EHR implementations succeed or fail based on execution more than product choice. Five practices distinguish successful implementations.
1. Executive sponsor with technical fluency. Sponsors who understand data flow ship faster than sponsors who treat it as an admin project.
2. Dedicated FHIR infrastructure team. FHIR as a subsystem with dedicated ownership. Not just an integration concern.
**3. Inferno in CI from day one.** Automated conformance testing catches regressions cheaply.
4. Terminology infrastructure investment. Standalone or bundled terminology server. Not bolted-on afterthought.
**5. SMART on FHIR launch early.** Third-party ecosystem access from the start.
Timeline (12-24 months typical)
| Phase | Duration |
|---|---|
| Planning + team | 2-4 months |
| Foundation | 3-6 months |
| Core resources | 3-6 months |
| Integration surface | 3-6 months |
| Production hardening | 2-4 months |
Common execution mistakes
1. No dedicated team → drift. 2. Deferred conformance testing → regressions. 3. Manual terminology updates → drift. 4. Custom auth instead of SMART → no ecosystem. 5. No metrics dashboards → blind to issues.
Success metrics
1. $validate pass rate >97%. 2. Reference integrity >99%. 3. Inferno tests passing. 4. Auth working end-to-end. 5. Bulk export operational.
EHR implementation is a solved discipline. The five practices above cover most of the difference between successful and struggling deployments.
