Two years into the ambient documentation wave, the picture is clearer than the early pilots suggested. The technology works. The deployment science is what separates the systems seeing 40% reductions in pajama-time from the ones that quietly walked the licenses back.
The strongest implementations share four traits: a clinically led design partnership with the vendor, a coding integrity loop running in parallel for the first 90 days, an explicit decision about specialty sequencing, and a willingness to redesign the visit — not just the note.