There's not much room for competition because the level of rules and regulations required to enter the market are very high. Basically the only companies that

There's not much room for competition because the level of rules and regulations required to enter the market are very high. Basically the only companies that can manage that red-tape are massive corporations. The end result is a system like Epic that can do everything. These monoliths are usually large, difficult to change, and riddled with tech debt. Creating user stories for the thousands of different things that an administrator/physician/nurse/patient can do in these systems is seemingly an insurmountable task. I wouldn't want to try to rebuild a software system like Epic and I absolutely would not want to work on a system like that. Furthermore, Epic is sold to administrators, not physicians. It checks all the boxes so it gets the contract.