The Nebraska Health Information Initiative has signed 14 critical access hospitals to its statewide health information exchange in recent weeks, with others expected to join as more hospitals roll out digital health record systems. 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. "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.