"Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. A staggering amount of money has been paid out under HITECH to incentivize providers to make EMR progress, but we still have countless situations where one EMR can’t talk to another one right across town.
When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay. Now, don’t get me wrong, I realize that “interoperability” is an elastic concept, and that the feds couldn’t just demand that vendors bolt on some kind of module and be done with it. Without a doubt, making EMRs universally interoperable is a grand challenge, perhaps on the order of getting the first plane to fly." The installed base of 'legacy software' required significant upgrading and even replacement. In addition to interoperability many health data exchanges had to be formed and a new sustainable business model had to be developed. Initially HITECH funding and other grants expired leaving the embryonic exchanges insolvent. It was and still is a complex problem.
A critical component for providers was the totally unrealistic timetable and time pressure coupled with financial incentives to change. Many are still resisting the MU process and would rather face a penalty for not adopting MU. Instead of completing the process in three to four years it will most likely take ten or more years to mature.