Malec: When I was at ONC and we were trying to get this thing, I had this notion that it doesn't matter who agrees that Direct is the best thing since sliced bread. If HIT vendors don't have the commitment to build this into their products, it's not going to matter for providers. That's one of the biggest lessons: If the vendors don't step up to get this job done. nobody else can solve that problem. If you look at how this work gets done in other industries, it's not government and standards organizations browbeating the WiFi vendors to adhere to the standard, it's the device makers saying, you know what? If this stuff just works, we're going to sell a lot more of it and it's going to be a lot more useful for the customers we serve. That's where we need to be in healthcare. We have an obligation to make sure that we're not making interoperability a barrier to making the U.S. healthcare system more IT-driven.

Hammergren: That evidence and that philosophy will help drive people to the solution that may otherwise have said, I don't know if I want to participate with those people because we compete with them. I think if you take the view of the patient and the view of the provider, and what's in their best interest, our customers, having access to the right data, a patient with an assured identity, is critical.

Q: Have you heard from your customers? Did you give any of them a sneak peek?

Hammergren: We were pretty careful about what we said publicly.

McCallie: We previewed this over the last couple of weeks with folks at ONC – Farzad and Claudia Williams and others. We previewed it with Deven McGraw, the privacy advocate and with Jamie Ferguson, who is driving the Care Connectivity Consortium with some of the larger IDNs, so they were not surprised by this. And, much to our delight, the feedback from them was uniformly positive. There was not a negative word raised. It really sort of surprised me a little bit.

Q: Farzad has seemed increasingly exasperated lately about lack of progress on interoperability, and has begun calling out vendors for not being more proactive on that front. What has he had to say about this?

McCallie: We shouldn't speak for him, but we can say that he was very encouraging. Arien spoke earlier today about the need to have the market pull with the government push. Without a little bit of both of those, it's not going to work.  

Malec: I'd say a market where the government has to do all the pushing is fundamentally a broken market.

Q: You've emphasized over and over that, even with this new alliance, these five EHR companies are still competitors. Talk about threading that needle between competition and collaboration.