I believe that patient initiated interoperability will be the single biggest driver of innovation.  That starts today with the advent of the information blocking rules.  

Innovators that can gather consumers and provide them a valuable service that utilizes their health record will be granted access to that information by the patient.  The health systems and payers in the future will have to comply or risk significant fines.  

What will the patient do?  What will the innovators come up with?  I have no idea, but I do know that the potential is there for exciting innovation.

Are there challenges.  You bet.  The scope is daunting to the EHR providers and systems.  some definitions need some clarity according to some of the participants.  But in the end, the patient has just been made the locus for information sharing around their health record.  

Should be fun to watch.