“ Our fear is that the politics and business interests are not necessarily aligned and will delay the ability to gain benefits from that type of data exchange.”

I’m not sure that’s so much of a fear as it is a reality. When the government passed the Stark exception that allowed hospitals to subsidize up to 80% of a physician’s EMR, it created a sort of arms race. Hospitals and health systems rushed to sign up as many local docs as possible so that they would be tied to their EMR. It was certainly in their best interest to do so, but created the issues you highlight.

“ But the first wave of that has and will occur in Radiology and Pathology (in my opinion), and over time move to other areas.”
As I was reading your post I was thinking about how “automation” has helped in those exact two areas. Telemedicine has definitely helped rural hospitals here in Michigan in those two areas in particular and while I’m not familiar with the data, I’m guessing outcomes have improved enough to justify any increased expense. It will be interesting to see if allowing say a hand specialist to have a video consult with an ER doc and patient in a rural/urban area can similarly improve outcomes enough to justify the expense. Is it that much better than a phone call? Also if it improves outcomes at all should we care about the expense? The ethical questions are interesting as well. Regardless, it’s wonderful and exciting to have these discussions at all.