural areas that lack robust Internet capabilities. Blumenthal acknowledged those challenges. "We know this is a heavier lift for you," he said, adding that the government is here to help. Beyond the RECs, there's the potential to receive advance Medicaid funding to get toward meaningful use. The Health Resources and Services Administration may—depending on budget negotiations—have $12 million in grants available for 40 rural HIT projects. ONC is talking with USDA and FCC to coordinate their broadband funding programs with meaningful use in rural areas. Importantly, ONC is also talking with vendors about the importance of offering affordable products in rural communities.

In an informal poll, attendees were pleased to hear Blumenthal express empathy for their position, but that didn't do much to ease their concerns about meeting the tight timelines. Foreshadowing things to come in stages 2 & 3 of meaningful use, Blumenthal suggested that it would be fair for the federal government to carve out one group (rurals) from the rest of the pack.