The biggest impact is the cost of time and energy spent exploring this fruitless and wasteful expenditure.
It's a database, a really slow database. What database has ever impacted cost or quality? When has a slower technology ever improved anything in healthcare?
As I wrote in my HISTalk readers write. .
Mostly in the finance/admin/supply side because there still a BIG missing link.
Why focus on the real challenge when we can recreate data persistence, ,data or message format, data or message containers, security, transport, and the like? Agreement on more detailed data standards are required. It is a vexing challenge but it can't be ignored forever.