I truly understand some of the questions posed by you, which seems to be in line with the challenges that not only have I faced personally but also have my other practicing physicians.

I completely buy you point about the right business models but the fact is that like hospitals or private physicians even the EHR vendors have a business model.
What is important for a practice is to not only judge the EHR vendors by their product features but also have a look at the overall business or physician outreach ( references ) of those vendors.

Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.

Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
Looking at the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of not only REC’s or EHR vendors but also helping out practices in managing and creating their unique business model. It can be one of the possible answers to the ’safe vendor challenge’ as discussed by many critics.