Jeffrey Paul is a Health Information Technology (HIT) Project Manager for the Greater New York Hospital Association. He is working on a four Year cooperative grant with the offices of The Center for Medicare & Medicaid (CMS). There are a total of 29 skilled nursing facilities with a designated Registered Nurse Care Coordinator (RNCC) at each site. The projected is aimed at reducing avoidable hospitalizations by managing acute changes of condition such as elevated temperature or shortness of breath while still in the nursing home. The RNCC educates the nursing on the use of a combination of hand written and electronically recorded tools that assess and monitor the patients progress during an acute change of condition. These tools increase communication amongst staff and have been attributed to the overall reduction of transfers at project sites.