While most states are gearing up health information exchange strategies, some states are further along than others. Nebraska is among states already making strides in expanding its capabilities for healthcare providers to exchange patient data.

The Nebraska Health Information Initiative, or NeHii, has expanded its presence in central Nebraska with the addition of data sharing by Mary Lanning Memorial Hospital, which serves the city of Hastings.

Until now, most healthcare providers contributing data to and using the exchange were situated in the Omaha area in the eastern part of the state. Last year, several major healthcare organizations and hospitals in the region, including Alegent Health, Children's Hospital and Medical Center, Methodist Health System, and Nebraska Medical Center, successfully completed a pilot of the exchange.

While Mary Lanning Memorial is the first hospital to join the exchange since the pilot launched, other large healthcare providers in the state will be joining soon, including Creighton University school of dentistry and the university's Creighton Medical Associates network of physicians, also in the Omaha area, said Deb Bass, interim executive director of NeHii.

After that, the exchange will expand west with the addition of Great Plains Regional Medical Center.

"By January 2012, we're looking at 90% to 95% of the population" of Nebraska to be represented in the exchange of patient data facilitated by NeHii, Bass said.

While the population of Nebraska is about 1.4 million, already data for 1.5 million patients is available through the exchange. That's because patients in neighboring states such as Iowa, Kansas, and South Dakota often seek care from major healthcare providers in the Omaha region, said Bass.

The key technology underpinning the exchange is a Web-based data exchange framework from Axolotl that includes master patient index, record locator, clinical messaging, and EMR products, said Bass.

The federated hybrid data model used by NeHii for data exchange has data providers -- e.g., the hospitals, labs and radiologists -- securely providing copies of patient data, such as lab and other test results, allergies, medications, and admission and discharge information, on "edge" servers.

When an authorized healthcare provider queries for patient data, the master patient index and record locator finds information about that patient from the edge servers and displays the data for the clinician.

"It works like Expedia does for travel, but for healthcare," said Bass.

Participating NeHii healthcare providers -- who also provide data to the exchange -- pay a monthly license fee.