diff --git a/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_0_0/5547-collation-index-fix.yaml b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_0_0/5547-collation-index-fix.yaml
new file mode 100644
index 00000000000..c6ab2f02556
--- /dev/null
+++ b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_0_0/5547-collation-index-fix.yaml
@@ -0,0 +1,5 @@
+---
+type: fix
+issue: 5547
+title: "The addition of the indexes `idx_sp_uri_hash_identity_pattern_ops` and `idx_sp_string_hash_nrm_pattern_ops` could occasionally timeout during migration in Postgresql on large databases, leaving the migration table in a failed state, and Smile CDR unable to boot. 
+Now existence of the index is checked before attempting to add it again."
diff --git a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/HapiFhirJpaMigrationTasks.java b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/HapiFhirJpaMigrationTasks.java
index 9d50199fb88..636b436746e 100644
--- a/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/HapiFhirJpaMigrationTasks.java
+++ b/hapi-fhir-jpaserver-base/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/HapiFhirJpaMigrationTasks.java
@@ -184,8 +184,10 @@ public class HapiFhirJpaMigrationTasks extends BaseMigrationTasks<VersionEnum> {
 									QUERY_FOR_COLUMN_COLLATION_TEMPLATE,
 									"HFJ_SPIDX_STRING".toLowerCase(),
 									"SP_VALUE_NORMALIZED".toLowerCase()),
-							"Column HFJ_SPIDX_STRING.SP_VALUE_NORMALIZED already has a collation of 'C' so doing nothing");
-
+							"Column HFJ_SPIDX_STRING.SP_VALUE_NORMALIZED already has a collation of 'C' so doing nothing")
+					.onlyIf(
+							"SELECT NOT EXISTS(select 1 from pg_indexes where indexname='idx_sp_string_hash_nrm_pattern_ops')",
+							"Index idx_sp_string_hash_nrm_pattern_ops already exists");
 			version.executeRawSql(
 							"20231212.2",
 							"CREATE UNIQUE INDEX idx_sp_uri_hash_identity_pattern_ops ON public.hfj_spidx_uri USING btree (hash_identity, sp_uri varchar_pattern_ops, res_id, partition_id)")
@@ -195,7 +197,10 @@ public class HapiFhirJpaMigrationTasks extends BaseMigrationTasks<VersionEnum> {
 									QUERY_FOR_COLUMN_COLLATION_TEMPLATE,
 									"HFJ_SPIDX_URI".toLowerCase(),
 									"SP_URI".toLowerCase()),
-							"Column HFJ_SPIDX_STRING.SP_VALUE_NORMALIZED already has a collation of 'C' so doing nothing");
+							"Column HFJ_SPIDX_STRING.SP_VALUE_NORMALIZED already has a collation of 'C' so doing nothing")
+					.onlyIf(
+							"SELECT NOT EXISTS(select 1 from pg_indexes where indexname='idx_sp_uri_hash_identity_pattern_ops')",
+							"Index idx_sp_uri_hash_identity_pattern_ops already exists.");
 		}
 
 		// This fix was bad for MSSQL, it has been set to do nothing.
diff --git a/hapi-fhir-sql-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/api/Builder.java b/hapi-fhir-sql-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/api/Builder.java
index 3f47dc4606d..39365829c77 100644
--- a/hapi-fhir-sql-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/api/Builder.java
+++ b/hapi-fhir-sql-migrate/src/main/java/ca/uhn/fhir/jpa/migrate/tasks/api/Builder.java
@@ -597,11 +597,11 @@ public class Builder {
 								"Only SELECT statements (including CTEs) are allowed here.  Please check your SQL: [%s]",
 								theSql));
 			}
-			ourLog.info("SQL to evaluate: {}", theSql);
+			ourLog.debug("SQL to evaluate: {}", theSql);
 
 			myTask.addPrecondition(new ExecuteTaskPrecondition(
 					() -> {
-						ourLog.info("Checking precondition for SQL: {}", theSql);
+						ourLog.debug("Checking precondition for SQL: {}", theSql);
 						return MigrationJdbcUtils.queryForSingleBooleanResultMultipleThrowsException(
 								theSql, myTask.newJdbcTemplate());
 					},