Remove server-replication
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What are the Cost Implications of Implementing Cloud Technology in Healthcare?

Healthcare IT Today

On-premise EHR servers drain valuable resources as they need to be replaced every 3 to 5 years and incur significant costs thanks to the large upfront installation fees and recurring price of regular backups. Michael Brickman, Medical Director of Plastic Surgery at ModMed Cloud-based EHRs are the gold standard for physician practices.

RCM 119
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Controlled Exchange Architecture Models for Scale on #FHIR

Healthcare Exchange Standards

I think there would need to be a trust domain, so as to enable this trust without replication of user accounts that have no added value. PRIM + mCSD See this article on Patient Identity Management using FHIR all organizations feed Patient updates upon registration to a central authority.

FHIR 40
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E-mail addresses -- Remedial and realistic

Healthcare Exchange Standards

Thus the protocols are all defined as "case preserving" while allowing a server side determination if the server-side wants to treat e-mail addresses as case-sensitive or not. That is to say that there is much software and services that support e-mail that don't quite implement everything that the standards allow.