The patients receiving treatment from a hospital need to interact with multiple entities when claiming reimbursements. The complexities of the medical service supply chain can be simplified with an electronic clearance management system that allows hospitals, medical insurance bureau, bank, and patients to interact in a seamless and cashless manner. This case describes the implementation of such a system for the medical insurance bureau of Xiamen. Although the architecture was simple, the implementation faced a number of challenges. Although there were both organizational and technical challenges, the problems of co-ordination and communication between the different teams tended to dominate the process of implementation. The project leader was faced with the decision of prioritizing the complex challenges, and finding out ways to overcome them. (Contains 1 table and 6 figures.)