Windows 8 was a turn off for traditional PC users because of its radical redesign of the user interface which required consumers to learn quite a bit just to be able to perform their routine tasks.
Each vendor charges the healthcare provider for licenses to enable the integration to happen plus the professional services required to write and test the interface.
Update: We received some clarification from the NCTA. Apparently in point number two, the word interface does not mean user interface, but at the same time the NCTA does believe that certain user interface screens should be required to be provided by the operator.
The FCC let it be known last week in a Memorandum Opinion and Order that a single standard wasn't actually required, as long as the IP interface on the cable box used an industry standard -- the Commission did bless the DLNA Premium Video Profile as a suitable example.
On a more practical level, the unit is compact, USB-powered, and has a built-in audio-interface (no extra sound card required for headphone monitoring).