The role would usually encompass development (the actual connecting, building, programming if necessary), monitoring (making sure all connections are good, responding to error queues, etc), and sysadmin (security, upgrades, etc.) Depending on how big the site is, sometimes all 3 of these can be 1 person and a backup, or multiple people per responsibility.

At my facility about 400 beds, it's been 1 main guy and a backup, and they were both mostly developers (which is a bulk of the role anyways).

Monitoring and response is something everyone does passively also, but my first major (and current) assignment is sysadmin in nature as I'm leading the upgrade of our engine.

The main day to day task would be developing and there is just a slew of projects always in the works that keep us busy. Every project is touched by the interface guy as we're not on a catch-all super EHR, but rather every department pretty much has their own unique application. Of course dev takes priority BEHIND putting out any fires which happen time to time, but as you mentioned if the heavy lifting (dev) is done right, this should be an abnormal occurrence and the goal is to make it hands-off. For example today at my site, our network guys updated some security settings which caused some dropped connections and the engine had trouble reconnecting, things of that nature are also occurrences.

The console (browser based) which shows us the various states of the engine is always open where we can take a quick peek whenever and it's more passive in nature. There are alerts and what not setup, and calls from help desk to on-call whenever we're not sitting at our desks.

Gluck