Insurance is part of it, but not all of it. Government regulation is also a big part. EHR mandates under the Obama administration (? who I was generally support

Insurance is part of it, but not all of it. Government regulation is also a big part. EHR mandates under the Obama administration (? who I was generally supportive of, so not a criticism of his presidency in general) created a kind of "false pressure" to move to EHR immediately, rather than "naturally" adopt it at an organic pace, adopting whatever is most beneficial due to demand. I'm not anti EHR, but the way those systems were adopted were definitely forced onto providers top-down, rather than bottom-up like traditional hospital record systems. Hospitals scrambled to implement them in time for deadlines, and there was no room for pushback against poorly implemented structures that were pushed on hospitals essentially. More recently in my field I've seen additional layers of documentation requirements that have nothing to do with insurance, that are entirely state law. I have no doubt in my mind that if EHR rules didn't exist, they would have been adopted much more gradually, and selection would have been dictated by the ability of EHRs to supply features in demand. More competition would have existed and it would have cost less. Maybe some government regulation would have been needed in terms of interoperability standards but it could have been rolled out much much much better. I don't think people fully comprehend the cost overruns associated with adoption of EHRs under government mandates, or how big of a shift there was from records being in-house flexible, and provider and patient-driven, to out-of-house inflexible, and IT-corporation-driven.