A lot of the current situation came about because of the Hi-Tech act. This was piles of "free" government money for healthcare facilities to use software that met voluminous requirements that are ultimately vetted by off-shore contractors hired by "beltway bandit" type organizations far removed from medicine, patients, etc. The vetting costs in the neighborhood of $100k. This creates a powerful incentive for people making software to make software that is the easiest to push through the gauntlet of vetting. It also immediately ended meaningful innovation because once you have something approved you are not going to rock the boat trying new things the require another approval cycle.