Two years ago, it took about two-and-a-half hours to send an X-ray over the Internet from Lake District Hospital in south central Oregon to the nearest big hospital in Bend. Now, it takes four seconds.

About $90,000 in funding from a Federal Communications Commission pilot program helped the hospital tap into a broadband connection that's several times faster than its old system. It's one of thousands of hospitals, clinics and other providers nationally that accessed about $400 million from the FCC for pilots aimed at expanding broadband access to rural health care providers.

Yet many rural hospitals are still stuck with slow Internet service — even dial-up. In the FCC's 2010 National Broadband Plan for improving broadband access, the commission estimated that 26 percent of the nation's roughly 1,300 critical access hospitals lack adequate high-speed Internet connectivity.

A dearth of broadband is just one hurdle small rural hospitals face in implementing an electronic health record and meeting the Centers for Medicare & Medicaid Services' meaningful use regulations, especially as the emphasis shifts toward health information exchange.

"We know some hospitals are lagging on EHR," says Aaron Fischbach, public health analyst at the Office of Rural Health Policy, part of the Health Resources and Services Administration. "Broadband is one of the issues."

Even as rural hospitals continue to charge ahead with deploying electronic health records and meeting Stage 1 of meaningful use, Stages 2 and 3 will require better flow of patient records between providers and patients themselves.

Stage 2 regulations represent "a foot in the door" for requiring telemedicine and the exchange of extremely large files such as mammograms, for example, or videoconferencing capabilities, says Neal Neuberger, president of Health Tech Strategies, a McLean, Va., consultancy.

Officials at CMS are aware that many rural providers could be handicapped in meeting any future regulations that call for transmission of dense digital files. In its Stage 2 proposal, CMS called for some "hardship exemptions" to meaningful use for providers with insufficient Internet access. [At press time, the final Stage 2 rule was awaiting approval from the Office of Management & Budget.]

Meanwhile, rural hospitals are left scrambling for funds to improve their broadband connectivity. About 50 consortia nationally participated in the three-year FCC pilot, which selected applicants in 2007, although many projects still are in process. Among them is the Oregon Health Network, which secured about $20 million for more than 200 providers, including Lake District Hospital.

In 2010, the FCC issued a proposal that would create a permanent program to help rural providers with both the cost of broadband infrastructure and monthly service payments. An FCC spokesman declined to comment on its status.