Your hospital system has decided to investigate implementation of an immunization data sharing project for adult and pediatric patients.  Each hospital and outpatient clinic are currently collecting immunization information from patients and also recording when they give immunizations.  You have been asked to outline a potential project to share bi-directional immunization information between these EMR systems as well as providing the information to the patient portals and NYS and CDC.  There are three hospitals involved, each of which uses a different electronic medical record system (A, B, C) and a series of walk-in clinics that use a homegrown system (D) and multispecialty and primary care clinics that use another system (E).  These different EMR systems and the state and CDC systems do not use the same coding for immunizations as there is no specific standard currently required.  Some of the clinics use registries attached to their EMRs to record information to facilitate sharing with NYS and CDC.