The Default Position
One approach some hospitals are taking is to standardize on one EMR throughout the entire organization, eliminating the best-of-breed approach that allowed different departments -- say, ER, radiology, and cardiology -- to pick their preferred EMR. While this doesn't address all the issues you raise, it does get rid of the multiple electronic records often associated with one patient. However, many physicians I've spoken to don't like this practice since some EMRs are not well-suited to the intriciacies of specific departments, according to them. They're unwilling to cede EMR control to a central body, which makes buy-in more challenging.