In this case, I don't think that standards based health information storage and exchange with or without open source systems will be sufficient to overcome the problem. This is a case where fighting fire with fire is probably the only way to get to a better solution than the status quo. That is, I think it will take entities of sufficient power and resources (i.e Microsoft and Google) and most importantly a direct relationship with health care services consumers (via other relationships with those same comsumers) to introduce a health information storage and exchange format that is non-health information system vendor specific.

It will never be in the commercial interest of health information system vendors to adopt standardized formats for storage and exchange. Hence, all of the ISO and other standards work in this area have gone and will go nowhere. While Microsoft/Google solutions will be in some sense still proprietary, they have the power to drag the commercial vendors along if they are successful. No doubt kicking and screaming for sure.