jvillagrasa:

Think about a RHIO that has [...] a crs document that grows every day with added or changed clinical information. Only a few xml tranformations and you will have diferents views of a Patient Record [...]

Ah, the nirvana of healthcare integration!! What you described is what everybody is after :-)

The reality is a different beast and what you described is in practice very difficult to achieve due to the multitude of format standards (HL7 v2, v3, CDA...) and vocabularies (ICD9/10, SNOMED, CPT, ICD...) with less than clear rules on how to transition from one to another.

And let's not talk about data lineage, ownership and maintenance...

Nonetheless it's good to think in those terms and move the industry agenda towards bold goals :-)