Crucial question.  There are two main lines of thought that I perceive. 
One is that we are trying to tie together legacy systems into a
"meta-system".  The other is that we are trying to create a basic,
functional electronic record.  The latter is where I would put my time
and effort.  And if we want to break the latter problem up into smaller
pieces, I would tackle medications.  This covers an enormous amount of
ground: discovering what medications a patient is taking, discovering
incompatibilities between medications, discovering what medications a
patient should be taking, knowing all the medications the patient could
take, transmitting prescriptions over the net, etc.
One of the good things about VistA as a model is that they have cracked
most of this already.
John Gage

"Woodhouse, Gregory J." wrote:

> I've really seen addressed is "What problems are we trying to solve?" Put a
> little differently: What is it that we intend to accomplish? What will the
> software we evnetually create offer that current systems do not (other than
> being open source)? Once those questions have been answered we can start

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