At minimum, a freestanding ER needs 24/7 network and endpoint monitoring, HIPAA-compliant security, and EHR support for Epic ASAP, Cerner FirstNet, or T-System, plus fast connectivity between on-site CT and X-ray, PACS, and the lab. It also needs continuous backup and disaster recovery, failover internet, and vCIO guidance for CMS and EMTALA readiness. Because there is no maintenance window, all of it has to be delivered without taking systems offline.