This paper reports from a large-scale openEHR-based EPR project 2012-2016 in the North Norway Regional Health Authority. To be able to support patient pathways across the health region's trusts, there is a need for standardized routines and practices. Therefore, the North Norway Regional Health Authority has since 2011 had an increased regional focus to prepare for this new system. This includes a) centralizing its IT portfolio to one location, b) creating regional work standards for using the EPR system, and c) establishing a Regional Department for functional ICT. There are several challenges connected to changing the focus from working as individual health trusts to work as one region. There are issues of power balance and local influence that will need a careful consideration to ensure a successful outcome.