Interoperability is easy on paper, but difficult to execute. One challenge is the numerous different EHR products. The United States has over 1100 different EHR vendors (Practice Fusion, 2017) and each of these vendors could have implemented different formats. Furthermore, hospitals using the same vendor could have tailored the EHR to fit each organization’s desires. A standard format to exchange data is difficult to design because of the numerous different vendors and different designed EHRs.Culture is another big challenge to interoperability. Interoperability requires organizations to entrust and to work with other organizations. However, trust and collaboration are troublesome in the United States because the healthcare industry is market-oriented. Market-oriented in relation to healthcare means that healthcare products and services are determined by the free market. Customers are free to spend their money on whatever product or service. Thus, organizations will compete with each other in order to receive the most customers. Also, healthcare in the United States seems to promote separate departments with separate processes. A problem that has plagued the sharing of patient information is information blocking. Information blocking is “the result of an unreasonable constraint imposed on the exchange of patient data or electronic health information” (TechTarget). This practice allows these vendors to charge high rates for the data. For instance, some vendors charge from $5,000 to $50,000 for EHR data to other providers (Reisman, 2017). Additionally, hospitals sometimes limit the information they send to other healthcare facilities. They believe that limiting and controlling patient information may increase revenue and establish higher control of the market (Reisman, 2017). True interoperability may not be possible with the current culture in the United States. Thus, the government may need to step in to help develop interoperability.