Abstract: An electronic medical record exchange system includes an electronic medical record appliance to interface with a first legacy electronic medical record system. An electronic medical record gateway server interfaces with the electronic medical record appliance and a second legacy electronic medical record system. The electronic medical record appliance and the electronic medical record gateway server communicate utilizing assigned doctor identifiers and patient identifiers that are different than assigned doctor identifiers and patient identifiers utilized by the first legacy electronic medical record system and the second legacy electronic medical record system.