OK, here is what the last guy screwed up. If you are serious about interoperable health records for every American, this should get you started.
Firstly, treat the initiative like the moon shot that it is. It is complicated, it requires a great deal of planning and a great deal of money. Think of NASA, now you have an idea of what it will take.
Secondly, you will need a patient identifier for everyone in the country. This includes non-citizens, because they get care too. If you are worried about the privacy implications of that, then scrap the whole thing. If every provider can’t use a single number to correctly identify their patient then this doesn’t work.
Thirdly, this is a national project. Treat it as such. Americans don’t stay in regions – we travel; we relocate. Focus on a single national solution.
OK, now the important stuff. The first time I ever heard the phrase “standards harmonization” was from the first person that the existing administration put in charge of health records. It is a STUPID concept. The existing standards cannot be reconciled. They are apples and oranges. Even if they could be, we can’t waste time trying to add a layer of complexity on top of something that is already too complex, which brings me to my last point…
Don’t try to make everyone happy. There will be winners and losers. There will be technology companies and healthcare providers that made bets on the wrong technologies and standards. You are going to have to break some eggs to make this big omelet.