When talking about sharing clinical data, we technical people have the tendency to point to the lack of standards and headaches associated with the secure transmission of such sensitive information. The good news is that over the years IHE (see below) has been faithfully working at creating frameworks for sharing medical data.
Last year, while at Connect 2009 in Washington DC, I had a chance to meet Karen Witting - the co-chair of IHE's IT Infrastructure technical committee. Karen, a senior software engineer with IBM, has done a lot of work for IHE and NHIN since 2006 and together with other very dedicated people has been working tirelessly at providing standards for sharing medical info.
Why is this relevant? Because no HIE should buy software from a vendor that does not implement the IHE frameworks. By the way, these are not "standards" but rather a theoretical abstraction of the interaction between various health entities. They are definitely the starting point.
Here is a short description of what IHE does:
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