To test this hypothesis, look to California. Here we have a very large healthcare system, a variety of insurance providers, a variety of care providers and no i

To test this hypothesis, look to California. Here we have a very large healthcare system, a variety of insurance providers, a variety of care providers and no internal barriers to insurance competition. Still, practices/insurers use different EMRs, sometimes a little different from one another, sometimes radically so. Further, providers/insurers are loathe to move away from systems they already have because of some of the issues mentioned by @JusticeJuice (currently top comment). 1.) It's super complicated 2.) It's super risky 3.) It's super hard to buy and sell, in part because of 1.) and 2.). Even without barriers to competition, there's no consolidated EMR format or a software market with many competing players, what makes you think that opening it up nationally would revitalize the market?