SCHIO connects more than 100 organizations including primary care and specialist physician groups, hospitals, federally qualified health centers, county clinics, providers of mental health and substance use disorder services, public health, EMS agencies, community service providers, national CHI and local reference labs, imaging centers and ancillary providers. SCHIO operated in the early years on the Elysium system and demonstrated clinical exchange in the first NHIN prototype demonstration in 2007.  The health information exchange migrated to the Mirth HIE platform in 2014 – 2015 which added a number of new features including better support for evolving industry standards, advanced electronic forms, the integration of Direct Messaging and successful connection with the eHealth Exchange, the national query network sponsored by The Sequoia Project. Driven by dynamics and the corresponding opportunities in the California healthcare ecosystem SCHIO changed its bylaws and name to Serving Communities Health Information Organization, retaining SCHIO and added the tag line, “Community Interoperability Since 1996”.  SCHIO has pivoted in a balanced effort to support both the California Advancing and Innovating Medi-Cal(CalAIM) as well as the California Data Exchange framework.