[SqueamOssi]

Isn't this problem with inefficient and expensive healthcare systems another example of poorly aligned incentives? The vendors have financial incentive to build and sell systems that require long term, expensive, support contracts. Hospital administrators are incentivized to install turnkey systems (that don't require lots of their involvement), and to choose systems that provide reasonable assurance of regulatory compliance. It is simplest to accept vendors claims of improved productivity and overall long term return on investment. When the cost turns out to be higher than anticipated due to reduced productivity of staff and growing software customization services, those costs can be passed on to patients. From the perspective of the Hospital admins, and the vendors, all is well.