Provider performance scorecards are widely adopted yet frequently abandoned. The barriers are rarely technical — they’re human. This presentation shares how one healthcare institution built a sustainable, high-performing scorecard through intentional co-development with informaticists, physicians, and clinical staff, solving what implementation guides ignore: informatics infrastructure, emotional response to personal data, and the leadership required to hold ground when the two collide. Development began in 2021; this is a five-year story of what it actually takes.