The exploding usage of telematics and internet techniques also in the Health Care environment imposes a re-thinking of the basic services that an Information System should provide. The standard CEN TC251 HISA ENV 12967, “Health Information System Architecture” while addressing specifications for patient coherent identification between departmental and global hospital information systems, leaves a cloud of uncertainty about inter hospital information system collaboration, delegating a pure technological layer (the so called “bitway” layer) to solve communication and interactions. The faced reality of heterogeneous systems in a regional healthcare environment drives the design of an architecture that includes functional middleware services implemented to create co-operation among several local identification systems and laying on a technical platform able to deal with distribution. This article explains how the InterCare HC4011 project designed and tested such services, and the conclusions reached.