If you integrate the crappy thing everyone's using with something less crappy, gradually displacing the crappiest parts, then the world has gotten better. Maybe not fast by Silicon Valley standards, but still an improvement.

As for health records, perhaps the expectation of a neat database decomposition—data perfectionism—is itself the enemy. For just about any given application, such complete information isn't necessary to improve on the status quo.

From my perspective, too much effort is spent creating One More Standard to unlock data nirvana, and not enough on breaking down the organizational walls and misaligned incentives that brought us to this point.

The post author alluded to this, in mentioning the EHR cash incentives that tragically lacked viable interoperability requirements, and so just served to lock in the major vendors' existing systems.