Healthcare is it's own thing, what happens outside it software wise isn't always applicable to healthcare. The system in question is electronic health records

Healthcare is it's own thing, what happens outside it software wise isn't always applicable to healthcare. The system in question is electronic health records (EHR). These are vast systems, really the comparison is "SAP for medical records" as they typically handle scheduling, billing, coding, store reports, notes, results (blood tests, as the tip of the ice berg). The tie ins to other systems are complex. And all of it is critical, as in patient injury or death if sole things go wrong. And much of it can fall under various federal laws, HIPAA is just the start. These are long lived systems, upgraded over time. Replacing one can be a multi year effort for even a small organization. So replacing one isn't done because a new shiny one exists. New entries face a long battle into the industry, and the needs of a family physician are very different from a hospital or large group of hospitals. If you want an idea of the scale and scope, the NYC Health and Hospitals project for their Epic EHR ran $1 billion over budget. Might have been more that that.