I don't have experience with health systems. I do have experience with entering a market with settled incumbents, and I do have experience in large organisations.
Firstly, Open Source is not a factor here. The number of customers who care about our code is zero. Not even rounding to zero, just zero. Paying someone to look at, understand, Make, test, change etc dwarfs what they pay us. They are in the "health" business not the software business.
Our business model -does- matter though. We often get evaluated "as a supplier". The obvious things like how long we've been around, staffing levels, track record etc. Also non-obvious things like profitability, income model, some even ask to see the books (we draw th line before that.)
It turns out they're not buying software. They're buying a relationship. They want to know we'll be around in 5 years, 10 years, 15 years. That's -much- more important than the cost.
(As an aside, having the primary message on your front page literally soliciting donations is a bad look. Funding via donations overall is not a good look.)
Lastly the software is not used by the guy who makes the purchasing decision. The buyer doesn't care about the UI or workflow (much). As long as the price is "ok" (and he has a large budget to spend) that doesn't matter either. He cares about the warm and fuzzies the salesman gives him. He cares about the success of the project overall. He cares about his job rolling out this big project. Decisions like this are career making, or career breaking.
Oh, and the desire to -change- systems is zero. Sure there's lots of whining, that's easy to ignore. Changing is high risk (and will bring in the same amount of whining).
This rings more than true, but it reflects market conditions that are not set in stone (otherwise we'd have lots of hundred-year old incumbents, but the evidence is that companies live shorter and shorter lives).
The cost dimension is (ultimately) what indicates whether a domain is ripe for disruption. No matter how cozy an arrangement it will eventually implode if it extracts unjustified rents while alternatives are readily available. Ofcourse cartels can remain untouched longer than you can remain solvent. There is a timing element and luck involved.
Open source can be an important lever in this direction because it is not just "free", it is also more transparent. Ceteris paribus the cost of assurance should be lower. When resistance to chance is primarily due to risk aversion this could be an other element to weigh in. But for this dynamic to kick in there has to be adoption and amortization of costs and that is a catch-22.
In other words you can choose to play the game, or you can choose to fight the rules. I don't recommend the latter, it doesn't work.
Frankly I recommend the former - if you don't like the game, don't play. There are lots of other markets to play - enterprise software is just one of them. Other markets have different rules and you should find a market that suits your strengths.
While it frankly doesn't matter, I will point out that your comment that "its bad" should have the phrase "from my point of view" tacked on. You might even suggest it's bad from the "users point of view". But the "business point of view" is a different view, and also important. The ability to understand that point of view - and to best address those needs as well, are critical if you want to enter the Enterprise space. The business writes yhe check, not the user. The business is the customer not yhd user.
Or, to reference back to the original article, if you want to play in the Hospital Admin space you need to understand what hospital admin is, and what it needs. Are hospital admins asking for free unsupported, open source software, with funding models based on "hope"?
As software people we are seldom trained to understand business needs. Our career is in writing software for end users. We focus on technical things, complain about bloat or speed, are UI focused and think "user" when someone talks about "customer experience".
Google is the poster child for this. They push the technical boundaries, have really good products, do technical things really well, spend lots of yikes on UI etc. But I wouldn't depend on them for my business, because, frankly they're not dependable. They don't offer me customer (much less user) support. Their pricing is erratic and subject to change. And the service they provide may be gone tomorrow. They serve "me the user" but not "me the business". They're not "bad" - they just don't serve the needs I have.
The last part missing is "build a flawed product and bake it into the contract so you charge high consultant costs to the customer to fix it" which is where the cash cow is for many enterprise / B2G products.
Firstly, Open Source is not a factor here. The number of customers who care about our code is zero. Not even rounding to zero, just zero. Paying someone to look at, understand, Make, test, change etc dwarfs what they pay us. They are in the "health" business not the software business.
Our business model -does- matter though. We often get evaluated "as a supplier". The obvious things like how long we've been around, staffing levels, track record etc. Also non-obvious things like profitability, income model, some even ask to see the books (we draw th line before that.)
It turns out they're not buying software. They're buying a relationship. They want to know we'll be around in 5 years, 10 years, 15 years. That's -much- more important than the cost.
(As an aside, having the primary message on your front page literally soliciting donations is a bad look. Funding via donations overall is not a good look.)
Lastly the software is not used by the guy who makes the purchasing decision. The buyer doesn't care about the UI or workflow (much). As long as the price is "ok" (and he has a large budget to spend) that doesn't matter either. He cares about the warm and fuzzies the salesman gives him. He cares about the success of the project overall. He cares about his job rolling out this big project. Decisions like this are career making, or career breaking.
Oh, and the desire to -change- systems is zero. Sure there's lots of whining, that's easy to ignore. Changing is high risk (and will bring in the same amount of whining).