Representatives from selected non-federal initiatives working to facilitate electronic health record interoperability say key challenges include insufficient standards, variation in state privacy rules, patient record matching, customization and other costs, and governance/trust-related issues, according to a new report from the Government Accountability Office. GAO interviewed representatives from 18 initiatives that concentrated in one of three challenge areas: standards implementation, data sharing agreements, or network services. Fifteen of the initiatives said they are working to address standards challenges, 11 privacy challenges, 13 patient matching challenges, 16 cost challenges, and 11 governance and trust challenges. Representatives from 10 of the initiatives said criteria currently used to certify EHR systems under the Medicare and Medicaid EHR Incentive Programs are not sufficient for achieving interoperability.