Scaled Agile Framework offers a solution to this problem. I've used it and it works, but it needs full support from senior management to be effective.

There is an industry standard for secure email. http://directproject.org/conte...

This is common practice. The specialized data entry person is known as a "medical scribe". Physicians (especially certain specialists) are so highly paid that hiring a separate employee to do data entry can actually save money by allowing the physician to see more patients in a day.

That's not true. You can send any file attachment such as JPEG or PDF encoded as an ED value in the OBX-5 field. No Z field segments needed.

Please explain how the HL7 V2 standards group could have used XML (standardized in 1998) or JSON (formally documented in 2002) when they did their work in 1990? The new HL7 V3 standards do use XML, however vendors haven't fully adopted the new version yet.