We have operated as the technical arm of the SouthEast Michigan Health Information Exchange (SEMHIE) since its inception in 2010. Our first project was the Social Security Administration’s nationwide E-Disability service. In 2012 we joined the Michigan Health Information Network (MiHIN) group of approved Quality Organizations (QOs). As a QO, we provided interconnectivity and messaging services for a number of Physician Organizations (POs), providing ADT Notifications, Statewide Lab Notifications and Medication Reconciliation Services. These services continue to run for select POs, now thirteen years later, and have totaled hundreds of millions of HL7 messages and CCD documents.