I know that EHR companies surely employ both engineers and medical professionals, but are they able to freely innovate and explore, or are they bound to top-dow

I know that EHR companies surely employ both engineers and medical professionals, but are they able to freely innovate and explore, or are they bound to top-down bureaucracy with, as another responder mentioned, misaligned incentives? The kind of thing that I imagine would be a fully open source, open standards implementation that could allow easy portability of records between all providers.