The Holomua Project brings together the Hawaii Primary Care Association, the Kalihi-Palama Health Center, Kokua Kalihi Valley Health Center, Hawaii Pacific Health, and the Queens Medical Center in an an approach to information sharing during transitional care. The overall goal of this project is to support the goals and aims directly derived from Holomua planning process. Our implementation plan will assist the Holomua partners in achieving the ultimate project goal to increase patient safety, quality and continuity of care during transitional care for vulnerable populations in Hawaii through improving the flow of information between patients/families, community health centers and hospitals using health information technology (HIT). The specific aims of the project are to: 1. Increase accuracy and timeliness of shared patient information during transitional care between primary care and tertiary care facilities. 2. Reduced incidence of medical errors that may occur due to linguistic and/or cultural barriers between patients and medical providers that prevent accurate communication of health information such as previous medical history and treatment, medications, referrals). 3. Reduced occurrences of duplicated diagnostic procedures performed on patients due to lack of communication between primary care and tertiary care facilities. 4. Increase participation and involvement in decision making by patients or family on health related matters 5. Determine mechanisms by which information resources, information systems, and other IT initiatives and/or networks in Hawaii can best support both short and long term implementation activities of the Holomua Project. The project will consist of both technological and non technological solutions to the problem of transitional care. The technological solution involves the development and implementation of a Master Visit Refigistry (MVR) as a measn of sharing health information between systems. The non technological solutions involve charting wrok flow related to transitional care, polices and pro cedures relative to transitional care, and using dialogue and communication to facilitate transitional care.The technological method was chosen as it represents a scalable, interoperable solutution that takes into account the disparate resources of all the partner organizations. The non technological methods are based on abundant research that illustrates the necessity to attending to the humna side of Information to ensure success of implementation efforts