Ambulatory EHR implementation targets 12-month timelines to production. Understanding what actually ships in that window shapes realistic expectations.
Months 1-3: Foundation
1. FHIR server deployed (dev, staging). 2. Terminology server operational. 3. Team training completed. 4. Initial US Core profile support.
Months 4-6: Core clinical workflows
1. Patient registration + Patient resource writes. 2. Encounter workflow + Encounter resource writes. 3. Vital signs + Observation resource writes. 4. Basic problem list (Condition resources). 5. Medication reconciliation (MedicationRequest reads).
Months 7-9: Integration and ecosystem
1. First SMART app launched. 2. Basic CDS Hooks integration. 3. HL7v2 ingestion pipeline operational. 4. e-Prescribing integrated.
Months 10-12: Production readiness
1. Bulk data export operational. 2. Auth server production-ready. 3. Inferno conformance passing. 4. Backup and DR procedures documented. 5. Team on-call ready.
Deferred to year 2
1. Full CMS-0057 compliance. 2. Advanced CDS Hooks. 3. Multi-EHR integration. 4. Da Vinci profiles. 5. Advanced Subscription semantics.
Team composition
1. Executive sponsor. 2. Technical lead. 3. 3-5 FHIR engineers. 4. 1-2 DevOps. 5. 0.5 terminology admin. 6. 1 clinical informaticist.
Common 12-month mistakes
1. Ambitious scope (aim for less, ship faster). 2. Deferred conformance testing. 3. Custom auth instead of SMART. 4. Manual terminology updates. 5. Bulk data deferred to "later".
Success signals at month 12
1. Core resources working end-to-end. 2. First SMART app in production. 3. Inferno tests passing. 4. Auth production-ready. 5. Team on-call.
Ambulatory EHR implementation in 12 months is achievable with focused execution and dedicated team.
