An EHR integration that legacy systems could live with.
A hospital network where three legacy EHRs did not speak to each other, and clinicians paid for it in charting time. We built a HIPAA-compliant integration layer over FHIR — no rip-and-replace, and every record access auditable.
What was breaking
A hospital network running three different legacy EHR systems with no interoperability between them. Patient records were duplicated across sites, billing reconciliation ran on manual review, and clinician time went into data entry rather than care. The integration had to be FHIR-compliant, had to leave the legacy systems as systems of record, and had to produce a HIPAA-aligned audit trail a compliance officer could sign off on.
The technical bets we made
- 1
Built a FHIR-compliant integration layer that translated between three legacy EHR formats and a unified internal patient model. No 'rip and replace' — the legacy systems remained the source of truth.
- 2
Designed a real-time deduplication engine using fuzzy patient matching on date of birth, name, phone and address — with a manual review queue for low-confidence matches, because a wrong merge in healthcare is far worse than a missed one.
- 3
Automated appointment scheduling with conflict detection across facilities, and SMS reminders sent through a HIPAA-compliant channel rather than a general-purpose gateway.
- 4
Streamlined billing reconciliation: claims auto-routed against insurance coverage rules, with anomaly detection flagging outliers before submission rather than after payout.
- 5
Set up immutable audit logging (cryptographically chained) for HIPAA compliance — every patient data access logged, queryable, exportable for audits.
What powers this system
From kickoff to production
Hospital walk-throughs, clinician shadowing, compliance officer interviews. FHIR mapping plan delivered week 2.
Integration architecture, FHIR resource model, HIPAA threat model. Compliance sign-off before code started.
Hospital-by-hospital phased rollout. 1-hospital pilot in week 8, full network live by week 22.
Adoption support, runbook handover, SLA monitoring setup. Final HIPAA audit passed week 26.
What the architecture changed
Interoperability stopped being a project and became a property of the system: a new site joins by mapping to the FHIR model rather than by another point-to-point integration. Deduplication moved patient identity from a per-hospital guess to a network-wide record. And because every access is logged into an immutable chain, HIPAA audit preparation became a query rather than a reconstruction.
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