According to the Centers for Disease Control, the prevalence of risk factors for a variety of chronic diseases is much higher in rural areas than in urban communities. Compounding risks at the individual level are environmental factors, such as significant shortages of health care professionals, geographic isolation from specialty care, and reduced reimbursement rates from third-party payers such as Medicare. The interaction among people, systems, and the environment yields unique rural challenges.

HSSC is working to improve the health of rural South Carolinians by engaging rural health experts including the State Office of Rural Health, the South Carolina Rural Health Research Center, rural hospitals, and health care providers in research initiatives. HSSC has also initiated programs such as the Lakelands Rural Healthcare Quality Initiative.

In May 2009, HSSC released a request for proposals as part of its Rural Healthcare Quality Initiative. Dr. Kevin Bennett at the University of South Carolina School of Medicine submitted the winning proposal in partnership with the Lakelands Rural Health Network; the project uses the network's health information exchange (HIE) as a living laboratory.

The Lakelands Rural Health Network is a vertically integrated network of hospitals, physician practices, and other providers in the counties of Abbeville, Laurens, Greenwood, McCormick, Edgefield, and Saluda. HSSC’s grant for the project builds on previous federal funding that established the HIE and addressed technical and governance issues around sharing relevant patient information.

The study, funded through The Duke Endowment, is examining (1) how select chronic conditions such as diabetes, asthma, and hypertension are managed using HIE, (2) whether participation in an HIE improves quality indicators (NCQA measures), and (3) clinician perceptions.