Wes asks, over in Google+, "Would that we were so orderly in health IT standards and that we were moving towards simplicity."
I am sure that everyone is thinking their plan brings Health IT to simplicity, and I would even assert that each plan would succeed. The problem is we don't all have the same plan, thus your efforts to take us down your plan toward your simplicity takes everyone off of my plan toward my simplicity (metaphorically speaking you vs me). Multiply this by the 100 some plans in play, and we get a mess.
This is not specifically bad, because every individual plan has some specific perspective on the problem that exposes a specific need. It is only with these divergences that we get to see what the other plan has to offer. Ultimately we get course corrections that are good. Good examples can be seen in the standards around ‘documents’, going back to text documents (with various character encodings).
Unfortunately in healthcare right now, there are too many alpha-dogs that are unwilling to listen to others. Some are protecting their business-plan, some are wounded by history, some focus on the big picture, some focus on the minute details. Unfortunately in healthcare we don't have just a few big vendors pushing the market, we have 10s of thousands (this is not bad, just not helpful toward fast convergence). We also have intermediary payers that most other industries don't have, who also have an opinion. Unfortunately in healthcare we also have a strong influence by some luminary patients (this is also not bad, just not helpful toward fast convergence). Specifically these unfortunate facts mean there are many plans in play.
This is reality, we must accept and work with this reality. Best case we would use an open and transparent discussion among equals where these perspectives can be harmonized before we start developing. This is simply not reasonable. I hope for reasonable ‘good enough’ stepping stones that seem to head in the direction that most plans are pointing. Each step is an opportunity to re-evaluate both the horizon, present, and past. I see evidence of this behavior changing, I am hopeful that we are close to making a huge leap forward. Unfortunately we have 1000* that huge leap to go.