On point #2: Greater sharing might spur patients to seek care elsewhere: See my post on "What Are you afraid of" (click on the link above)

http://motorcycleguy.blogspot.com/2011/07/what-are-you-afraid-of.html

There's a simple way to make patient records available to providers. Organize them around the patient. Our patent-pending MedKaz personal health record system does just that (see medkaz.com).

It stores a patient’s records from ALL their providers in ALL formats, paper and electronic, on a distinctive flash drive the patient owns and controls (NOT on remote servers).

It requires NO networks. The patient simply hands it to their provider who accesses its contents as needed; updates it after each visit (we pay them to do so). It's free to providers, easy to use, doesn't disrupt their workflow, increases their income, and saves them time. They can avoid mistakes and unnecessary tests, and coordinate their patient's care with other docs.

The patient also benefits. They know their records are secure yet available whenever needed, at home or away, in network or out. They can read and correct them, and participate in their care decisions. It’s easy to use and inexpensive.

http://medkaz.com

The problems associated with health information exchange are not primarily technical--they're cultural. Provider groups don't share data mainly because they choose not to do so for competitive reasons. The solution to the health information exchange problem therefore lies far more in breaking down those barriers rather than in looking for a better technology mouse-trap.