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Billing and marketing is likely the reason. There is no one responding to RFPs advocating for GNU Health, and it likely is not up to scratch for medical billing/automated overbilling of insurance providers.

EHRs in the USA, Germany and other countries with numerous health insurance providers are primarily there to ensure every service and tools used is billed fully (or overbilled).

Because the EHR system is not itself an independent system, but part of a broader complex that also includes handling of financial transactions, and financial transactions are what moves money.

GNU Health’s support for the whole set of pre-authorization, billing, payment, and related transactions seems to be...generating manual invoices.

Everyone hates all enterprise software because it is designed to meet the needs of everyone, not the needs of any particular user.

> why not then!

Because people stand to lose profit if GNU Health is used.