After years of implementing digital health systems across developing markets, I've seen the same failure patterns repeat.

1. Starting with technology instead of workflows. Most teams pick an EHR platform first, then try to fit clinical workflows around it. Flip it. Map the workflows, then choose the tool.

2. Underestimating connectivity constraints. You can't deploy a cloud-first system in a district where 60% of facilities have intermittent power. Offline-first architecture isn't optional.

3. No change management plan. Training ≠ adoption. If frontline health workers don't see how the system makes their job easier, they'll find workarounds. Budget 30% of your timeline for change management.

4. Ignoring interoperability from day one. If you're not thinking about HL7 FHIR, OpenHIE, or basic API standards from the start, you're building a silo that becomes expensive to fix later.

5. No stabilization phase. Going live is not the finish line. The 90 days after go-live are where most projects quietly die. Performance drops, bugs surface, staff frustration peaks. Plan for it.

At Nexoria Advisory, we help government and NGO health programs avoid these traps. We've done the hard implementation work — and we know what separates the projects that scale from the ones that stall.