Once providers have EMRs than one needs to have a way for information to move securely between them. Most health service organizations understand that they need a way to share information between various EMRs. This will include the ability to move CCDs between EMRs. What happens to the information, how it is viewed, whether the EMR’s decision support tools can act upon the information from another EMR is a complex question and the details of intention and capability matter here. Examples of companies who provide this service are Health Unity, RelayHealth, Kryptiq among others. This is becoming a commodity service.
Accurate patient matching is important in this layer. A community wide master patient index (EMPI) is an almost essential component this layer, though new developments eliminate this requirement over the next 10 years.