Here are my 0.02USD on the situation. I lead an engineering team at a health IT startup doing realtime physiological monitoring and operations analytics for clinical use. I have seen our software through FDA certification in record time. I have glimpsed the madness.

dlitz and others are playing the Waldorf-style heckling from the sidelines "doh ho ho, hospitals-as-startups would shave ads into your scalp". That's real cute. The fact is, hospitals as they've evolved are super gnarly behemoths. They have this insanely conservative culture at all levels...nobody wants to lose their job, and especially in IT, the successful ones have basically made it their life's mission to prevent physicians (who are, generally, pretty smart and freakishly stubborn people) from being overzealous and doing stupid things like spewing patient data over cell phones. They still do this.

Any change whatsoever in their operating environment takes months, because they are completely optimized to prevent systematic change from occurring. There is paperwork and lawyers and billing the likes of which you've never seen. Sales cycles are over 18 months. 18. Months. You could conceivably have two full children at a hospital before they have approved the project you'd use to pay for same.

The technology in hospitals is a bad joke. They cannot reliably tell you the status of a patient, what department they're in, or where in the hospital they've been. Frequently, updates to patient details will come out saying "Oh, whoopsie...this patient? They really are this other patient...wait, shit, those are the same patient." Nurses and docs will occasionally just horde equipment in their offices to guarantee that their department has what it needs, and the hell with the rest. It's absurd. They thought, for a long time, that no nurses would ever be interested in texting results around--and now, guess what, in the handful of places rolling that out, it's been like the best thing ever.

The people? Hoo boy. The nurses are awesome, but turnover and burnout tends to be large, least of all because of how shitty the alarm management situation is in certain ICUs. The docs? Some pretty great people, but getting product feedback from them is basically like calling rand() over and over. They also basically are in fire-fighting mode all the time. So, they'll do nothing to help you until they need something yesterday, and then magically their bitching will open up administrative doors that previously you didn't even know existed.

And that brings us to the administration. Some folks "get it". Mostly, though, especially in IT, they don't. They started their careers as machine operators, and with the awesome application of seniority, they rise through to their maximum level of incompetence. Things like billing 10K for 10gb of network storage on a VM. They only buy big name software, and that's how the deathgrip of Epic happens.

And if you could just bribe these folks to get shit done that'd be one thing--but hospitals (correctly) tend to have these super draconian gift policies, to the extent of not even being able to buy like a ham sandwich for a client. The hospital systems sometimes employ technically incompetent people, but always also close the backdoors we'd use to work around them.

Let's assume you find some docs and nurses on your side. Let's assume you find some IT folks that know how to Get Shit Done, or at least stay out of your way (you know, instead of taking two months to open a fucking port to let something work). Well, now, it's off to the fucking races with legal and billing.

Why? Because legal will have somebody look at a contract, go over it, send it back, and then have somebody else look at it, back and forth and back and forth, take vacations, sometimes just fucking lose the contracts, and then if anybody anywhere made a revision, the process resets. We've had some SLAs and MLSAs held up nearly years because of this. And you can't get them fired, and nobody cares, because of the magical fucking pixie dust of "We're saving people's lives here".

Billing and money, that's the real magic. Why? Because you've got to figure out which buckets of money you're going to get paid from. Is it going to be a grant? Is it going to be funding for some initiative? Is it going to be operations? Will maintenance fall under normal service budget, or will it be some setaside from a budget normally earmarked for new construction? Did legal fuck you and make you miss a quarter's budget freeze?

And that's just the clients trying to buddyfuck you. Like, actually worse than gamers as customers.