Kristen Valdes from b.well reflects on building CMS's voluntary Health Technology Ecosystem framework after discovering that, despite a decade of interoperability policy, live demos showed only 1 out of 30+ providers could return data automatically. She shares lessons on community organizing when 500+ companies need coordination, but the government can't lead, why the real barriers are business and liability issues rather than technology, and how to prevent legacy players from relitigating settled policy when the goal is implementation, not debate.