In April 2011 five leading US health systems joined forces to create the Care Continuity Consortium, and promised to achieve a clinically operational secured sharing of health information between them by early 2012, this seems an aggressive challenge. But it also drew some respect to see pioneers in the use of electronic medical records systems such as Geisinger Health System, Kaiser Permanente, Mayo Clinic, Intermountain Healthcare and Group Health Cooperative, engage into national level of information exchange.
They are sending the message that the current available standards and profile, do work and can be successfully implemented. This interoperability serves well the clinicians, and patient consent can be managed effectively with large scale interoperability being a matter of political will.
Further development will continue to be done to dial in more and more functionality, efficiency, and privacy. An important message is that the system can fill a need, does support more use-cases than Direct, and is more automateible due to a mature metadata model.