And it's so many things -- it's regulation, it's slow-moving, it's hyper-local and non-uniform, it's privacy concerns, it's vested interests, it's interoperability, it's political.
Both health care and education have huge amounts of money poured into them -- the money spent on a child's education per-year is orders of magnitude greater than a Netflix or Spotify subscription. Same with your monthly health insurance costs. So despite all the challenges I listed above (and more), it still seems like if you can pull it off, it's a bet worth making. But that doesn't stop it from being really, really hard.
I'm not sure how one unties that particular knot.
[1] Corruption here being that the primary mission is the collection of monies and health outcomes are a tolerated side effect of that.
Sadly, my observation is that this is the rule (and not the exception) in many industries.
From _The Prince_ by Machiavelli
The long term trend is towards consolidation into combined payer + provider organizations like Kaiser Permanente. All the large medical insurers are hiring or acquiring more doctors to bring member care in house and better align the financial incentives.
https://appleinsider.com/articles/21/08/19/apple-health-divi...
If Apple and Google are both ditching health projects simultaneously, I wonder if that suggests that they have advance warning of some change to the regulatory climate.
But I think there is a growing opportunity for innovation in the new SMART on FHIR app stores run by several major EHR vendors. They're copying the Apple / Google app store model by allowing ISVs to use their platform in exchange for a cut of the revenue. In theory you can write an app once, then deploy to any standards compliant EHR (reality is a little more complex). So the platform handles all the compliance stuff and you can focus on innovation. I expect we'll see a wave of start-ups targeting that platform over the next few years.
I suspect healthcare in the US (and probably elsewhere) has to deal with a lot of liability, and so processes that fly in other situations do not fare well in healthcare. Everything i has to be dotted and every t crossed to make sure you do not end up with any part of the culpability for an adverse healthcare outcome, as well as liabilities from laws such has HIPAA.