Koppel argued that meaningful use stems from a plan hatched by vendors 30 years ago to sell more software with the help of government subsidies and did not always have interoperability in mind. Koppel said a 2009 New England Journal of Medicine article by then-national health IT coordinator David Blumenthal, MD, Ashish Jha, MD, and other Harvard researchers that heavily informed Stage 1 meaningful use regulations did not ask a single question about usability, patient safety, interoperability, data standards or what Koppel called "clunky interfaces."

One attendee, David McCallie Jr., MD, the vice president of medical informatics at Cerner, challenged Koppel's assertion, saying that vendors got together with ONC and created the open-source Direct Project that anyone can use right now to exchange health information securely. The complexity comes from incorporating it into EHR code and into workflows.

McCallie further noted the speed in which the industry developed the continuity of care document. "It happened in two years, which in standards terms is lightning fast," he said.

Koppel was more praiseworthy of the new Stage 2 rules. "I really appreciate what has been done in MU2. It's a marked step forward," he said. He also acknowledged that health IT has so many components, complexities and "moving parts," making interoperability particularly difficult.

Solomon said that interoperability often falls off the priority list when vendors update products, and urged AMIA members to demand it.