https://www.beckershospitalreview.com/ehrs/klas-ehr-market-s...
I once asked my former hospital IT team why we didn't get Epic ourselves and it was described to me as "You don't get to buy Epic, they reach out and 'offer' to sell it to you". You then buy what they tell you to buy, hire who they tell you to hire, train what and who they tell you to train. If you do any bit of it wrong it eats into your support costs because of a "quality of install" score that either raises or lowers your annual support fees.
As a local hospital IT director told me, "Vanilla is the best flavor." By that she meant that if they purchased a piece of software they were going to use it as-is and not get sucked into a black hole of customization.