The first point he raises is the most critical by far. The silverbacks of the industry deliberately stymie efforts for true interoperability because it goes directly against their primary goal, which is forcing everyone into their platform. Epic in particular has zero intention of allowing anyone else to take their market share by enabling easy sharing of data across platforms. It's far better for them from a business perspective to make interfacing so unreasonably difficult that you are forced to implement their full suite of applications, at which point they hold your organization's data hostage to induce other orgs to do the same. The larger their ecosystem grows, the less they need to worry about interoperability - improving patients' outcomes is not even an afterthought. Their vision of population health reporting is one in which every major healthcare org has been trapped inside their walled garden.