Prior research based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study sought to expand upon those findings by focusing on the wide-scale implementation of these measures in the 79 CAHs in Minnesota from 2011-2013 through interviews with six representative CAHs. It found all six participated in one or more type of training for reporting the measures, expressing satisfaction with modes ranging from webinars to in-person trainings. Some challenges to implementation included inconsistent information on timing and reporting standards (causing confusion and frustration), in addition to several CAHs demonstrating a lack of familiarity with the emergency department patient transfer communication measure set and its intended quality improvement benefit. Most hospitals found submitting their data to be easy, but most also cited stress from the quick turnaround time expected. While the study’s results with volunteers may not be indicative of a full-scale implementation that requires facilities to participate, the success of implementing required reporting of quality measures relied upon a team’s composition, communication efforts, prior relationships, and experience with data collection and abstraction tools.