OBJECTIVES To determine whether the implementation of an Internet-based communication system improves the amount of essential information conveyed between a skilled nursing facility (SNF) and the emergency department (ED) during patient care transitions. DESIGN: Interventional; before and after. SETTING ED of an urban teaching hospital with approximately 55,000 visits per year and a 55-bed subacute free-standing rehabilitation facility (the SNF). PARTICIPANTS All patients transferred from the SNF to the ED over 16 months. INTERVENTION An Internet-based communication network with SNF-ED transfer form for communication during patient care transitions. MEASUREMENTS Nine elements of patient information assessed before and after intervention through chart review. Secondary outcomes: changes in efficiency of information transfer and staff satisfaction. RESULTS Two hundred thirty-four of 237 preintervention and all 276 postintervention care transitions were reviewed. The Internet communication network was used in 78 (26%) of all care transitions, peaking at 40% by the end of the study. There was more critical patient information (1.85 vs 4.29 of 9 elements; P<.001) contained within fewer pages of transfer documents (24.47 vs 5.15; P<.001) after the intervention. Staff satisfaction with communication was higher among ED physicians after the intervention. CONCLUSION The use of an Internet-based system increased the amount of information communicated during SNF-ED care transitions and significantly reduced the number of pages in which this information was contained.