This project explored the financial consequences of health information technology (IT) in Critical Access Hospitals (CAHs) and other rural hospitals. This study had three primary objectives. First, we updated measures of health IT adoption and utilization in CAHs and other rural hospitals. This helped identify potential obstacles to health IT adoption for rural hospitals. Second, we measured the effect of health IT on hospital efficiency. Third, we studied whether health IT interacts with hospital inputs. This project provided ORHP and State Flex Program staff with current data on HIT adoption and utilization in CAHs and other rural hospitals. It also helped identify potential obstacles to health IT adoption for rural hospitals and helped determine whether the HITECH Act is enhancing rural hospital efficiency or imposing an undue burden on rural providers.