Have you implemented OpenMRS? Please participate in the Implementation Site Survey. If you already have, thank you!
Whenever possible, start with the floss. See the solution through end-to-end, since this is often the best way to understand the problem and often informs the next pass at the solution. In the end, it is rare that we fully understand the problem until the third iteration of the solution.
Be agile, open to corrections, and iterate on your solutions. But, most importantly, take action.