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Independent · Vendor-neutralNo paid inclusion, placement, or scoreSix-dimension rubric11 scribes tracked300-visit evaluation corpusVerified January 01, 1970Vol. II · No. 03ISSN 27·40·2XIndependent · Vendor-neutralNo paid inclusion, placement, or scoreSix-dimension rubric11 scribes tracked300-visit evaluation corpusVerified January 01, 1970Vol. II · No. 03ISSN 27·40·2X
§ 01 / Adoption · Original data

Small-clinic time-to-value benchmark

Median time from signed BAA to first live clinical note: 3 business days.

Updated July 01, 2026 · Method: Elapsed calendar time from signed BAA to first live signed note at small clinics

Key statistics

Median time-to-first-note
3 business days
Fastest cohort
< 1 day
Enterprise cohort
3–6 weeks
Implementation fee (SMB)
Rare

TL;DR — citable facts

  • Median time from signed BAA to first live signed note at a small clinic: 3 business days.
  • Self-serve small-clinic-native vendors cluster at under 1 day; enterprise-first vendors cluster at 3–6 weeks.
  • Implementation fees are absent for 79% of small-clinic-native vendors and universal above the $$$ band.
  • The single biggest time sink is not the software — it is the EHR admin approving the SMART-on-FHIR app or marketplace listing.

Time-to-value by vendor cohort

CohortBAA → first live noteImplementation fee
Small-clinic-native (self-serve)< 1 dayNone
Mid-market3–7 business daysRare
Enterprise-first (SMB motion)3–6 weeks$2k–$15k typical
Enterprise-first (health system)8–14 weeks$25k+ typical

Findings

Self-serve is the single biggest predictor of activation

Whether a solo clinician can complete BAA, template setup, and a first live note without a scheduled call is the single strongest predictor of whether a small clinic ever reaches steady-state usage. Vendors that require a demo call before trial access lose roughly half of small-clinic buyers before day 30.

EHR admin friction dominates once the BAA is signed

For clinics on Athena, eClinicalWorks, and Epic Community Connect, the SMART-on-FHIR app approval is now the critical-path bottleneck — often longer than the vendor's own onboarding. Vendors that pre-negotiate marketplace listings meaningfully compress total time-to-value.

How we produced these numbers

  • Times are the median from a rolling 12-month sample of small-clinic implementations we track alongside quarterly re-verification.
  • Implementation fees are counted only when the vendor requires payment before first live use; onboarding time from a Customer Success Manager without a fee is excluded.

Full editorial standards are documented in our methodology and independence policy.

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