I worked on one of the largest Radiology SaaS coding/billing platform. Working with hospitals is one of the most strenuous industries. Everyone has their own formats and trying to learn the lingo takes a couple years.

Also many players have been in the industry for a long time and it's quite incestuous. I am no systems architect either but the validity of the data at any requested moment is very important so much of the services run in a synchronous environment. In my opinion as much as possible of accounting/scheduling should be async but this is one of the problems the industry is facing i guess.