Short answer: hospitals, insurance companies, governments Long answer: It's not like people don't understand that the current situation is suboptimal. It's tha

Short answer: hospitals, insurance companies, governments Long answer: It's not like people don't understand that the current situation is suboptimal. It's that any kind of change implemented unilaterally will leave you unable to communicate with your counterparties. The severe consequences of this (not getting paid, being out of compliance with HIPAA) means that any kind of change to health-care IT at a system-wide level requires an absolutely massive amount of politicking and often fails to improve the situation. The problem is that health care institutions are so interlinked that driving any kind of global change is a process best measured in decades. Combine this with the fact that the culture in health care is very conservative, and people tend to be hostile towards change by default and you have a situation where it's often easier to leave the industry and save your sanity than to remain and continue bashing your head into a brick wall over and over again.