While the HITECH Act allotted about $547 million to states and state entities to develop health information exchanges, some healthcare providers are taking matters into their own hands to create data exchanges that more immediately meet the information needs of regional clinicians.

Such is the case of Fremont Area Medical Center, located in northeast Nebraska, about 35 miles from Omaha. The 202-bed non-profit hospital, which is owned by Dodge County, just signed a contract to implement Lawson Enterprise Exchange to create a single source of patient data across all care settings, including hospital, clinics, primary care, and specialty physicians, that are affiliated with or employed by FAMC.

Like most states, Nebraska is building a statewide health information exchange, however to date, patient data that's part of the Nebraska Health Information Initiative, or NeHii, includes primarily lab and radiology reports and demographic info, said Richard Beran, FAMC director of hospital information systems.

While the vision for FAMC's planned HIE is to "plug into theNeHII," the more immediate goal is for FAMC is to create a "community wide health information exchange that provides more depth" in the range of data that's shared, including discharge summaries, doctor office visit summaries, medications, and other information that offers clinicians more comprehensive patient information at the point of care, he said.

The FAMC health exchange will include a central repository of patient data that will assist in government-required reporting, as well as data analysis of "general health patterns," to determine, for instance, whether the community is experiencing larger than expected numbers of cardiovascular cases, diabetic complications, or other issues that could be helped by preventative care, wellness programs, or other initiatives, he said.

"It's essential that we create a HIE for health reporting," said Beran. The creation of the HIE is one part of a three-prong FAMC mission that also includes meeting the U.S. Department of Health and Human Services meaningful use requirements, as well as working with physicians in the community to help them adopt e-health record systems in practices.

FAMC plans to integrate into the community HIE patient data from a number of vendors' e-health record platforms that are used or might be implemented by area doctor practices. However, the "first priority" for FAMC is integration into the HIE of data from eClinicalWorks e-health record systems that many doctors in the community are expected to roll out and are being hosted for the FAMC effort by a third-party firm, Physician Select Management, Beran said.

FAMC is the only hospital in the immediate community, which is home to about 25,000 people. In addition to its hospital, FAMC has about 50 affiliated doctors and five employed physicians that provide care in the region. Most of the practices in the community have about two to five doctors, Beran said.

Beran expects the FAMC HIE will take about six to nine months to install. By next summer FAMC hopes to have at least six to eight doctor practices live on e-medical record systems and ready to exchange data, he said.

FAMC is funding the development of the HIE, but to help sustain it long term, doctors will be charged a yet-to-be-determined subscription fee to use the exchange to access patient data, he said.