And I have seen shifts that ACOs have caused first hand! Unfortunately, the only insurer running ACOs is Medicare which is an example of a political solution to the problem. While we have yet to see what the financial implications of ACOs are, I can say that I've seen admins work hard to develop data-oriented preventative care. However, these advances are still only limited to the ACO population, which gets back to my point. Hospitals aren't going to fund patient risk analysis until the economic incentives are in place, and for that reason, I fear that the issue of bad interoperability will exist for as long as we live in a "fee-for-service" world.

As for Kaiser adopting Epic, remember I noted that hospitals can customize the EHR to their needs in detail--it does however require troves of cash. Since Kaiser heavily relies on data-driven preventative care as part of their business model, they pay to have a lot of data systems in place to facilitate their operations. Hell, Kaiser even had an Open API since 2013!![0] Good luck finding that anywhere else!

[0]: http://interchange.kp.org/

In fact they were essentially the first and the reason it has become a near monolopoly

Kaiser was, however, one the first systems to start (2000) and finish (2010) their electronic transition. Their decision had nothing to do with the government mandate in 2009, precisely because their business depended on it.

Also, don't forget that EHRs don't come with a data governance model, so the entire onus of maintaining clean, available, interoperable data falls on the institution. Again, since Kaiser depends on clean, available, interoperable data, they made that a priority both internally and in their contracts with Epic.