2003, in San Diego, California, as an assessment of where the majority of the industry stands in relation to information systems and associated data standards for data interchange. The Interoperability Demonstration Project was a series of live technology demonstrations, conducted in partnership with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Markle Foundation/Connecting for Health initiative, and 19 participating member organizations. The project presented real-world scenarios and clinical cases focused on the prevention and reporting of potential adverse drug events (ADEs), public health reporting of notifiable diseases, and continuity of care. It was intended to highlight several HL7 standards and show how they currently address these critical health care issues, as well as to explore the gaps between what is available today and what is needed to meet a set of increasingly complex demands on the health care system.

The basis for one of the interoperability demonstrations was a patient scenario describing an ADE as well as a near miss. The events in this scenario were characterized by the need to coordinate care across multiple providers in different settings; thus the demonstration was focused in particular on exploring the potential for using interoperability standards to improve care coordination. From the committee’s perspective, the goals of participating in this demonstration were to:

• Highlight how interoperability standards can improve communication and coordination of clinical data among care settings (inpatient, outpatient, pharmacy).

• Identify limitations of existing systems and emerging standards with regard to patient safety.

The participants in the demonstration worked together over several months to define what functions would be demonstrated and how they would be implemented. The scenario was modified to reflect the available vendor participants and corresponding system functionality (see Box 2-1).

Participants learned several lessons in preparing for the demonstration. They spent considerable time making decisions, compromising, and agreeing on how to capture and share data, in part because there were several potential approaches and no clearly established standard for implementing particular functions. In the scenario, for example, the clinicians treating the patient in the emergency department and in the hospital must discover what medications she is taking; as it turns out, medication recently prescribed for hypertension may have resulted in an ADE. This information may be re-