After 36 years of implementing advanced IT systems in highly critical and complex, medium to large scale enterprise networks for a wide variety (93) of industries, military, scientific research, retail businesses, national intelligence, insurance, pharmaceuticals, hospitals and clinics, I don't believe in promises at all. What I discovered is that more time and all the money is wasted in believing and learning the wisdom of methodologies dreamed up by PHD's with high anxiety complexes that have to publish technical white papers every six months to survive. Most of their career is spent on figuring out how to make IT systems more complex and applying for grants. Yes, I've worked for principal investigators.
The IT marketeers who are the new "Music Man" for this generation make large amounts of money by providing "certified" curriculum that wash through thousands of victimized IT professionals on technology that already has a scheduled "end-of-life". If I had not lived as long as I have through the mazes of successful and failed technology "promises" I would not have these eyes.
You will end up with the norm. And the norm in Health Care IT is that 70 million is really 200 million, and 200 million is really 500 million, and so forth. Why? Because you still believe in the promises and never take responsibility for engineering your own solution. This is where I make my living and when it fails two to three times, my work begins.
Stop trying to just plug and play. Stop your "setup.exe" wishes. Begin by knowing about the business you're in. You must painfully author a document that sets the expectations, service level agreements and expected results from an IT system - be meticulous not technical . IT is the tail not the dog. Hire a good enterprise network architect to translate your document into a technical solution using industry best practices (not theories). Do not skimp, plan on spending more than you expected to for start up, more for good IT leads, include a perpetual training curriculum for your IT staff, end users and management. Include all the HIPAA and CFR requirements up front in your infrastructure design. Plan to spend lots of money on a storage system for disaster recovery - do not leave this out whatsoever.
Automobile engines only lasted up to maybe 100,000 miles. Now we can expect over 300,000 miles or more from the engines of today. Why? The engine components are now cut using lasers, almost to perfection. The engines today are balanced, in the past this methodology was only applied to racing engines. Laser cut and balance your IT solution. Yes, you will pay more at that beginning, but you pay one price once and not often and get better than expected performance, scalability, reduced anomalies, and a real return on investment.
If you want "methodologies", then that is what you are paying for. But read the blogs on why EHR implementations fail so that you will know where you can contribute your story after polishing up your resume.