My daughter is currently in rural Louisiana visiting with family, so typing this post is hitting home.
The last issue of Health Data Management magazine had a supplement titled " Top Technology Innovations 2008"and it included an article about the Louisiana HIE (LAHRIX) expanding rural data access for physicians and patients via the federated model. It is a partnership with LSU (Go Tigers!)Health Sciences Center and the Rural Hospital Coalition that starts with implementing a portal structure. As the article states,
"in a little more than a year, physicians at LSU and in rural areas of Louisiana have transitioned from faxing medical records to viewing patient medical information in real-time via a Web portal."