Healthcare organizations struggle with integrating heterogeneous legacy systems in real-time environments. This 18-month prospective study examined Apache Camel and Red Hat Fuse implementations across three U.S. healthcare delivery systems (patient populations: 1.2M, 850K, and 2.1M respectively). We collected performance metrics from 23 production integration flows, conducted semi-structured interviews with 18 IT practitioners and clinical users, and documented 7 significant implementation failures with detailed root cause analyses. Contrary to vendor claims, we found that median data integration latency was reduced from 2,847 ms (legacy point-to-point baseline) to 189 ms (Camel/Fuse implementation), representing a 93% improvement (p<0.001). However, we also discovered critical deployment challenges: initial CPU overhead was 340% higher than expected due to inadequate JVM tuning, requiring 4 months of performance optimization. Clinical workflow time savings averaged 34% per transaction, translating to approximately 2.7 full-time employee equivalents recovered per institution annually. This paper presents raw experimental data, comprehensive failure case analyses with remediation timelines, and practitioner perspectives rarely discussed in vendor materials. Our implementation framework emphasizes modular architecture, phased rollout strategies, and organizational change management that practitioners identified as essential for success. The work contributes quantifiable evidence for healthcare IT leaders evaluating enterprise integration platforms in complex operational environments, with particular attention to the gap between vendor expectations and real-world deployment realities.