I agree that data integration is not the only problem. But no user interface and no decision support function can work sufficiently without data. Indeed it has been the sense of the people who built the RMRS, that you first need to give physicians useful data before you can ask them to enter data (as notes or orders.) So, while data is not the only problem, it is the most crucial problem.

"The software is the standard" sounds catchy, almost like "the message is the standard" as it had been said by the XML (then SGML) proponents in the past. Neither is really true, because you need to interpret the XML message and interpretation of non-trivial content is not self-evident. The same is true for software. Any large software project, the RMRS not exempt, has a big problem with rules of interpretation of data being hidden in program code. The key of a standard is that it lays these rules open. As the data and the rules for their interpretation get more complicated, it is not an easy thing to do even for a standard.

But the most important point about a standard is that it is implementation independent. I can overload any data with my software so that it works beautifully, but I cannot expect anyone else to do the same tricks, if I even understand those myself.

I think the right approach for VistA is to find an adopter in one of the new RHIO projects that are presently ongoing. I think the excercise of transplanting VistA to a truely new organization will be a great way to make that point. Are you not involved with any of the federally funded RHIO projects? I think you should.

I agree that it might be a lot more effective for struggling RHIO consortia who spend millions of $ on meeting and consulting fees to instead forge ahead with a VistA implementation. But I do not think that a federal mandate that requires the use of VistA should be considered, and I don't think you mean to say that.

I agree with your last sentence. There is a lot of activism to do something even before that is reasonably possible. With really useful HIT we are still in an era akin to the time when people tried to build contraptions that would allow them to fly. There were many beautiful devices, some even worked a little, but it took all that to figure out how best to fly. Let's not try to establish an FAA to regulate the early efforts of the Wright brothers. ;)