(click image for larger view)

Slideshow: 17 Leading EHR Vendors

Nebraska, which has a population of about 1.8 million, is one of the most rural states in the U.S., and with 65 critical access hospitals, or CAHs, has more of these facilities than most other states.

And while more than a dozen CAHs just joined the Nebraska Health Information Initiative, many of the remaining CAHs in Nebraska "are still implementing e-health records," said Deb Bass, a former nurse and NeHII executive director.

[ There is a lot of activity involving health information exchanges. Read Central Illinois Upgrades Health Information Exchange. ]

"Until these other hospitals get that work done, having all of them part of NeHII is still a pipedream," she said. There are many constraints on CAHs rolling out EHRs, including "a lack of technology skills," she said. "Many have only a part-time IT person," she said. Some of those hospitals in Nebraska are so small that they treat fewer than five patients a day, she said.

Still, having the state's CAHs part of NeHII is vital, she said in an interview with InformationWeek Healthcare.

Among other government requirements, CAHs must be located in rural areas and separated from other hospitals by at least 35 miles, or less in mountainous regions.

For many people in Nebraska, there may be a four-hour or more drive to the nearest hospital, said Bass. "That's why HIEs are so critical, especially in very rural areas like this," she said. "When a doctor refers a patient to a hospital, information about that patient need to be sent back and forth," including upon discharge from a hospital, she said.

Among the data exchange services supported by NeHII are the sharing of patient information such as medication and allergy lists, problem lists, pathology and radiology reports, progress notes, and instructions related to transition of care.

NeHII is powered by technology products and service provided by Axolotl, which is part of United Health Group's OptumInsights unit.

To date, NeHII supports data sharing for 1.9 million patients, including some who live in neighboring states but have received care by healthcare providers in Nebraska. Approximately 1,400 healthcare professionals have signed up to use the NeHII service, which costs physicians a monthly license fee of about $51.66, Bass said. "That's cheaper than cable [TV] service," she quipped.

NeHII received a $4.9 million grant as Nebraska's statewide integrator for its HIE. So moving forward after its grant money is spent, for NeHII like most other HIEs that received grants, a sustainable business model will likely depend on subscriptions.

The momentum at NeHII comes during a time when the HIE landscape is in great flux. There are more than 200 HIEs in the U.S., many launched over the last year or two.

Some efforts are struggling to maintain sustainable business models after seed money or grant funding dries up. Others are consolidating into larger HIEs in their communities or states.

Among those HIEs recently closing up shop was CareSpark, a regional HIE in Tennessee, and also the Minnesota Health Information Exchange, the latter which consolidated with the Community Health Information Collaborative.

In a brief issued earlier this month, the National Association of State Chief Information Officers (NASCIO) urged state CIOs who are developing HIEs to improve their business strategies, including mapping out ways to generate revenue to cover operating costs before public funds they already received run out.

The 14 CAHs that have joined NeHII are Antelope Memorial Hospital in Neligh; Avera Creighton Hospital in Creighton; Avera St. Anthony's Hospital in O'Neill; Chase County Community Hospital in Imperial; Cherry County Hospital in Valentine; Community Hospital in McCook; Community Medical Center in Falls City; Community Memorial Hospital in Syracuse; Lexington Regional Health Center in Lexington; Memorial Health Center in Sidney; Perkins County Health Services in Grant; Plainview Area Health System in Plainview; Providence Medical Center in Wayne; Tri Valley Health Center in Cambridge.

Not every application is ready for the cloud, but two case studies featured in the new, all-digital issue of InformationWeek Healthcare offer some insights into what does work. Also in this issue: Keeping patient data secure isn't all that hard. But proposed new regulations could make it a lot harder. Download it now. (Free with registration.)