EHR-FHIR implementation delivers value through specific practices. Five that show up in successful deployments.
1. FHIR-native data model from day one. Skip proprietary + facade duplication.
**2. Inferno conformance testing in CI.** Catches regressions cheaply.
3. Terminology as its own subsystem. Not embedded in application code.
**4. SMART on FHIR for all auth.** Even internal service-to-service.
5. Metrics from day one. Per-resource-type dashboards.
Investment sequence
1. FHIR server + terminology + auth (foundation). 2. Core resources (US Core). 3. Integration surface (SMART, bulk data, CDS Hooks). 4. Production hardening (Inferno, metrics, backup). 5. Regulatory compliance (CMS-0057).
Common execution mistakes
1. Custom internal model. 2. Custom auth. 3. Manual conformance testing. 4. Terminology in application code. 5. No metrics.
Success metrics
| Metric | Target |
|---|---|
$validate pass rate |
>97% |
| Reference integrity | >99% |
| Inferno passing | 100% |
| Bulk export SLA | Under 4 hours for 12M |
| Auth E2E | Working |
Team composition
1. Technical lead (1). 2. FHIR engineers (3-5). 3. DevOps (1-2). 4. Terminology admin (0.5). 5. Clinical informaticist (1).
Value realization
1. 6 months: basic FHIR operational. 2. 12 months: SMART ecosystem, bulk data. 3. 18 months: CMS-0057 attestation. 4. 24+ months: full Da Vinci support.
EHR-FHIR implementation delivers real value in 2026. The five practices above cover most of the success difference.
