When you get right down to it, lots of individuals and organizations fear interoperability. I am finding a great deal of resistance to the notion of the real deal of single sign-on longitudinal type record across organizations interoperability. Most want to only emit little squirts of electronic data and only under pressure to do so.
Many fear ‘their’ records and ‘their’ patients being ‘stolen’ from them by other organizations, practitioners or whomever. Because the ‘other’ organizations and practitioners will steal but they won’t. Classic Prisoner’s Dilemma thinking. https://en.wikipedia.org/wiki/Prisoner%27s_dilemma
Those fears are very powerful and in my opinion not rational in the face of a nationwide doctor shortage. Convincing others to change under those emotional circumstances is very difficult. I am wrestling with that now.
My fear is that classic interoperability notions and architectures ‘work’ about as well as government ‘works’. I further fear what the government might promulgate in the name of interoperability when it isn’t a software issue.