EHR & HIS Integration Rubric

Why score readiness before you scope a project

"Can you integrate with our EHR?" is the wrong first question — almost any modern platform will say yes. The question that actually determines timeline and cost is: how ready is your existing system for that integration, independent of which vendor you choose? A system with clean FHIR support and consistent patient identifiers integrates in weeks; one with proprietary flat-file exports and duplicate patient records across departments takes considerably longer, regardless of who's on the other end of the integration.

Score each category from 0 (not in place) to 3 (fully in place). Add the six scores together.

1. Interoperability standard support

• 0: No structured export — data lives in the system's own interface only
• 1: Flat-file or CSV export available, manually triggered
• 2: HL7 v2 messaging supported
• 3: FHIR API available, with documented endpoints for patient, appointment, and observation resources

2. Patient identity matching

• 0: No consistent unique patient identifier across departments or branches
• 1: A unique identifier exists but duplicate records are a known, unresolved issue
• 2: Identifier is consistent, with occasional manual de-duplication
• 3: Identifier is consistent and actively deduplicated, with a documented matching process

3. Scheduling data sync

• 0: Scheduling lives entirely in a separate system with no export
• 1: Batch export of schedules is possible (e.g., nightly file)
• 2: Near-real-time sync is technically possible but not currently automated
• 3: Real-time, automated scheduling sync is already in place with at least one other system

4. Lab and results flow

• 0: Results are only available as scanned PDFs or paper reports
• 1: Results are digital but unstructured (free text, not coded)
• 2: Results are structured but require manual mapping to standard codes
• 3: Results are structured and coded (e.g., LOINC) and available via API or HL7 message

5. Authentication and identity readiness

• 0: No centralized identity provider — each system has separate logins
• 1: Centralized directory exists but isn't used for all clinical systems
• 2: Single sign-on is in place for most systems
• 3: Single sign-on with role-based access is in place and used consistently across systems

6. Data governance clarity

• 0: No documented owner for data-sharing decisions
• 1: An owner exists but data-sharing agreements with other systems are informal
• 2: Data-sharing agreements exist for major systems
• 3: A documented data governance policy covers what can be shared, with whom, and under what conditions

What your total score means

• 0–6: Foundational work is likely needed before integration — this isn't a reason to delay a platform decision, but integration should be scoped as a phased effort, not a week-one deliverable
• 7–12: Integration is feasible with moderate effort; expect the discovery phase of any rollout to focus heavily on mapping and identity matching
• 13–18: Your stack is integration-ready; a platform with FHIR support should connect in the timeframe described in The 8-Week White-Label Launch Plan

A note on honesty in scoring

The most common mistake teams make with a rubric like this is scoring based on what a system is capable of rather than what's actually configured and in use today. A FHIR-capable EHR that nobody has turned the FHIR module on for still scores as a 1 or 2 on interoperability, not a 3 — the goal is an accurate starting point, not a flattering one.

Related reading

• Data Residency & Compliance Checklist — what to verify alongside integration readiness
• The 8-Week White-Label Launch Plan — where integration work (weeks 5–6) fits into the overall rollout