COLUMBIA, Mo.—Statewide health information exchanges in Missouri, Kansas, Nebraska and Illinois will be able to send and receive basic healthcare messages between each using the federally developed secure messaging protocol. The Office of the National Coordinator for Health Information Technology at HHS launched an effort in 2010 to develop a simplified method of “peer-to-peer” health information exchange under the American Recovery and Reinvestment Act of 2009. Federal health IT authorities saw the system, dubbed Direct, as the key component of its broader program to establish a Nationwide Health Information Network that could serve a highly mobile population or regions that encompass multiple states. Direct enables hospitals and physicians with already-established trust relationships to send and receive basic clinical messages such as referral letters, lab results or patient-care summaries. It contrasts with the broader NWHIN technology of query-and-response enabling a clinician or researcher to query a universe of records for a single patient across multiple providers through regional health information organizations, or a network of RHIOs, and obtain copies of those records. Missouri, Kansas and Nebraska are the latest states to link together using Direct. Missouri and Illinois previously announced they were exchanging test messages. Last April, ConnectVirginia, a statewide exchange based in Richmond, launched its services with Direct and offered a year of free messaging as an inducement to get members to use it.