As the ARRA-driven momentum builds toward EHR adoption by physicians, the issue of certification for these systems still has some issues to resolve. The high cost of certification has been seen as prohibitive for affordable, open source EHRs seeking to compete in this new marketplace. Other potential roadblocks are the ability to modify source code, and the ability to fire your EHR vendor, which are incompatible with the current certification model.
CCHIT has just held a Town meeting to address some of these issues and promote more dialog with the open source community. Slides are available here. This is definitely a welcome development in the quest to make open source a viable healthcare information system option.