Two years after John (EMR & HIPAA) wrote this post, I look at it again, and you may have just as well written it today. Nothing has changed. As you've mentioned, not all vendors and providers face the same challenge, but majority of them do. In fact, I venture to say that the problem has increased, judging by the number of requests we get from providers that want to 'switch'. When I ask why, the answers in most cases is systemic to what you've outlined here.