Slow software releases to custom client environments. Slowly and painfully trying to standardize the environments while keeping existing clients happy and supporting old releases. Hotfixes, custom install scripts, and supporting linearly scaling sql server vms causes a slow churn of software updates. DOS, gets maybe 2 or 3 releases a year. Meanwhile other (EDW, big data, and BI)software vendors are surpassing Health Catalyst in features and scale.