Ken Pitz, M.D.“There may be one or two other small practices that may not go electronic, but we probably would still offer them some type of Web-based interface with the HIE,” says Pitz. Eventually, FAMC hopes to get all interested practices onboard next summer or fall. And further down the line, FAMC will connect with the Nebraska Health Information Initiative (NeHII), the statewide health information exchange. The Nuts and BoltsFAMC opted to use a central repository for its HIE in order to facilitate community health reporting. “When we looked at Axolotl—that’s what the state of Nebraska has—it’s a non-federated model, and that was not quite the direction we wanted to go with for our community,” says Richard Beran, FAMC’s director of information services, referring to the San Jose, Calif.-basedAxolotl Corporation. FAMC is partnering with the St. Paul, Minn.-based Lawson instead, which purchased Dallas-based integration and application technology company HealthVision this January.FAMC has the basics out of the way, but still has a lot of action items left to address in order to make the health information exchange a reality. Namely, what’s left is to figure out a governing structure that has the right balance of physician and hospital administration input. Other next steps include defining what facilities will be able to participate; figuring out how the HIE will share data and build a database; and addressing the necessary privacy and security issues.FAMC intends to initially fund startup costs, and thereafter charge an annual subscription fee for physicians to participate. This is how Pitz and Beran intend to drive sustainability. “Our goal as a community is to exchange and share health information, and the use of the information exchange I think will drive the sustainability,” says Beran. “People will see the value.”