Great Lakes Health Connect (GLHC) found that Meaningful Use has driven the implementation of electronic submissions of immunization, reportable lab, and syndromic surveillance messages to state registries. Scaling the implementation from hundreds to thousands of locations in a short period posed a significant challenge. Building unique interfaces for each EHR was not a scalable approach. GLHC implemented a single gateway for each state registry and developed a standard interface process through their HIE vendor. Instead of establishing a costly VPN, GLHC used a software agent from their vendor that uses the public internet to transact encrypted messages to GLHC’s core platform. This made the requirement for even the smallest office to have just a simple internet connection. GLHC was able to install the agent in a few minutes and have each office ready to go. Overall, this architecture allowed GLHC to on-board many offices each week and quickly respond to the needs across the state.