Introduction: The ubiquitous availability of medical or care data for authorized clinicians and nurses is expected to increase quality while reducing costs in the health care sector. The standardized, distributed provision of medical or care data is capable to support the vision of patient centered shared electronic health records (SEHRs). A main contribution to cross-institutional data exchange is provided by Integrating the Health care Enterprise (IHE). However, holistic implementations of IHE based eHealth infrastructures for SEHRs are currently rare and security and privacy regulations are not fully covered by existing IHE Integration Profiles. This work aims to point out our experiences and lessons learned from five years of development and the implementation of IHE compliant products.

Methods: Cross-Enterprise Document Sharing (XDS) describes the base components for exchanging medical or care data. A unique patient Identification is described by the Patient Identifier Cross-referencing (PIX) and the Patient Demographics Query (PDQ) Integration Profile. All interactions are logged in an Audit Record Repository deployed once per Affinity Domain and defined in the Audit Trail and Node Authentication (ATNA) Integration Profile.

Results: Based on the IHE Integration Profile XDS and other Integration Profiles high-level components for eHealth infrastructures and applications, supporting a holistic, secure concept and, based on these concepts, software products for a socio-technical cooperative care infrastructure, has been developed. The products are practically evaluated in several real-live projects for setting up an IHE compliant XDS Affinity Domain in the Austrian district of Tyrol as well as of Vienna and for the religious orders hospitals in Austria, resulting in a number of lessons that have been learned over the last years.