The MidSouth e-Health Alliance is a health information exchange that has been in use in the Memphis, Tennessee region since May, 2006. This health information exchange took two years to develop from the time it was initially conceived. Following on the work done by the Indianapolis project, the MidSouth e-Health Alliance focused initially on implementations in emergency departments throughout this region. A total of 321 clinicians have used the system in the 5 emergency departments since s initial deployment. This paper reports on the processes users are engaged in to use the system as well as the demographics and patient characteristics associated with system use to date.