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I gave a talk on “Unbundling the electronic health record” at #reclojure22 - . I think we need to turn what we think of as the “electronic health record” inside out. 
The conventional approach means thinking in terms of applications, and not data, and is centred on organisations / providers, not the patient, or the wider ‘service’. Architecturally, it is a monolith, at least to outsides, and proprietary and organisationally-centric.
Standards and interoperability in the conventional model are outward-facing - requiring external interfacing and a combinatorial explosion. We end up with multiple concretions, fossilised architectures that are poorly adaptive to change, with data only in context of applications.
