[jihoon796]

Like qudat said, the level of rules and regulations required to enter the market are indeed pretty high, but I don't think they are insurmountable. And industry connections certainly do help in getting contracts, but people will generally listen if you have good ideas.

The people making the purchasing decisions are almost always pretty removed from day-to-day usage of clinical software (and the bigger the company, the more true this is).

But how will you present to them that your new product is "better" than that of the incumbent's? You can say, "our product can do X feature 10x better than another product", but if they reply with "unless your product has dark mode for a select number of physicians who live in WA and NY state, it's going to be a no-go. We already have another quote from someone else who will do this for us", what are you going to do? You may resist at first, but in order to win the business, you too will likely repeat this process ad-nauseum, until your "MVP" becomes just a "VP".

These decision-makers are also cautious about "new" technology (and rightly so, for the most part). Since if something does go wrong with patient data, it is considered catastrophic - and who will be to blame then?