A new practice has a date, and everything that has to be running on that date is non-clinical. The clinical side is the part the clinician already knows how to do. The rest, the systems, the people, the material and the explanations, has to be built from nothing, usually by someone who is still working elsewhere until the week before.
Most lists of what to set up are complete and unhelpful, because they are lists. The order matters more. Set things up in the wrong order and each step has to be redone when the next one arrives.
First, the systems
The EMR, the scheduling, the eligibility checks and the way notes get written come first, before anyone is hired, because everyone who is hired has to be trained on them. If AI scribing is going to be used, it should be installed and tested before the first visit, not introduced in month three when the clinician is already behind on notes.
This is also the moment to decide what talks to what. The website form, the phone system, the billing and the patient reminders should all be connected to the EMR at this stage, when connecting them is a configuration task rather than a migration.
Second, the people
The front desk and the billing should be hired once the systems exist, so the hiring can say which systems, and so the new staff can be trained on the practice's own configuration rather than on a generic version of it. A receptionist who starts on the same day as the EMR learns two things at once and does neither well.
Remote staff change this calculation. A remote front desk can be interviewed, placed and trained on the practice's systems while the physical office is still being fitted out, which removes the last-week scramble entirely.
Third, the referral material
Referrals are the first weeks' patients, and the physicians who send them decide whether to based on what they are handed. The referral one-pager and the presentation should go out before opening, not after, so the first week has a schedule. They should be written for the referring physician, in the two minutes that physician will give them, and they should say exactly what the front desk will say when the referred patient calls.
The website belongs in this step, not at the end. It is what a referring physician looks at before sending a patient and what the patient looks at before calling. It should be written from the same brief as the referral material and built by someone who can connect its form to the EMR set up in step one.
Fourth, the explanations
Every practice has a few procedures it will perform more than any other. The explanation of each one should exist as a video and a leaflet before the first patient is booked, approved by the clinician who will perform it, so that from the first visit the explanation is delivered by the video and the leaflet rather than by the clinician, live, every time.
Done at this stage, the video uses the same wording as the referral material and the website, and the front desk sends it with the booking confirmation. Done later, it is one more thing to reconcile.
Why the order matters
Each step is built on the one before it. Staff are trained on systems that exist. Referral material says what the staff will say. Videos say what the referral material says. Reverse any two steps and the earlier one has to be redone.
This is also why opening a practice is the clearest case for one team rather than four vendors. The steps are handoffs, and a handoff between two vendors who have never met is a gap the practice closes itself, in the last week, at night. The Medical Operations does the four steps in this order with four businesses that were built to hand work to one another, which is the reason the order can be kept.