The National Health Information Network (NHIN) is a federal mandate of the US Government. It involves setting the standards for interoperability and effective information technology in health care for hospitals, urgent care, private practices, insurance carriers, and other health care participants. Much attention has been paid to mixed NHIN funding outcomes of Regional Health Information Organizations (RHIOs) but here we take the different perspective of the private practice. This paper examines a Pediatric implementation, PedOne®, that is designed to deliver an intuitive and friendly environment to provide clinical data management and decision support. PedOne® interfaces to public health and internal medical knowledge bases. In an analogy to the Internet Engineering Task Force (IETF) role in building the Internet, we focus on the running code and the physician design involvement to provide lessons learned with respect to Pediatric Electronic Health Records system evolution. The design principles we uncover can be extrapolated to other medical specialties.