Lot of good points above. I would agree with many; here I will emphasize the Ref App’s value in keeping some consistent application structures as a home for core, reusable basic application-level structures
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It is a starting point for implementations, as described above.
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It contains basic core application-level modules such as drug ordering, notes, allergy entry, test results, perhaps more advanced but widely-valued things such as flowsheets and immunization records. It reduces the need for rebuilding in each implementation, propagates useful functional innovations across current and new sites, reduces the structural divergence that would otherwise happen with those varying implementations, and ensures that core services such as security, reporting and clinical decision support can be largely reused from one site to another.
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It (eventually) could be a basic usable turnkey distribution for implementations that don’t have access to development resources. It does not have to be complete in the immediate future, but incrementally gets closer to being a complete basic application.