> Hospitals don't check software quality when making purchasing decisions (much beyond "this button doesn't work")

This! The worst piece of low quality garbage I've seen from the inside is hospital software. Nobody really cares or understands software on the hospital side, so anything goes. The product is inherently complex, so there are only a small number of large companies who don't care either since they can rely on customer lock-in, no matter how crappy their service is.