When networked PCs and rapid application development platforms became popular there was a "Cambrian explosion" of custom electronic health record and practice management applications built by doctor hackers who knew exactly what they wanted, and had just barely enough technical skill to sort of make it partially work. Those have gradually died off because commercial products kept improving, and the cost of complying with security and interoperability requirements kept escalating. But I predict that the cycle will now repeat because the combination of AI coding tools plus headless EHR platforms (built in security, storage, and APIs) has made it easier to build a custom EHR that actually works.