My day job is building healthcare interfaces. I've done more than my share of immunization registry interfaces, where we connect a clinic up to the state registry.

If I've learned anything working with state governments, it's that they all think they know better than the other states. They'll all set off on their own paths, rather than duplicating the successes from other states.

Only after a few annoying failures will they come to something akin to parity (in the case of immunization registries, it's the CDC's specification guidelines, which were there all along).