Rip-and-replace EHR programs fail in US ambulatory groups when the cutover ignores how physicians actually document, order, and hand off work. The chart is the product, not the vendor logo.
A safer pattern is staged modernization: map real workflows, freeze a clinical data model, ship documentation and orders that clinicians will use, then attach FHIR or HL7 exchange once the chart is trustworthy.
Multi-location groups in the United States also need identity, scheduling, and e-prescribing that survive state and DEA constraints. Those are not “phase two” extras; they block go-live if they are late.
Measure success in documentation time, inbox volume, and interface incidents — not in modules listed on a slide. If after-hours charting does not fall, the modernization did not happen.
If you are planning an ambulatory EHR program, budget for clinical champions, a pilot site, and a rollback story. US operators will not bet a Monday morning clinic on a weekend cutover with no exit.