Hell, poorer clinics use old versions of EMR/EHR software that they bought in '08 and host locally. Some of that shit barely supports Windows 7. Some of that software doesn’t support things like HL7 properly so getting the data out and into a newer one can be cost prohibitive in and of itself because you’ve got to pay someone to write a translator for a shitty database in a format that was purposefully confusing to keep vendor lock in for a vendor that went tits up a year later.
I mentioned before that I have a lot of certificates for a lot of those companies that no longer exist. If it wasn’t soul crushing I could probably make a decent living just moving people from those systems. But my soul is already a shriveled piece of garbage and I don’t want to purposely squeeze the last little bit of juice out just yet.