SUMMARY The number of persons 65 years of age and older with Alzheimer’s disease and related dementias (ADRD) in the United States is expected to reach 13.8 million by 2060. Funded by the NIMHD (R01MD011523), our studies have identified the effectiveness of care coordination and system integration are essential to promote population health for racialized populations. Fully functioned system-wide integration requires appropriate health information technology (HIT) capacity. Compared to urban and suburban areas, rural areas have a higher percent of older adults, a higher incidence of health disparities, and substantially poorer health care infrastructure, including HIT adoption and telehealth capabilities. The COVID-19 pandemic is having a major impact and will change the landscape of HIT use in the long run. As more investments are directed toward developing and strengthening telehealth capacity in rural areas, it is both an opportune and critical time to assess HIT infrastructure and system integration. Yet, evidence is lacking. Our recent preliminary findings suggested that hospital-based HIT infrastructure that aims to improve care coordination and patient engagement are effective to reduce rural and urban disparities among ADRD patients. Encouraged by these findings, our team, with expertise in health care coordination HIT, aging, disparities, rural health, and ADRD research, is committed to building this pilot project to comprehensively investigate rural and urban disparities of access to such effective HIT infrastructures among ADRD patients, with a focus on racialized Black and Latinx ADRD patients. Our central hypothesis is that racialized rural ADRD patients encounter substantial barriers to access HIT infrastructures; and policy initiatives, such as Accountable Care Organizations (ACOs), can be designed to encourage HIT investment in rural areas and improve access to HIT for this vulnerable population. Specifically, we will investigate the access to hospital-based HIT functions among the racialized rural aging population with ADRD and risk factors of ADRD (Aim 1), and examine the extent to which that ongoing policy initiatives, such as ACO models, can improve hospital HIT adoption in underserved rural areas to reduce urban and rural and racial and ethnic disparities. Results of our study are expected to (1) identify barriers to access HIT infrastructure among racialized rural populations with ADRD and ADRD risk factors, and (2) provide evidence for ACO design that can encourage HIT adoption to promote treatment effectiveness and continuity and patient engagement for the ADRD population, and engage health care providers in promoting population health among people who have risk factors for ADRD. The COVID-19 crisis has underscored the critical role of HIT and strengthening HIT and public health systems in rural areas has become even more critical. Our study will provide timely evidence pertinent to system design.