Replacing an EHR without pausing care

01 — The challenge

Where it started.

The legacy EHR was rigid, slow and poorly interoperable. Placing an order took seven or more clicks, transcription was done by hand, and every workflow carried an accumulated workaround on top of it.

The cost was paid in clinician time and clinician goodwill. A satisfaction score of 42% is a retention problem as much as a software one.

Replacing it was unavoidable. Pausing clinical operations in order to do so was not an option.

02 — What we built

The work itself.

Microservices on Azure AKS. The estate split into independently releasable services, so the replacement could proceed in phases rather than as a single cutover.

HL7 through Mirth Connect, and a FHIR gateway. Messaging with surrounding systems handled on standards rather than point-to-point integrations — which is what made parallel running possible.

Azure AD, OAuth 2.0, AES-256 and TLS 1.3. Identity, authorisation and encryption at rest and in transit designed in from the start, against a dataset where that is not negotiable.

Power BI Embedded on Azure Synapse. Clinical and operational reporting inside the application rather than as a separate extract into a separate tool.

03 — Results

What the client has now.

Chart retrieval time down by half. Medication order turnaround down by 35%. Clinician satisfaction up from 42% to 85%. Delivered over eighteen months with minimal disruption to clinical operations.