FHIR-native interoperability platform enabling secure clinical data exchange between hospitals, payers, and specialty networks with full audit trails.
A regional health network needed to consolidate fragmented point-to-point integrations with 40+ partner systems into a governed exchange layer. Prior integrations lacked standardized consent enforcement, produced inconsistent patient matching, and generated audit gaps that complicated HIPAA assessments. I designed a hub-and-spoke architecture with a canonical patient index, protocol adapters, and policy-driven routing that respects data use agreements. The platform processes admission, discharge, lab results, and medication events with sub-second routing for critical clinical alerts.
Care coordinators spent 45 minutes per patient manually reconciling records across EHR instances before transitions of care. Duplicate patient records caused 2.3% of lab orders to attach to incorrect profiles, triggering safety review incidents. Payer prior-authorization cycles averaged 72 hours due to missing clinical context at the point of request. Regulatory auditors identified insufficient logging of PHI access across legacy middleware.
We built adapter services for HL7 v2 MLLP, FHIR REST, and batch SFTP ingestion, each normalizing payloads into an internal canonical model before persistence. A master patient index applies probabilistic matching with manual review queues for low-confidence merges. Consent and purpose-of-use policies are evaluated at the API gateway using attribute-based access control tied to partner contracts. All PHI access is immutably logged to a tamper-evident audit store with 7-year retention.
The exchange hub runs as containerized .NET services on Azure Kubernetes Service with network policies isolating PHI-processing namespaces. Inbound messages land on Azure Service Bus topics partitioned by facility ID, with dedicated consumer groups per downstream subscriber. The canonical store uses SQL Server with row-level encryption for sensitive identifiers and temporal tables for historical replay. FHIR resources are exposed through Azure API Management with OAuth 2.0 SMART-on-FHIR profiles for external consumers.
Key interfaces and system views from the engagement.
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