these do come preimaged.
they have this special post install script. All I do is enter my credentials, then asks for hostname. We have to use the original pc's hostname because they have some apps that only work and authenticate users by the hostname unfortunately, so we can preset em them more than that in our office. So we enter hostname, and it reboots 2-3 times putting in whatever settings it does and joins the domain.
It comes with only about 4 standard preinstalled apps , the majority of the health system uses, but if were in medical records, then they need the barcode scanner app. Im in credentials, and they need scanners to works, etc.
So far so good. Get some more exp under my belt, since health care isnt going anywhere for a bit. And I finally have a few bucks in my pocket.

I've focused more on healthcare also, It's the only growing business currently. everything else is stagnant besides the have no choice but to upgrade or replace.