I work at a major hospital/university as a research engineer and, 100%, the whole system is completely broken. Using our hospital and the 10 or so other major hospitals we work with as my source, I cannot come to any other conclusion.
HIPAA is constantly touted as the reason to push more and more CYA hurdles on to the staff's day to day interactions. One of the hospital I work with has an email system where you receive a notification (via email) that you have a message from xyz@majorhospital.com, in the body is a link you have to click through to reach a "secure" portal, then you 2FA, just to read an email someone sent _you_ (with no PII).
While the system that actually handle all the PII are basically rubber stamped with no real security reviews. Prototypes I've built that should never pass a security review, regularly do and get let out into the wild. I've been screaming from the top of a mountain for years and all I ever hear back is that it would cost too much, or prolong the dev cycle, or <enter reason here>. If I counter with "I can't believe this will pass HIPAA muster," the answer is always the same: "It passed the review and that is what matters."
When that something eventually happens, we can say we went through the proper vetting with the review team and that's it, next to no liability for building crap infrastructure. Of course the security review team will say, they used an analysis software that cleared everything so it's not their fault. Finally the company that made that software will say it's not perfect, but it got certified by XYZ, and just like that the whole thing blows over.
The hospital itself is what facilitates this shifting of responsibility, they pays millions upon millions of dollars for any software claiming to securely retain and protect PII, when all to often that software isn't even in beta, let all vetted and hardened. But hey, they got some certification that the hospital can point to and say "It wasn't us." Every year there is some new thing we are supposed to do that feign interest in security, but the weakest links just keep getting weaker. No one cares about your personal information, hospitals only care that they aren't liable when your personal information getting leaked.
I literally lie to my doctor, not because I don't trust her, but because I know that it's just a matter of time before my information is out there.