It&#x27;s also just a lot of legacy stuff that no one wants to touch because it currently works and brings in money. Good design and practices compared to today just weren&#x27;t around 10-15-20 years ago. Building a large and robust EHR and&#x2F;or practice management solution from scratch using good techniques and design (and good security practices like, stupidly enough, parameterized queries instead of string concat) would be great if it wasn&#x27;t astronomically expensive and risky from a business standpoint. Then by the time you were ready to hit the market you&#x27;d be five years behind or something.<p>Plus everyone will ask &quot;Can you convert some other EHR&#x27;s notes&#x2F;data into your system&#x27;s notes and vice versa?&quot; and now you get to inherit all of that system&#x27;s bad decisions in that area.