A multi-site clinic group ran capable systems that did not speak to one another. Patient records sat in one system, appointment scheduling in another, the laboratory in a third, and billing in a fourth. A single visit therefore meant entering the same patient details several times, copying results between screens, and reconciling by hand at the end. Staff spent time on re-entry that should have gone to patients, and every manual copy was a chance for a transcription error in a setting where errors matter.
The group was clear that this was about assisting clinical and administrative staff, not replacing their judgement, and that patient privacy could not be traded for convenience. Any integration had to move the minimum necessary information, to the right system, with access properly controlled.
The challenges we had to solve
- Four systems from different vendors had to exchange data without anyone re-keying it between them.
- The work involved patient health information, so privacy and access control were design constraints, not afterthoughts.
- The systems spoke different dialects, so we had to bridge older HL7 v2 messaging with newer FHIR interfaces.
- Clinical work could not pause, so changes had to land without disrupting a working day at the clinics.
How we approached it
We started with the flows that caused the most duplicate effort — registration once at the front desk feeding scheduling and records, lab results returning to the patient record as structured observations, and clinical events reaching billing without a second entry. We used HL7 v2 messaging where the established systems already spoke it and FHIR where the newer interfaces and any patient-facing work were better served, with an integration layer in the middle translating between them and carrying only what each step needed.
We delivered one flow at a time, validating each with clinical and administrative staff before moving to the next, so the clinics were never asked to absorb a large change at once. Privacy stayed in front of us throughout: least-necessary data, controlled access, and a record of what moved where. We handed over clear documentation of the interfaces and the data each one carries, so the group’s own team can maintain and extend them.
Where it stands
Staff enter a patient’s details once and see results and billing line up without shuttling between screens. The time that went into re-entry now goes to patients, and a category of transcription error has been designed out rather than watched for. The systems remain the specialist tools each department chose; what changed is that they now pass the right information to each other, within boundaries the group set.