Replacing seven systems with one, without stopping a hospital

1 The problem

Meridian Health ran 40 facilities on seven systems that did not talk to each other. A patient record lived in one, billing in another, pharmacy in a third. Staff re-keyed the same data up to four times, and nobody could answer a simple question — how many beds are free right now — without three phone calls. Two previous replacement attempts had been abandoned mid-project.

2 Our approach

We did not attempt a big-bang cutover; that is what killed both previous attempts. Instead we built a single patient record first and ran it alongside the old systems, syncing both ways. Once staff trusted it, we migrated one module at a time — admissions, then pharmacy, then billing — with a rollback path at every step. The last legacy system was switched off in week 31, and no facility ever had a day without a working system.

3 What we built

• Two-way sync layer so old and new systems could run in parallel
• Unified patient record with full audit history on every field
• Role-based clinical access down to individual field level
• HL7 FHIR interfaces for lab and imaging equipment
• Offline-tolerant ward tablets for rounds
• Real-time bed and theatre availability dashboard

4 Technology