It's the procurment process and the lack of skilled management. With the Ontario eHealth debacle[1], the people in charge were hospital administrators with no software project experience. They were taken advantage of by the contractors, their employees and, to be fair, their own greed. These kinds of large projects really need to spend the money on a real CTO and/or CPO.

[1] https://en.wikipedia.org/wiki/EHealth_Ontario#Consulting_and...