So my startup hosts and supports a decent number of EHR/EMR solutions and I even seriously entered talks at one point for us to partner up with a large medical conglomerate to write a new platform. That idea died for the same two reasons most similar initiatives in healthcare die: Government and Insurance (called "Payers" in the healthcare industry).

You can write the absolute best EMR & PM (Practice Management) platform on the planet but if you can't get the payers to integrate with it you're dead in the water. The only practices who would even consider you without those integrations are ones not currently using an EMR, which means that your first hurdle with them has to be convincing them to go electronic - which means you own all the logistical hurdles associated with a large-scale chart-scanning operation, user training, mindset shifting, and much more.

And don't even get me started on the barriers to entry the Department of Health and Human Services have put in place....