transmitting radiology (and other) image-based data, sponsored by NEMA (National Electrical Manufacturers Association) HL7 (HL7v2, C-CDA) – a standardized messaging and text communications protocol between hospital and physician record systems, and between practice management systems Fast Healthcare Interoperability Resources (FHIR) – a modernized proposal from HL7 designed to provide open, granular access to medical information ISO – ISO TC 215 provides international technical specifications for EHRs. ISO 18308 describes EHR architectures xDT – a family of data exchange formats for medical purposes that is used in the German public health system. The U.S. federal government has issued new rules of electronic health records. Open specifications openEHR: an open community developed specification for a shared health record with web-based content developed online by experts. Strong multilingual capability. Virtual Medical Record: HL7's proposed model for interfacing with clinical decision support systems. SMART (Substitutable Medical Apps, reusable technologies): an open platform specification to provide a standard base for healthcare applications. Common data model (in health data context) A common data model (CDM) is a specification that describes how data from multiple sources (e.g., multiple EHR systems) can be combined. Many CDMs use a relational model (e.g., the OMOP CDM). A relational CDM defines names of tables and table columns and restricts what values are valid. Sentinel Common Data Model: Initially started as Mini-Sentinel in 2008. Use by the Sentinel Initiative of the USA's Food and Drug Administration. OMOP Common Data Model: model that defines how electronic health record data, medical billing data or other healthcare data from multiple institutions can be harmonized and queried in unified way. It is maintained by Observational Health Data Sciences and Informatics consortium. PCORNet Common Data Model: First defined in 2014 and used by PCORI and People-Centered Research Foundation. Virtual Data Warehouse: First defined in 2006 by HMO Research Network. Since 2015, by Health Care System Research Network. Customization Each healthcare environment functions differently, often in significant ways. It is difficult to create a "one-size-fits-all" EHR system. Many first generation EHRs were designed to fit the needs of primary care physicians, leaving certain specialties significantly less satisfied with their EHR system. An ideal EHR system will have record standardization but interfaces that can be customized to each provider environment. Modularity in an EHR system facilitates this. Many EHR companies employ vendors to provide customization. This customization can often be done so that a physician's input interface closely mimics