Starting Point: Quick System Snapshot

• Which major clinical, lab, billing, and public health systems does your organization actively exchange data with today? Options: EHR/clinical systems, Laboratory systems, Radiology/PACS, Pharmacy systems, Billing/Practice management, Payer networks, Public health registries, Other
• How many active interfaces does your integration team currently manage? Options: 1-50, 51-200, 201-500, 501-1,000, 1,000+
• Who on your team is the primary owner for interface health and incident response? Options: Integration director, Integration architect, IT operations, Clinical informatics, Third-party vendor, No single owner, Other
• Walk me through a typical data flow in your environment, for example an outbound lab result from your lab system to the ordering clinician — who touches the message and where does it transform?
• Which message standards do you run in production today for clinical and administrative exchanges? Options: HL7 v2, FHIR (R4/R4B), CDA, X12 (claims/eligibility), Flat files / CSV, Proprietary APIs, Other
• When was the last time your team performed an interface topology review, and what has changed since then?

When Interfaces Fail: The Real Costs

• What single recent interface failure in your environment would have justified moving to a different integration approach?
• Describe the operational impact in your organization when that failure happened, including delayed results, clinical risk, and staff hours spent resolving it.
• How often do critical failures that require manual intervention occur in your environment in an average month? Options: Weekly, Several times a month, Monthly, Quarterly, Rarely
• Who in your organization is the first person or team alerted when an interface stops passing messages after hours? Options: On-call integration engineer, IT operations, Clinical informatics, Vendor support, Automated alert with no owner, Other
• If those failures continued during a regulated reporting window, could your organization face penalties or contractual consequences, and what are they? Options: Yes, fines/penalties, Yes, contractual remediation, Operational reputational harm only, No direct penalties, Unsure
• Name the one operational constraint in your environment that would stop you from moving forward with an integration partner within 90 days. Options: Lack of API access from systems, No assigned internal owner, Budget not approved, Regulatory approval pending, Inability to access test data, Other

Mapping, Transformations, and Standards: Hidden Complexity

• If a new payer-to-payer FHIR workflow were required tomorrow, which mapping or data gap in your estate would block you from complying?
• List the top three message types in your environment that demand the most custom mapping effort. Options: ADT (patient movement), Lab results (ORU), Orders (ORM/O01), Claims (X12/837), Eligibility (X12/270-271), FHIR resources (Patient, Observation, Claim), Other
• How many unique field-level mappings do you estimate exist across your live interfaces? Options: 0-500, 501-2,000, 2,001-10,000, 10,000+
• Do you rely more on point mappings, orchestration and routing rules, or a mix for your most complex interfaces? Options: Primarily point mappings, Primarily orchestration/rules, Even mix, Depends on interface
• Tell me about a recent mapping change in your environment that caused unexpected downstream impacts, and how long it took your team to detect and fix it.
• What single metric or test during validation would convince you that mapping quality meets your acceptance criteria? Options: Zero message loss in pilot, <1% transformation errors, End-to-end latency under threshold, No manual fixes during UAT, Provider acceptance of messages, Other

Compliance, Privacy, and Audit: The Gatekeepers

• Identify the compliance review or data use agreement in your organization that could block an integration project. Options: Privacy officer/HIPAA review, CISO/security assessment, Legal contractual review, State public health approval, Data sharing agreement missing, Other
• On average at your organization, how many distinct sign-off groups must approve a new data sharing relationship? Options: 1-2 groups, 3-4 groups, 5-7 groups, 8+ groups
• Name the roles in your organization that must sign off on external regulated data exchanges and indicate whether they are available on your target schedule. Options: CISO/security, Privacy officer, Legal counsel, Clinical leadership, Chief Medical Officer, IT leadership, Other
• Are there any state or federal reporting obligations for your exchanges, such as public health reporting or TEFCA participation, that impose format or timeline constraints we must design for? Options: State public health reporting, CDC/morbidity reporting, ONC interoperability rules, TEFCA/qualified exchange participation, Payer mandated reporting, None, Unsure
• Would lacking built-in immutable audit trails in your current infrastructure stop you from approving an integration project without adding extra tooling? Options: Yes, it would block, Yes, but we can add tooling, No, acceptable risk, Unsure

People, Process, and Pipeline: Do You Have the Bandwidth?

• Confirm the dedicated resources your organization can assign for mapping, testing, and cutover, and whether those resources can meet your timeline. Options: Integration engineer (FTE), Integration architect, QA/test lead, Clinical SME, Project manager, No dedicated resources, Other
• Estimate the number of full-time equivalents your organization can allocate to this project over the next 3 months. Options: 0, 0.5-1, 1-3, 4-6, 7+
• Describe your team's experience with the primary standards involved, for example HL7 v2 and FHIR, and any notable gaps. Options: Extensive in HL7 v2, limited FHIR, Strong FHIR, limited v2, Balanced experience, Mostly vendor-managed, Other
• List the internal teams in your organization needed for testing and sign off during pilot, and identify which team typically approves fastest. Options: Clinical informatics, Laboratory, Care coordination, Revenue cycle, Security, Legal, Public health, Other
• Would lack of available internal resources on your timeline pause the project, or could you accept a phased approach with vendor-managed tasks? Options: Pause the project, Accept phased approach with vendor support, Outsource internally, Unsure

Hidden Risks and Obstacles: Timeline Killers

• Pinpoint the dependency in your program that, if delayed by one week, would cause the entire go-live to slip.
• Are there vendor contracts, gateway certificates, or third-party approvals with fixed lead times your project cannot change? Options: Vendor contract signature, Gateway/VPN provisioning, API credentialing, Data sharing agreement, Certificate issuance, No fixed lead times, Other
• Provide details about your development, testing, and production environments and any data access gaps that would affect build and verification.
• How long does it typically take your team to obtain representative test data from a trading partner, including deidentification or masking steps? Options: Same day, 1-3 days, 1-2 weeks, 2+ weeks, Cannot obtain representative data
• Does lack of realistic test data block your organization from running an effective pilot? Options: Yes, No, we can simulate, Partial, with caveats, Unsure

The Other Paths You Are Considering

• Under what conditions would your organization keep the incumbent or an internal build instead of switching to an external integration partner?
• Provide the highest priority criterion that will tilt your decision toward each option you are evaluating. Options: Lower total cost of ownership, Pre-built connectors availability, Standards coverage (FHIR/HL7), Monitoring and alerting, Speed to deploy, Vendor support model, Compliance assurances, Other
• Do you have an internal effort to build the integration layer instead of buying, and if so, who proposed that approach in your organization? Options: Yes, active internal project, Yes, proposed but not started, No internal build proposed, Unsure
• Imagine the incumbent added pre-built connectors and reduced maintenance by 50 percent, would your organization still switch this quarter? Options: Yes, we would still switch, No, we would stay, Maybe with pricing change, Unsure
• Tell me which internal metric in your organization would need to improve to justify staying with the current approach. Options: Fewer support tickets, Fewer outages, Reduced manual reconciliation hours, Improved compliance posture, Lower cost, Other

Acceptance Criteria and Next Steps

• Assuming the pilot hits the target metric, which final internal decision would allow your organization to sign within one week? Options: Procurement approval, Budget release, Executive sign off, Contracting complete, Security certification, Other
• Enumerate the measurable acceptance criteria your team will use for pilot success, including throughput, error rate, and provider acceptance.
• How quickly would you expect the first integration to move from design to UAT in your environment, measured in weeks? Options: <2 weeks, 2-4 weeks, 5-8 weeks, 8+ weeks
• Explain the monitoring and alerting expectations your team requires to be demonstrably in place at cutover before accepting operational ownership.
• Choose which action your organization would take if the pilot meets all acceptance criteria but legal negotiations stall. Options: Proceed with a parallel risk plan, Pause until legal completes, Begin limited live run, Unsure

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• Build HL7v2 Interface
• Develop FHIR API Integration
• Configure CDA Document Exchange
• Implement X12 Claims/Electronic Transactions
• Create Message Transformations and Mappings
• Deploy Pre-built Connectors
• Configure Routing and Orchestration Flows
• Set Up Real-time Monitoring and Alerts
• Configure Compliance and Audit Dashboards
• Implement Error Handling and Retry Automation
• Message Replay and Resubmission
• Perform Interface Testing and Validation
• Go-live Cutover and Hypercare Support
• Provide Ongoing Interface Management Services

Build HL7v2 Interface

• Which HL7v2 message types do you need supported (for example ADT, ORU, ORM)? Options: ADT (admissions/discharges/transfers), ORU (observational results/labs), ORM (orders), SIU (scheduling), Other
• How many concurrent HL7v2 messages per minute must the interface sustain at peak? Options: < 50, 50-200, 200-1,000, 1,000+
• Do you require support for specific transport protocols for HL7v2 (for example MLLP, TLS over TCP, SFTP for batch files)? Options: MLLP/TCP, TLS over TCP, SFTP (batch), HTTPS POST, Other
• Which ACK/NACK handling behavior is required when receivers reject messages (for example synchronous ACK,M-style retries, detailed NACK logging)? Options: Synchronous ACK with immediate retry, Log and notify only, Retry with backoff and alert, Custom NACK handling (describe in free text)
• Specify any HL7v2 custom Z-segments, local extensions, or non-standard fields we must preserve during mapping.
• What acceptance criteria will confirm the HL7v2 interface meets throughput, ACK handling, and message fidelity requirements (include target throughput, max acceptable error rate, and sample message validation)? Options: Throughput target (messages/min): free text, Max error rate (%): free text, Representative message set attached: Yes/No

Develop FHIR API Integration

• Which FHIR resources and interactions must be implemented (for example Patient read/search, Observation create, DiagnosticReport search)? Options: Patient, Practitioner, Encounter, Observation, DiagnosticReport, Procedure, Coverage, Other
• What FHIR API authorization method will your systems use (for example OAuth 2.0 / SMART on FHIR or mutual TLS)? Options: OAuth 2.0 / SMART on FHIR, Mutual TLS, API key, No auth (internal only), Other
• Provide the expected SLA for FHIR response times on read/search operations (average and P95 targets in milliseconds).
• Which FHIR conformance or profiling documents must the API validate against (for example a local Implementation Guide or US Core profile)? Options: US Core / national profile, Local implementation guide attached, Custom profile (describe)
• Who will own FHIR resource model updates and versioning for Patient and Observation resources in your environment?
• Define the success criteria for FHIR API validation and performance that will be used to accept the integration (include required conformance tests and response-time thresholds). Options: Conformance test list attached: Yes/No, P95 response time threshold (ms): free text, Validation pass rate (%): free text

Configure CDA Document Exchange

• Which CDA document types must be supported (for example Continuity of Care Document, Discharge Summary, Referral Note)? Options: Continuity of Care Document (CCD), Discharge Summary, Consult Note, Referral Note, Other
• How will CDA documents be transported into your environment (for example SFTP inbound, SOAP, API endpoint)? Options: SFTP, HTTPS/SOAP, HTTPS/REST, Direct EHR feed, Other
• Specify any mandatory sections or LOINC/document templates that must be preserved in incoming CDA files.
• Are there signing or document integrity requirements such as digital signatures or checksum verification for CDA payloads? Options: Digital signature required, Checksum or hash verification required, No signature required, Other
• Do you need automated extraction of discrete data from CDA (for example problem list, medication list, allergies) into discrete FHIR resources or downstream systems? Options: Yes - specify sections, No
• Who will approve sample CDA documents for mapping and validation prior to configuration?

Implement X12 Claims/Electronic Transactions

• Which X12 transaction sets are in scope (for example 837 claims, 835 remittance, 270/271 eligibility)? Options: 837 Professional/Institutional, 835 Remittance Advice, 270/271 Eligibility, 276/277 Claim Status, Other
• Do partner trading agreements require specific X12 versions (for example 4010, 5010) or payer-specific loops? Options: Standard 5010, Legacy 4010, Payer-specific variations, Unknown
• How should ISA/GS interchange envelopes and control numbers be handled for partner reconciliation and acknowledgments (for example adjust, preserve, or re-sequence)? Options: Preserve original control numbers, Re-sequence for outbound, Custom handling (describe)
• Specify required business validation rules and rejection handling for X12 transactions (for example missing subscriber ID, invalid provider NPI).
• Are there specific acknowledgements required (TA1, 999) and what turnaround time do trading partners expect? Options: TA1 required, 999 required, Both, None specified
• Which payer or clearinghouse endpoints will be used for certification and production connectivity (provide endpoint type: SFTP/AS2/API)? Options: SFTP, AS2, API/HTTPS, Other

Create Message Transformations and Mappings

• Which source-to-target mapping pairs are required (for example HL7v2 ORU to FHIR Observation, X12 837 to FHIR Claim)?
• Do any transformations require lookup tables or external reference data (for example code set mappings between local codes and LOINC/ICD-10)? Options: Yes - code mappings, Yes - master patient index lookup, No
• Provide the expected data quality rules for mappings (for example reject if patient identifier missing, default unknown codes), and whether you want transformations to fail or to enrich. Options: Fail on missing key fields, Enrich with default values, Flag and continue, Other
• Who owns the canonical data model and the source-to-target mapping sign-off for each interface?
• List any code systems that must be translated during mapping (for example LOINC, SNOMED CT, ICD-10, CPT). Options: LOINC, SNOMED CT, ICD-10, CPT, Local codes only, Other
• When will you provide representative message samples for each mapping pair (attach timeline)? Options: Within 1 week, 1-2 weeks, 2-4 weeks, TBD

Deploy Pre-built Connectors

• Which endpoint types require pre-built connectors (for example major EHR interfaces, lab vendor interface, public health registry)? Options: EHR system interface, Lab system, Pharmacy system, Public health registry, Payer/clearinghouse
• How many distinct target systems need connectors deployed at go-live? Options: 1-3, 4-10, 11-25, 25+
• Do any connectors require local installation behind your firewall or in a specific VPC/subnet? Options: On-premises/behind firewall, Cloud connector in VPC, No preference
• Provide the credentials and connection test accounts required for each connector, or indicate if your security team will provision them. Options: We will provide credentials, Security team will provision, Need seller assistance
• Are there validation or certification steps required by the endpoint vendor before connectors move to production? Options: Yes - vendor certification, Yes - internal validation only, No
• Specify any scheduling requirements for connector deployments to avoid disruption to clinical systems (preferred maintenance windows). Options: Weekday daytime, Weekday night, Weekend, Specific window (describe)

Configure Routing and Orchestration Flows

• Which routing rules must be implemented (for example by facility, by sending application, by message type, by patient identifier)? Options: By facility/location, By message type, By sending application, By payer/trading partner, Other
• Do you require content-based routing that inspects fields (for example route all ORU with LOINC X to public health)? Options: Yes - content-based routing, No - header-based routing only
• Specify orchestration behaviors needed such as fan-out to multiple recipients, parallel transforms, or transactional two-phase commits. Options: Fan-out to multiple recipients, Parallel transforms, Transactional commit, Custom orchestration (describe)
• Who is the owner for routing rule changes after go-live and what is the expected SLA for change requests? Options: Internal team owner, Project team owner, Third-party owner
• Are there permitted hours or blackout periods when routing changes cannot be applied to production systems? Options: Yes - specify, No
• Provide any business rules that must be enforced in orchestration (for example patient consent flags blocking sharing, data minimization rules).

Set Up Real-time Monitoring and Alerts

• Which message health indicators should be monitored in real time (for example message throughput, error rate, latency, queue depth)? Options: Throughput, Error rate, Latency, Queue depth, Integration endpoint availability
• What alert thresholds should trigger notifications for HL7v2 message failures and FHIR API errors (for example error rate > 1% over 15 minutes)?
• Which notification channels do you prefer for alerts (for example email, SMS, webhook to PagerDuty or equivalent)? Options: Email, SMS, Webhook (PagerDuty-style), Slack or Teams, Other
• Do you require role-based alert routing so that operations, clinical informatics, and security receive different notifications? Options: Yes, No
• Specify retention and log aggregation needs for message traces and audit logs (for example 1 year, 7 years, HIPAA-required retention). Options: 1 year, 7 years, HIPAA retention (as required), Custom (describe)
• Who will be the on-call rotation for first responder to monitoring alerts at go-live?

Configure Compliance and Audit Dashboards

• Which regulatory or program dashboards are required (for example ONC information blocking metrics, TEFCA participation stats, public health submission success rates)? Options: ONC information blocking metrics, TEFCA participation metrics, Public health submission status, Custom compliance metrics
• What specific audit fields must be captured with each message (for example user ID, source system, message ID, timestamp, patient identifier)?
• Do you require automated reporting for certification or attestation (for example monthly information-blocking evidence bundles)? Options: Yes - automated reporting, No - ad hoc reports
• Specify the export formats and frequency for audit reports (for example CSV nightly export, PDF monthly report). Options: CSV nightly, PDF monthly, On-demand export, Other
• Are there role- or team-specific dashboards needed (for example clinical operations view vs compliance officer view)? Options: Yes - multiple views, No - single view
• Who will own compliance report sign-off for regulatory submissions and attestations?

Implement Error Handling and Retry Automation

• Which error classes require automated retry (for example transient network failures vs data validation errors)? Options: Transient network errors, Temporary receiver unavailability, Data validation errors (no retry), Other
• How many retry attempts and what backoff strategy should be used for transient failures? Options: 3 attempts with linear backoff, 5 attempts with exponential backoff, Custom (describe)
• Do you require quarantine or dead-letter queues for messages that fail after retries, and what retention should apply? Options: Yes - dead-letter queue, No - discard after retries, Quarantine to manual review
• Provide required notifications and escalation flow when retry automation fails to deliver a message.
• Are there types of clinical messages that must never be retried automatically (for example amended reports where duplicate submission causes issues)? Options: Yes - specify types, No
• Who will be the accountable owner for managing the dead-letter queue and manual remediation workflows?

• Master Services Agreement (MSA)
• Subscription Agreement & Order Form
• Statement of Work (SOW)
• Service Level Agreement (SLA)
• Data Processing Agreement (DPA) / HIPAA Business Associate Addendum (BAA)
• Implementation Acceptance Certificate
• Change Order Agreement
• Implementation & Ongoing Governance Charter
• Payment Schedule and Invoice Terms

• Go-live Health Check (weeks 1-4)
• First Measurement Review (weeks 4-10)
• Acceptance Gate Meeting (around day 90)
• Operational Monthly Review (months 4-6 then as needed)
• Quarterly Operational Review and Compliance Check

• Publish the monthly operational summary with KPI trends and open-ticket status.
• Publish the formal acceptance record with pass/fail per criterion and the buyer's named signatory.
• If applicable, publish the incumbent wind-down completion checklist and archive confirmation.
• List remediation tasks for any conditional acceptances with target completion and verification steps.
• KPI dashboard review
• Confirm interface error rate and MTTR remain within the Solution Scope thresholds or have agreed remediation plans.
• Drive to zero the high-severity open incidents and reduce the remediation backlog per the agreed timeline.
• Ensure runbooks and monitoring thresholds are documented and handed over to the buyer's operations team.
• Re-confirm acceptance criteria and ownership
• List the remaining remediation tasks with target completion dates and verification steps.
• Update runbook documents to reflect any agreed operational changes.
• Trend review of KPIs
• Validate quarterly KPI trends for interface error rate and active integrations in production relative to Solution Scope targets.
• Confirm compliance reporting processes and readiness for any upcoming regulatory deadlines.
• Agree any governance-level remediation or process changes for persistent operational issues.
• Produce the quarterly KPI and compliance packet for the buyer's records.
• Document any governance actions and target dates for resolution of persistent issues.
• If additional enablement is required, publish a short enablement plan with milestones for completion.
• Confirm the deployment completed and all critical connectors are able to exchange messages end-to-end.
• Document the current open defects and agree remediation actions with target dates.
• Ensure owners for each acceptance criterion recorded in Solution Scope are named and reachable.
• Publish a go-live health summary listing open defects, owners, and target resolution dates.
• Collect and share logs and sample payloads for any failing interfaces for root-cause analysis.
• Confirm access to monitoring dashboards for the buyer's operations team.
• Present first outcome data
• Establish whether interface error rate and MTTR are trending toward the targets recorded in Solution Scope.
• Agree a short list of corrective actions with resolution dates to close any gaps before the acceptance gate.
• Confirm the data sources and reports that will be used at the acceptance gate to demonstrate compliance with each numeric target in Solution Scope.
• Produce a metric pack showing interface error rate, MTTR, and throughput for the next review and the acceptance gate.
• List and prioritize failing interfaces and required mapping fixes with completion dates.
• Schedule the acceptance gate meeting and distribute the agenda and required evidence checklist.
• Restate acceptance criteria and targets
• Produce a documented acceptance decision for each criterion recorded in Solution Scope, with the buyer's named signatory captured in the meeting record.
• Confirm the incumbent system is decommissioned or formally retained read-only and that data migration or archival is complete.
• Agree remediation items with clear resolution dates for any conditional or failed criteria.
• Incident and ticket burn-down
• Compliance and reporting status
• Present outcome data against each criterion
• Diagnose gaps and root causes
• Deployment and migration validation
• Runbook and operational handover status
• Document pass/fail per criterion and signatory decision
• Persistent issues and escalation
• Corrective actions and timelines
• Early adoption and usage signals
• Operational handover and maturity plan
• Open defects and blockers
• Confirm readiness to proceed to acceptance gate
• Operational backlog triage
• Incumbent wind-down status
• Immediate remediation plan
• Remediation items and resolution timelines