COORDINATE is an optional, HIE integrated software suite that works with the traditional HIE to improve care coordination, which includes transition of care management. Also included is notification and reports for patients with a transition of care, patient prioritization and management, readmissions management, length of stay management and population insights. A feedback loop between acute and post-acute care facility and additional information from acuate and post-acute discharge plans is available, as well as creating a circle of care for the patient based on friends, family, and providers. Post-acute discharge plans, ambulatory visits, home health care and inpatient visits is also provided. This solution is customized based on the facility needs.