How Much Do Integrations Matter? It Depends.
How Much Do Integrations Matter?
It Depends.
The first question any hospital CIO or physician asks is simple:
“Does this integrate with _____?”
Epic.
Oracle/Cerner.
Meditech.
Athena.
eClinicalWorks.
In healthcare, integration is not a feature request.
It is a gatekeeping mechanism.
You can have the best product in the market.
You can demonstrably reduce burnout.
You can save hours per clinician per week.
If it does not integrate into the existing system workflow, the conversation often ends there.
Integration is treated as permission to proceed.
Why Healthcare Is So Integration Sensitive
Healthcare infrastructure is deeply embedded.
Unlike other industries, hospitals and large provider groups do not operate with loosely connected tools. The EHR anchors:
Documentation
Billing
Compliance
Quality reporting
Clinical decision support
Revenue cycle
Scheduling
Patient communication
Audit trails
Every operational function eventually ties back to the core system.
When a product does not integrate, it introduces risk.
Risk of:
Duplicate documentation
Missed charges
Compliance gaps
Workflow fragmentation
Increased clinician fatigue
Healthcare buyers are not just evaluating features.
They are evaluating operational disruption.
Integration reduces perceived disruption.
Integration as a Risk Filter
In enterprise environments, integration is rarely about convenience.
It is about risk mitigation.
A CIO is thinking:
Will this create shadow workflows?
Will this require retraining across hundreds of users?
Will this impact billing integrity?
Will this trigger compliance review?
Will IT own this forever?
When integration is absent, the answer often feels like “yes” to all of the above.
Even if your team is two weeks away from completing an integration, most enterprise buyers will not move forward.
Because if something breaks, they own the fallout.
No one wants to be the guinea pig inside a live health system.
In enterprise healthcare, integration is binary:
Integrated = viable
Not integrated = deferred
The Hidden Cost of Waiting for Perfect Integration
But here’s the strategic tension:
Building enterprise grade integrations is expensive and slow.
It requires:
Technical certification
API mapping
Security reviews
Legal reviews
Data governance alignment
Ongoing maintenance
Version management
Dedicated implementation resources
For early-stage companies, this can consume 6–12 months of runway.
The danger?
You can spend a year building integrations before proving that your product actually changes behavior.
Integration does not equal product market fit.
It equals access.
The Middle-Market Operates Differently
This is where the conversation shifts.
Small practices (2–5 clinicians) and even mid-sized outpatient groups (20–50 clinicians) operate under different constraints.
They know their EMR is not Epic.
They know customization is limited.
They know IT resources are thin.
But they also feel the pressure more acutely:
Staffing shortages
Documentation overload
Margin compression
Reimbursement pressure
Administrative burden
Their calculus is different.
If a product:
Saves real time immediately
Reduces charting burden
Improves billing capture
Reduces staff dependency
Improves patient throughput
They may tolerate lighter integration or even operate adjacent to the EHR if the value is clear and immediate.
For them, workflow improvement can outweigh architectural perfection.
Integration vs. Immediate Value
The core question becomes:
Is integration enabling value, or is value obvious without it?
Some products must live inside the chart:
Clinical documentation tools
Order entry systems
Decision support engines
Billing automation
For these, integration is foundational.
Other products sit adjacent to the chart:
Pre-visit intake optimization
Revenue analytics
Staff scheduling optimization
Patient engagement
For these, integration enhances durability, but value can be demonstrated without it.
The key difference:
Integration is about data flow.
Adoption is about behavioral change.
The Overlooked Risk: Integration Without Adoption
There is a dangerous assumption in healthcare SaaS:
“If we integrate with Epic, we win.”
That assumption is wrong.
Technical integration does not guarantee behavioral integration.
You can:
Pass IT review
Embed into the EHR
Launch
Train every department
And still see low usage.
Why?
Because integration solves access.
It does not solve friction.
If a product increases cognitive load, adds clicks, or slows clinicians down, usage will stall even inside Epic.
Workflow fit always outranks technical access.
Integration as a Scaling Mechanism
The more durable strategy for many companies is phased:
Phase 1: Prove value in flexible environments
Phase 2: Refine workflow fit
Phase 3: Build integration to scale
When value is validated first:
Buyers are more patient during integration timelines
Internal champions are stronger
Budget justification becomes easier
Expansion paths become clearer
Integration then becomes an accelerant, not a prerequisite to survival.
Where Integration Is Non-Negotiable
There are environments where integration is not optional:
Large academic medical centers
Multi state health systems
Highly standardized enterprise networks
Tools touching billing or compliance directly
In these environments, integration is table stakes.
The buyer is optimizing for:
Governance
Data integrity
Enterprise reporting
Standardization
Security posture
Here, integration is about control.
And control often outranks speed.
The Strategic Tradeoff for Founders
Every healthcare founder eventually faces this question:
Do we build integrations first, or do we build value first?
The answer depends on the target market.
Enterprise first strategy:
Longer sales cycles
Higher contract value
Heavy upfront integration investment
Slower iteration
Middle-market-first strategy:
Faster validation
Clearer usage signals
Lighter integration
Potentially faster revenue velocity
Both paths work.
But they require different capital strategies and patience levels.
The Inevitable Future
Long term, integration will be expected everywhere.
Interoperability standards are improving.
APIs are becoming more normalized.
Buyers are becoming more sophisticated.
Even small practices will increasingly expect:
Single sign-on
Embedded workflows
Clean data exchange
Minimal duplicate entry
Reporting continuity
The question is not whether integration matters.
It does.
The question is when it becomes a gating factor versus a scaling factor.
A Practical Framework
Integration importance depends on three variables:
Customer size
Operational complexity
Immediacy of demonstrated value
Large system + high complexity + moderate value = integration required upfront
Small practice + moderate complexity + immediate visible value = integration can follow
The strongest companies understand where they sit on that spectrum.
Closing Thought: Integration Opens the Door. Value Makes You Necessary.
Integration helps you enter the workflow.
Adoption makes you indispensable.
Healthcare organizations do not reward software that simply connects to Epic.
They reward software that changes how work gets done.
The companies that win will do both.
But they will sequence them intelligently.
More Founder Thoughts
If you have made it this far, thank you for reading.
Founders often assume that landing a deep Epic integration is the milestone. In reality, it is a distribution milestone, not a product milestone. It gets you access. It does not guarantee behavior change.
If you are early and still validating your value add, start where iteration is easier. Athena can be a practical first step. Their marketplace provides more accessible API pathways and faster integration cycles. That speed matters when you are still refining workflows, messaging, and proof points.
Use that environment to learn:
Are clinicians actually using your product?
Would someone advocate for it internally?
Are you creating pull from end users or pushing through procurement?
Integration strategy should follow evidence of adoption, not the other way around.
Integration opens the door.
Proven value keeps you in the building.
Hunter Wolma, MBA
Co-Founder, General Partner
