Yes, this will be interesting to observe. As someone who helps physician's offices make best use of technology I have three observations:
1. I think that initial product costs often receive too much attention. Other costs to consider include training, software workflow customization, ongoing support, product enhancements, usability, and integration with other systems (ie medlists, clearinghouses, diagnosis codes, etc). If these things are done poorly then the costs/lost opportunities could, over time, far outweigh product cost savings. If the Vista system has a good vehicle for ongoing support and upgrades, then it will have a much better chance of succeeding. If not, "buyer" beware.
2. My observations continue to reinforce the idea that EMR implementations need to focus on adding strategic value first. We implement information technology because IT helps us do the things we already do better (and maybe differently) than we used to; and because IT helps us do things that we couldn't do without IT. So a decision to go with an EMR system should be based on this idea of strategic value first, not cost. That being said, I believe that the value proposition of EMR systems, in general, has a lot of maturing to do and this probably has something to do with why the cost factor looms so large.
3. This leads me to the idea of Connected Communities. In a community without EMR systems you have a bunch of paper silos. In a community with EMR systems you have a bunch of electronic silos. EMR systems should not automatically imply connectivity. Implementation of EMR systems at the physician's practice can build internal efficiencies at the practice level, but they do not address the fact that a patient often travels to many points of service within a healthcare community. Individual EMR's still leave a fractured clinical record because information does not flow with the patient. There appears to be a fairly strong initiative underway to address this problem. I can see that a connected community initiative could add incredible strategic value as well as reduce entry costs by providing some economies of scale, especially for smaller offices. As you say, "We'll have to wait and see."
Here's a link from the Medical Records Institute website regarding the Continuity of Care Record (CCR), a standard that is being designed to help enable connected communities. http://www.medrecinst.com/pages/about.asp?id=54
