A regional healthcare system serving twenty-three hospitals attempted electronic health record integration following a series of acquisitions. Each hospital used different EHR systems, creating dangerous fragmentation: physicians lacked visibility into patient histories across facilities, medication reconciliation consumed excessive time, and duplicate testing wasted resources whilst delaying care.
The business analyst assigned to this initiative began by mapping stakeholders across clinical, technical, administrative, and patient perspectives. She identified immediate resistance: physicians feared workflow disruption and additional documentation burden, IT teams doubted technical feasibility, and administrators worried about costs exceeding benefits. Rather than treating resistance as an obstacle to overcome, she treated it as requirements input.
Through extensive elicitation including shadowing physicians, interviewing nurses, and analysing current workflows, she discovered that successful integration required far more than technical connectivity. Physicians needed single sign-on across all systems to avoid logging into multiple platforms mid-examination. Order entry workflows had to preserve muscle memory physicians developed over years—changing button placements or keyboard shortcuts would create dangerous delays in emergency situations. Medication formularies had to reconcile automatically because different hospitals used different pharmaceutical suppliers.
