For example: we used to (still do) keep large files of old notes for patients. In the worst cases think reams of paper three inches thick held together by the flimsiest of plastic ties.

The solution for computerising this? Scan it all. Categorise by date and medical specialty. Unfortunately using this database turns out to be horrendously slow. Each doctor has to download each page from the database in order to look at it and make sure it's not the page they are looking for (no or poor text recognition). As you can imagine, hundreds of doctors doing this at 9am in the morning grinds the network to a halt.

That's just one component of the system we use every day - I have more!

The sales cycle is a year long. At the end of the year the result is either "we are sticking with BigCo's crap that they told us they would improve the last 5 years" or "budgets are due and they need a new wing so ours was cut"

A coworker explained it perfectly: the industry is run in fear. Fear that if you buy software that fails you will be fired. Fear that if someone across the street buys some software and it works you better get it too.