Nebraska Health Information Initiative (NeHII) and the Nebraska Department of Health and Human Services (NE DHHS) successfully launched a Public Health Gateway (PHG) pilot project to automatically share syndromic surveillance data. The pilot implementation demonstrated successful integration and automation between a critical access hospital’s electronic health record system, NeHII, and the state’s Syndromic Surveillance Detection of Nebraska (SSEDON) data collection process. The hospital’s ADT feed to NeHII was enhanced and route to the PHG Syndromic Surveillance interface, which provides data mapping, transformation, and sequencing to meet state syndromic surveillance implementation guide specifications. The Many-to-one gateway model provides an efficient alternative to development of point-to-point interfaces between healthcare facilities and the state. Planning is underway to expand this service to additional NeHII participating organizations.