So you're saying you don't want them to have backups of their systems?

Not being a facebook user I would find it amusing if a meteor took out their data center today and the site can't be restored on account of the ToS not allowing them to keep backups.

As in many cases with updated contracts (not even sure a ToS counts as a real contract), this is mostly just the paper being adjusted to reflect reality.

Nonsense. There are thousands of hospitals alone and perhaps they all have single-system record keeping, but I doubt it. To take a famous example, the Cleveland Clinic is local to me, they employ about 800 IT staff; I know for a fact they have a cadre of Oracle DBAs as well as a team of SQL Server DBAs. I also know for a fact they have 200+ production databases throughout their organization--most of which contain patient records of some sort.

However my family doctor employs 0 IT staff. She uses commercial off-the-shelf software to manage her records, having gone digital a couple years ago. Yes, there's a database in there somewhere, but no DBA. And she still has tens of thousands of paper folders with paper records in them and no plan to digitize them--and don't forget this plan requires such records to be digitized. The logistics of doing such a thing for tens of thousands of single-doctor practices nationwide are staggering.

Again, I think it's a great project and we'd get way more than $100B back out of it in a generation, but if anything they underestimate the size of the project. I'm not saying it's complex, it's just huge and labor intensive.

Because they don't have any notion of interoperability and because an individual practitioner (or hospital, for that matter) won't realize any direct cost savings.

But interconnected health systems are key to patient well-being and cross-the-board cost savings. Health care specialists are great for fixing localized problems, but if my cardiologist and my dentist don't talk about my prolapsed mitrial valve, I can get an infection and drop dead sometime between having a mouth full of cotton and spitting into the little sink you can never quite reach from the chair. (OK, maybe not that fast but you get the point I hope.)

This is a big idea initiative that can benefit our society so greatly in so many ways it's staggering (consider the medical research possibilities of mining such a database, not to mention the possibility of genuine customer care). This is the kind of thing that government has to do because private industry has no motivation.

The problem is that precious few people around here (including me) would want to get involved doing technical work for the government. I have a feeling it won't be as easy or as cheap as they seem to think, even though at its heart it's a really easy (if labor-intensive) project, because a lot of the high-grade nerds can't stand the way government does things.