No sarcasm here (really) -> You have to remember that not everyone is as smart as you.
Lots of folks only know enough to realize they'd bankrupt and lose their medical business trying to reverse engineer and develop software.
Sometimes 'in-house' just isn't an option. An unbelievable amount of the time, it's as unworkable as in-house developing your own transport vehicles instead of buying them from car manufacturers.
I know of a critical application to an eye surgeon practice (2 surgeons) that scans the retina and 3d maps it for the surgeons to track swelling measured in single micrometers. Happily for them, it's running on 7 (this decade's XP). Unfortunately, the 'house' to 'in-house develop' in is a medical outfit that knows nothing about how to do in-house software/hardware/optics development..
Regardless of the price, there is simply no way on earth they're going to be able to reverse engineer that machine/software setup, build the machines and write the software. They're doctors, and the imaging machine development had to cost at least a million, minimum, before you even start talking about patents to license. Hell, reverse engineering and replicating a 1960's sports car is a 1/3 million dollar project, and that is for a company that has already done it and knows exactly what they're doing. Learning how to do their first car cost several million dollars in real money through the bank account.
Even when you start talking about something as simple as billing systems, you still have metric f***tons of paperwork and legal crap for HIPAA compliance, and you have to spend another few tens of thousands of dollars in brib..., er, compliance studies and certifications, with approved Health Department pet consultants who are often relatives of DC power brokers.
It's just a mess.
And all the above assumes that the doctors WANT to become software developers.