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Interoperability Services

Healthcare Interoperability Solutions

HL7, FHIR, X12, and DICOM in production. We integrate, sustain, and modernize healthcare data exchange for US payers, providers, and HIT vendors.

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HL7 FHIR X12 DICOM
Healthcare interoperability solutions connecting EHRs, payers, labs, and health IT systems
15+
Years in U.S. healthcare IT
15M+
Patient records touched
200+
Healthcare integrations live
All
Major EHRs supported

Where Healthcare Data Works Together

Our HL7 and FHIR integrations move millions of clinical records, X12 claims, and patient encounters between EHRs, payers, labs, and devices every day. Designed by engineers, monitored continuously, and built so your team can ship the next thing instead of firefighting the last one.

What We Integrate

Healthcare data moves through dozens of formats and a handful of engines. We work in all of them.

Our Healthcare Interoperability Solutions

Six categories of integration, the standards inside each, and how we deliver them.

Core Clinical Data

Why it matters

ADT messages, orders, results, and care summaries are the daily traffic that keeps clinical operations running. A late ADT means the bed isn't ready. A missed ORU means a duplicate test. A misformatted CCDA means a care summary that the receiving system silently drops.

How we do it

We design HL7 interfaces in Mirth Connect, BizTalk, or Cloverleaf depending on what your team already runs. For sites moving toward modern apps and patient portals, we expose the same data through FHIR R4 APIs without ripping out the HL7 layer that already works. Every interface is tested against real partner traffic before go-live, not synthetic samples.

Standards we work in

  • HL7 v2.x for ADT, ORM, ORU, MDM, SIU
  • FHIR R4 and R5 for app, portal, and patient-access APIs
  • C-CDA for care summary exchange under USCDI v3

Imaging & Labs

Why it matters

Radiology and lab data are high-volume and time sensitive. A delayed ORU on a stat lab order isn't an inconvenience; it changes a clinical decision. PACS-to-EHR mismatches lose images. Older ASTM-based bench analyzers don't speak HL7 without a translator.

How we do it

For imaging, we move DICOM and DICOMweb to cloud or hybrid storage, with vendor-neutral archive options where you need to consolidate across departments. For labs, we handle the full ORM/ORU loop, including ASTM 1394 device integrations that older bench analyzers still ship with. Every result lands in the chart with the correct LOINC mapping, not a generic "test result" field.

Standards we work in

  • DICOM and DICOMweb (PACS, VNA, modality integration)
  • HL7 ORM, ORU, OML for order and result loops
  • ASTM 1394 for direct bench analyzer connectivity
  • LOINC for result code mapping

Payers & Revenue Cycle

Why it matters

A failed 270/271 eligibility round-trip means the front desk hands the patient a form they shouldn't be filling out. A rejected 837 means cash that should have hit A/R in 14 days hits in 60. Prior auth bottlenecks delay care and lose revenue.

How we do it

We build EDI gateways that talk to clearinghouses, direct payer connections, and PBMs. Real-time 270/271 for eligibility at point of service. 278 for prior auth where the payer supports it. 837/835 for claim submission and remit reconciliation, with rejection logic that tells your billing team exactly which loop or segment failed instead of returning the generic "invalid" code.

Standards we work in

  • X12 EDI 270/271, 276/277, 278, 834, 835, 837 (Professional, Institutional, Dental)
  • NCPDP SCRIPT and Telecom for e-prescribing and pharmacy
  • Direct API connections to major clearinghouses

HIE & Secure Exchange

Why it matters

Sending a discharge summary to a state HIE or a referral through DIRECT messaging isn't optional anymore. Most states require it for participating providers, and many payers require it for value-based contracts. The hard part isn't sending. It's making sure the receiving system can read what you sent.

How we do it

We connect EHRs and partner systems to HIEs using IHE XDS.b for document exchange and PIX/PDQ for patient matching. When DIRECT messaging is the right fit (often for smaller specialist offices), we set up HISP-grade secure channels that work inside the EHR's referral workflow instead of as a separate inbox someone has to remember to check.

Standards we work in

  • IHE profiles: XDS.b (document exchange), PIX/PDQ (patient matching), XCA (cross-community access)
  • DIRECT Protocol via HISP
  • TEFCA-ready document and FHIR exchange

Consumer Health & Devices

Why it matters

The Cures Act and USCDI v3 made patient API access non-optional for certified EHRs. Beyond compliance, patients now expect to see their data on their phone, and clinicians need device data flowing into the chart automatically instead of being typed in by a nurse.

How we do it

We implement SMART on FHIR for trusted apps that need scoped patient access. For device data, we bridge IEEE 11073 and BTLE wearables and bedside monitors into clinical workflows, mapping each metric back to a structured chart entry instead of free-text comments. Every implementation aligns with USCDI v3 so the same APIs work for patient access, payer data exchange, and quality reporting.

Standards we work in

  • SMART on FHIR for app authorization and scoped access
  • USCDI v3 for the data class set
  • IEEE 11073 and Bluetooth Low Energy for device integration

Compliance & Nationwide Exchange

Why it matters

TEFCA flipped national exchange from "if you can find a connection" to "if you're certified to participate." For payers and providers in value-based arrangements, TEFCA alignment is becoming a procurement gate, not a future consideration.

How we do it

We map existing feeds and APIs to TEFCA exchange purposes, validate completeness against USCDI v3, and prepare interfaces for third-party audits when QHIN onboarding requires them. For organizations not joining a QHIN directly, we align with their connecting QHIN's technical requirements so the integration path works either way.

Standards we work in

  • TEFCA Framework and Common Agreement
  • QHIN onboarding technical specifications
  • USCDI v3 data class compliance

How We Work Across Your Integration Lifecycle

We cover every stage, whether you're enabling new connections, keeping legacy stable, or simplifying what's grown too complex.

Enable New Interoperability

When you're adding partners, expanding workflows, or building new product capability, you need modern standards-driven connections that hold up in production.

  • Build HL7 v2 interfaces on Mirth Connect, BizTalk, or Cloverleaf
  • Implement FHIR R4 APIs and FHIR Bulk Data with OAuth2 and SMART
  • Deliver EDI revenue cycle streams (837, 835, 270/271, 278, 834)
  • Submit CQM data via QRDA Category I and III for quality reporting
  • Support TEFCA exchange and QHIN onboarding workflows
  • Deploy on-prem, cloud, or containerized depending on your security model
Healthcare professional reviewing integration workflows on a tablet

Sustain What Already Works

Most integration outages aren't dramatic failures. They're partner schema changes nobody told you about, certificates that expired on a Friday night, and tribal knowledge that left when the engineer who built it changed jobs.

  • Continuous interface monitoring with alerting on volume and error-rate anomalies
  • Rapid response when partner systems version-bump or change feed structures
  • Automated regression testing that catches breakages before production
  • Documentation rebuilt from the actual running config, not what was supposed to be running
  • Standards updates (HL7 v2 to FHIR, ICD-9 to ICD-10, USCDI v2 to v3)
Team sustaining healthcare integration operations

Reengineer & Simplify

After ten years of point-to-point fixes, most healthcare data architectures collect interfaces faster than they retire them. Three feeds doing what one should. Custom adapters for partners who left two years ago. Duplicate transformation logic in three different engines.

  • Inventory and map every active integration touchpoint
  • Identify redundancies, dead interfaces, and consolidation candidates
  • Design a target-state architecture grounded in FHIR APIs and standardized engines
  • Migrate incrementally so existing partner workflows never see a downtime window
Engineering team rearchitecting healthcare integrations

Whether you're building new, keeping the old running, or simplifying what grew too complex, we keep healthcare data moving, compliant, and ready for what's next.

U.S. Healthcare IT

Why Choose Nalashaa for Healthcare Interoperability

  • Deep Healthcare Context We don't just plug systems together; we know how every HL7 feed, FHIR API, or X12 transaction fits into real-world care, claims, and compliance.
  • Predictable Costs, No Surprises We structure engagements with clear phases, fixed timelines, and scoped budgets so you know what you'll spend, when you'll be live, and what you'll get.
  • Ready-Made Accelerators Proven interface templates, reusable modules, and compliance-ready patterns cut build time without cutting corners.
  • Built Fast, Tested to Last We deliver fast — then back it up with automated testing, version control, and rollback plans to keep every interface stable as standards change.
  • Ongoing Support, Zero Tribal Knowledge We don't walk away when the build is done; we monitor, maintain, and document every connection so your teams aren't left guessing.
HL7 FHIR X12 DICOM TEFCA

Interoperability work we've shipped in production

Production deployments across EHR vendors, specialty platforms, and payer workflows.

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Get a free integration assessment

Working on FHIR, HL7, prior authorization, or payer data exchange? We start with a current-state review. Typically, a 45-minute call plus a written summary of integration and compliance gaps within 5 business days. No commitment to engage further.

Call us 732-602-2560
Email us info@nalashaa.com
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Other healthcare IT services we deliver

If interoperability is one piece of a larger initiative, we cover the rest of the stack.

Development

Connect healthcare systems bidirectionally while ensuring security and regulatory alignment.

Learn more

Data Services

Clean, structure, and transform clinical data to support reporting, analytics, and integration.

Learn more

Automation

Streamline repetitive workflows with secure, audit-ready automation across clinical and admin processes.

Learn more

Cloud Services

Scale your product to reliable, cloud-native infrastructure with automated deployment and monitoring.

Learn more

Compliance & Validation

Build with pre-validated controls, audit trails, and documentation aligned to HIPAA, 21 CFR Part 11, and HITRUST.

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Quick Reads to Help You Navigate Healthcare Interoperability

FHIR vs HL7 v2 – What Healthcare Vendors Need to Know

If you’re building or updating healthcare integrations, chances are you’ve come across both HL7 v2 and FHIR. One has been the industry’s default for decades. The other is shaping how future systems will connect. For vendors, knowing the strengths and limits of each can help avoid costly missteps in architecture and planning.

HL7 v2: Still in Use, But Showing Its Age

HL7 v2 is one of the oldest and most widely implemented standards in healthcare. It uses a pipe-delimited message structure and supports many clinical workflows, such as admissions, discharges, and lab orders. Despite its reach, HL7 v2 has some clear drawbacks. The standard is loosely defined, leading to inconsistent implementations across systems. It’s also not built for modern APIs, which makes real-time, web-based communication more difficult.

FHIR: Designed for Modern Interoperability

FHIR (Fast Healthcare Interoperability Resources) was developed to support current web technologies. It uses RESTful APIs and represents data in formats like JSON and XML, making it easier for developers to build, test, and maintain integrations. FHIR is modular, more consistent across use cases, and aligns with recent regulatory efforts such as the 21st Century Cures Act and TEFCA.

Which One Should Vendors Use?

The answer depends on your audience and your goals. If your clients still use systems that rely on HL7 v2, you’ll likely need to support it. But if you’re building new features, patient-facing apps, or looking to scale integrations, FHIR is the better foundation. Many vendors opt for hybrid support, maintaining HL7 v2 compatibility while gradually building out FHIR capabilities.

Understanding both standards helps vendors plan for long-term interoperability. HL7 v2 isn’t disappearing overnight, but FHIR is rapidly becoming the industry’s preferred approach for scalable, API-driven healthcare data exchange.

A Quick Guide to TEFCA and What It Means for Your Product Roadmap

TEFCA (Trusted Exchange Framework and Common Agreement) is a national framework developed by the Office of the National Coordinator for Health IT (ONC) to improve how healthcare data is shared across systems, networks, and organizations. For health IT vendors, this signals a clear direction in interoperability efforts — toward unified rules, common standards, and centralized exchange pathways.

What Is TEFCA, in Simple Terms?

TEFCA aims to connect various health information networks under a shared set of policies and technical standards. At the center of this framework are Qualified Health Information Networks (QHINs), which act as exchange hubs for healthcare data. In early 2024, several

QHINs — including CommonWell, eHealth Exchange, and Health Gorilla — began participating in live data exchange, laying the foundation for TEFCA's operational model.

Why Vendors Should Pay Attention

Even if vendors are not currently required to participate in TEFCA directly, their clients — including providers, payers, and public health entities — are starting to adopt it. This shift impacts product development and integration planning in several ways:

  • Interoperability Standards: Clients will expect solutions to align with data standards like USCDI and FHIR, both of which are foundational to TEFCA.
  • Exchange Readiness: Applications may need to support QHIN-enabled workflows, including data queries and push-based information sharing.
  • Market Perception: Vendors that adapt early and show alignment with TEFCA-related goals are more likely to be seen as future-ready.
How to Respond

Begin by reviewing how your product handles structured data, external APIs, and exchange protocols. Supporting modular FHIR APIs and USCDI-compliant datasets can provide a smoother path toward TEFCA compatibility in the future. Monitoring TEFCA updates and understanding QHIN onboarding criteria will also help you anticipate client needs before they escalate.

TEFCA represents a long-term shift in how U.S. healthcare systems connect. For vendors, preparing now can reduce future rework and open new doors as nationwide exchange becomes more standardized.

How to Prepare Your Legacy System for Modern Interoperability

Many healthcare vendors still rely on legacy systems-built decades ago. These systems often handle critical workflows reliably, but they were not designed to connect with modern APIs, FHIR servers, or national exchange frameworks like TEFCA. The good news is that modernization does not always mean starting from scratch. With a practical approach, legacy platforms can be prepared for today’s interoperability demands.

Understand What Your System Can and Cannot Do

The first step is a clear assessment of existing capabilities. Can your system support data in a structured format like JSON or XML? Does it already produce HL7 v2 messages? Are there any existing APIs, even if outdated? Knowing your baseline helps identify what needs to be upgraded and what can be reused.

Add a Translation Layer
Instead of rewriting the core system, many vendors choose to build an interoperability layer on top. This layer translates internal data structures into modern formats such as FHIR, allowing the legacy backend to remain intact. It acts as a bridge, handling tasks like API calls, data validation, and secure exchange with external systems.
Focus on Modular Upgrades

Rather than a full rebuild, look at modular enhancements. Start with use cases that have clear ROI — for example, creating a FHIR interface for patient demographics or lab results. This phased approach allows teams to gain experience, reduce risk, and show value quickly.

Align with Current Standards

Make sure that any new components are aligned with industry standards like FHIR R4, SMART on FHIR, and USCDI. This improves compatibility with partner systems and positions your product for upcoming regulatory changes. Even if the core application is dated, wrapping it with compliant interfaces can extend its relevance.

Avoid Over-Customization

Many legacy systems rely on heavy customization that makes future upgrades difficult. Try to reduce dependencies and simplify workflows where possible. Clean, modular interfaces are easier to manage and scale.

Modernizing for interoperability does not have to be disruptive. With the right planning, even older platforms can stay in the game — and meet the evolving expectations of providers, payers, and regulators.

Top 5 Interoperability Mistakes Healthcare Vendors Make (and How to Avoid Them)

Interoperability is no longer a technical add-on. It has become a core requirement in product development for healthcare IT vendors. Yet even well-established teams fall into common traps when trying to support data exchange across systems. Here are five mistakes to watch for — and how to avoid them.

Treating Interoperability as a One-Time Effort

Many vendors build an interface and assume the job is done. But interoperability standards evolve, clients change systems, and regulations shift. Maintaining interoperability is an ongoing process, not a single milestone.

Ignoring Implementation Variability

Even with standards like HL7 v2 or FHIR, implementations vary between systems. Assuming every partner will interpret the standard the same way leads to failed exchanges and costly debugging. Always allow for flexibility in your integration logic.

Overlooking Security from the Start

Data exchange without proper authentication and access control opens up major compliance risks. Security cannot be an afterthought. Plan for OAuth2, audit logs, encryption, and role-based access from the start.

Focusing Only on the Technical Layer

Successful interoperability depends just as much on data quality and workflow alignment as it does on APIs. If the source data is inconsistent or workflows are mismatched, even the best integration will fall short. Spend time understanding how users interact with data before building connections.

Not Planning for Scale

Point-to-point integrations may work for a handful of clients, but they become hard to manage as your client base grows. Vendors need to think about centralized integration hubs, reusable APIs, and scalable messaging patterns early in the design process.

Avoiding these pitfalls can save significant time and effort down the road. Interoperability is a moving target — and vendors who treat it as a strategic capability, rather than a checkbox, are better equipped to deliver lasting value.

The Role of FHIR Servers in Scalable Healthcare Integration

As healthcare shifts toward API-first architectures, FHIR servers have become central to how data is exchanged, accessed, and managed. For vendors building modern solutions, understanding the role of FHIR servers is essential — especially when planning for scalability and long-term interoperability

What Does a FHIR Server Do?

A FHIR server acts as a data access layer built around the FHIR standard. It stores clinical data as modular “resources” — such as Patient, Encounter, Observation — and exposes them via RESTful APIs. This allows external systems, apps, and users to interact with healthcare data in real time, using standard query formats.

Why It Matters for Vendors

A FHIR server is more than just an API reusability to data exchange workflows. Instead of building custom interfaces for every integration, vendors can use a FHIR server to:

  • Centralize data access
  • Support SMART on FHIR apps
  • Simplify third-party integrations
  • Align with TEFCA and regulatory mandates

This approach reduces development overhead and improves compatibility across systems.

Scalability Through Modularity

FHIR servers support granular access to data. Clients can query only the information they need — for example, a list of lab results for a specific time frame. This reduces load on the system and makes data retrieval more efficient. With proper indexing and security controls in place, FHIR servers can scale across hundreds of clients without significant performance issues.

Preparing for Broader Ecosystem Demands

With payers, providers, and public health entities adopting FHIR, vendors who build around a stable FHIR server architecture are in a stronger position to support future partnerships. Whether it’s data sharing with a QHIN or enabling a patient-facing mobile app, the FHIR server becomes the foundation.

In a landscape that continues to prioritize openness, agility, and data liquidity, FHIR servers are not optional. They are the infrastructure layer that makes modern healthcare integration possible — and sustainable.

Frequently Asked Questions

Healthcare interoperability solutions are tools and systems that enable secure, accurate, and efficient data exchange between different healthcare software platforms. These solutions help connect EHRs, labs, payers, and third-party applications to ensure timely access to clinical and administrative information.

The four levels of interoperability are:

  • Foundational – Basic data exchange between systems
  • Structural – Consistent data formats and syntax
  • Semantic – Shared understanding of data meaning
  • Organizational – Governance, privacy, and policies that support exchange across systems and entities

A hospital’s EHR system sending real-time lab results to a specialist’s clinic using FHIR APIs is a practical example. Both systems use interoperability standards to exchange structured, meaningful data without manual input

Improvements start with adopting standards like FHIR and USCDI, reducing reliance on custom integrations, and working with vendors that offer scalable, standards-compliant interoperability services. Participation in national frameworks like TEFCA also enhances exchange readiness.

Two major challenges include:

  • Data inconsistency across systems due to legacy formats or poor standardization
  • Lack of aligned workflows, where even connected systems struggle with timing, permissions, or context for data use

Examples include:

  • Proprietary software that resists data sharing
  • Incompatible data standards or formats used across platforms

FHIR servers act as standardized access points for healthcare data, using modern APIs to facilitate real-time, secure information exchange between systems, apps, and users.

TEFCA is not mandatory yet, but it is shaping how national health information networks will operate. Vendors aligned with TEFCA principles are more likely to remain compatible with emerging client requirements.

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