Go-Live Preparation:
Mt. San Rafael
A New EHR Won’t Fix Old Problems

By Michael Archuleta, CIO, Mt. San Rafael Hospital and Clinics

 

Let me say something that doesn’t get said enough before an EHR go-live: the problems your infrastructure has today will follow you into the new system.

Not pessimism. Just physics.

When you migrate to a hosted EHR environment like Oracle Health CommunityWorks, you are handing the keys to a new partner. Whatever was lurking in your on-premises environment gets inherited. A slow, unstable foundation doesn’t suddenly become fast and stable simply because a new application sits on top of it.

At Mt. San Rafael Hospital and Clinics, we signed with Oracle Health in December 2025. We chose Oracle Health CommunityWorks because it provides enterprise-grade infrastructure, modern capabilities, and an AI-native platform without the burden of maintaining a large internal IT organization. The decision was deliberate and strategic.

But signing a contract doesn’t guarantee a successful go-live.

Preparation does.

The goal was never simply to prepare for an Oracle Health go-live. The goal was to establish a foundation capable of supporting the next generation of healthcare technology.

Regardless of organization size, the challenge is the same: delivering reliable technology that enables clinicians to provide exceptional patient care. At Mt. San Rafael Hospital, we approach technology investments with the same discipline, accountability, and strategic rigor found in the nation’s leading health systems. Every decision must be supported by data, aligned with organizational objectives, and ultimately improve the clinician and patient experience.

 

Want to learn more? Request to speak with a healthcare IT consultant.

Challenge

The statistics surrounding EHR implementations are sobering. According to KLAS Research, only 38% of healthcare organizations report that their EHR transition fully met expectations. In the same research, 73% of organizations reported below-average clinician experience scores following implementation. KLAS data also demonstrates a strong relationship between system performance and clinician satisfaction. When physicians believe response times are adequate, satisfaction rises dramatically. When performance declines, satisfaction follows.

EHR speed and reliability are not simply technical metrics. They are foundational components of clinician experience.

As our Oracle Health implementation progressed, it became clear that we needed a more objective understanding of clinician experience within our environment.

Clinicians were reporting inconsistent logon times and occasional application responsiveness concerns. The feedback was legitimate, but the underlying causes were unclear. The challenge is that clinicians can tell you when something feels slow, but they cannot always tell you why. Identifying the “why” is what ultimately allows healthcare organizations to solve problems instead of simply reacting to symptoms.

The deeper concern was this: our Oracle Health go-live date was approaching, and any performance issue rooted in our on-premises virtual desktop infrastructure would not disappear when we flipped the switch.

In a CommunityWorks model, Oracle manages the hosted EHR environment. We own our infrastructure. If infrastructure issues exist within our environment, they remain our responsibility to address. Left unresolved, those issues become significantly more difficult and expensive to untangle after go-live.

We had one opportunity to get ahead of the problem.

I wasn’t going to waste it.

 

Solution

Oracle Health introduced us to Goliath Technologies as part of our go-live preparation process. Goliath’s platform is designed to provide healthcare organizations with visibility into what clinicians are actually experiencing when they interact with the EHR, without relying solely on self-reporting, help desk tickets, or manual observation.

We engaged Goliath to perform a Go-Live Infrastructure Health Check and Clinician Experience Measurement assessment.

Deployment was straightforward. Working alongside our local IT team, the platform was operational within days and began collecting performance data across our virtual desktop infrastructure environment.

The platform correlated session behavior, resource utilization, application performance, and user experience metrics across the environment. For the first time, we could objectively measure what every clinician was experiencing, regardless of location.

What stood out most was the ability to move from assumptions to objective measurements with minimal deployment effort. Instead of relying on anecdotal feedback, we now had visibility into the actual experience of every clinician utilizing the environment.

No surveys.

No waiting for complaints.

Just data.

 

What the Data Revealed

The findings came quickly, and they confirmed what I suspected: we had infrastructure issues that would have surfaced after our Oracle Health CommunityWorks go-live.

The analysis identified three distinct areas requiring attention.

1. High Memory Utilization Across Sessions

More than 50% of clinician sessions were operating with elevated memory utilization. On the surface, user workflows appeared normal. However, underlying background processes were consuming resources that should have been available to clinical applications.

Without objective measurement, this issue would likely have remained invisible.

1. VDI Disk Latency Impacting User Experience

The platform identified intermittent spikes in disk latency that directly correlated with degraded clinician experience.

These performance issues were subtle and episodic. Traditional monitoring methods would likely have missed them entirely. However, session-level analytics made the relationship between infrastructure performance and user experience unmistakable.

1. CPU Ready Contention Across All Four Hosts

The most significant finding involved elevated CPU Ready metrics across all four virtualization hosts.

CPU Ready contention occurs when virtual machines are waiting for physical CPU resources. Those delays compound throughout the clinician experience, resulting in longer logons, slower application response times, and increased frustration.

Because the issue was distributed across the environment, no single user complaint would have identified the root cause.

The data did.

Taken together, these findings painted a clear picture: remediation needed to occur before go-live, not after.

 

Infrastructure Readiness is AI Readiness

One lesson became increasingly clear throughout this process: infrastructure readiness is no longer simply an EHR discussion.

It is an AI readiness discussion.

Healthcare organizations cannot expect to realize the full value of ambient documentation, predictive analytics, clinical decision support, intelligent automation, and future AI-enabled workflows if foundational infrastructure issues remain unresolved.

As healthcare continues its transformation toward AI-assisted care delivery, organizations that establish strong operational and technical foundations today will be best positioned to capitalize on tomorrow’s innovations.

Technology leaders who ignore infrastructure readiness may find themselves limiting the very innovations they hope to adopt.

 

Path Forward

Mt. San Rafael Hospital has engaged Goliath to support remediation efforts before our Oracle Health go-live.

The issues identified are fixable, and more importantly, they are fixable now, on our terms, with time to validate improvements before clinicians begin using the new platform.

The data has also allowed us to make targeted investments rather than broad assumptions. Instead of guessing where resources should be allocated, we now have objective evidence guiding our decisions.

Perhaps the greatest value of the engagement has been confidence.

Not perfect certainty, because healthcare technology rarely offers that.

But confidence that comes from understanding the environment, identifying root causes, and addressing issues before they impact patient care.

 

Lessons for CIOs Preparing for Go-Live

As we continue preparing for our Oracle Health implementation, several recommendations stand out:

• Establish an infrastructure baseline before implementation.
• Measure actual clinician experience, not just system uptime.
• Validate concerns with objective data before making investments.
• Address infrastructure bottlenecks before activation.
• Treat infrastructure readiness as a patient care initiative, not simply an IT initiative.

The most successful go-lives are not defined by technology alone.

They are defined by preparation, execution, and the ability to remove obstacles before clinicians encounter them.

 

Final Thoughts

A mentor once told me that technology should never be the star of the show.

The patient should be.

As CIOs, our responsibility is not simply to implement technology. Our responsibility is to remove barriers that stand between clinicians and patients.

When infrastructure, workflows, applications, and people work together seamlessly, technology becomes nearly invisible. That is the true measure of a successful go-live.

Ultimately, success is not measured by activation dates or project milestones. It is measured by the ability of clinicians to focus on delivering exceptional care and by our ability as leaders to ensure that technology enables, rather than hinders, that mission.

That is how we build stronger healthcare organizations.

And that is how we ensure a patient’s ZIP code never determines their healthcare outcomes.

To learn more about how Goliath helps health systems surface and resolve clinician EHR experience issues, reach out directly at techinfo@goliathtechnologies.com or request to speak with a healthcare IT consultant.

If you would like to connect and share perspectives on EHR transformation, clinician experience, artificial intelligence, cybersecurity, or healthcare innovation, feel free to reach out: marchuleta@msrhc.org

About the Author

Michael Archuleta serves as Chief Information Officer at Mt. San Rafael Hospital and Clinics in Trinidad, Colorado. A nationally recognized healthcare technology executive and healthcare innovator, he is known for advancing cybersecurity, artificial intelligence, digital transformation, and technology-enabled care delivery. Under his leadership, Mt. San Rafael Hospital has earned HIMSS Stage 6 recognition, multiple Healthcare’s Most Wired awards, and national recognition for innovation in healthcare technology. Archuleta has been recognized by Becker’s Hospital Review as one of the nation’s top hospital and health system CIOs, is a HITEC 100 award recipient, serves on national healthcare advisory boards, and is a frequent speaker on leadership, cybersecurity, artificial intelligence, and digital transformation. He is a strong advocate for ensuring that a patient’s ZIP code never determines their healthcare outcomes.