This document discusses challenges and approaches to integrating information systems at both the national and international levels. At the national level, legacy issues like unfamiliar platforms, protocols and business rules embedded in user interfaces can increase integration costs. Common approaches to integration include standardizing communication protocols, data formats and classifications. Successful integration also requires addressing technical, organizational and semantic aspects. At the international level, defining common standards and data models is even more difficult due to the need to account for different legal requirements and technical solutions across countries. The epSOS project aimed to enable cross-border health information exchange in Europe by defining common document structures, classifications and semantic services while preserving the original structure and content of data.