The three items listed are understandable and can be imroved but one of the purpose of all this was interoperability;
and for no good reason the the Direct Addresses of all users is almost non accessible except my own EHR
 which has these addresses available to all the users of myEHR. This use by Direct Address referrals
 and Thank you for referral  notes was mandated 4 yrs ago and was part of the Meaningful Use. 
Further the corresponding Direct Addresses to facilities/hosp/etc be disseminated 
albet only among the authorizeed community is providers and healthcare institution.

Second , the Rx promgrams in EHR be used to order narcotic and such restricted drugs with a compusuory automatic infaced logon to State
 or can be national narco database ( consolidated from state efforts ) and the the rx can go through--state effort and such are OK 
but for completeness use the EHR construct to the fullest.