Building an HL7 healthcare integration solution

Our customer is a radiology center specializing in diagnostic imaging services. Their business relies heavily on accurate and efficient handling of medical data, images, and clinical reports. Like many healthcare organizations, the center manages a complex ecosystem of specialized software, each handling different parts of patient care and data processing.  

For example, they use a first system for patient registration, a second for managing clinical information, a third for storing and viewing diagnostic images, and a fourth for preparing medical reports.  

The critical problem the customer faced was a lack of integration among these systems, highlighting the broader Electronic Health Record (EHR) interoperability challenges common in healthcare. Radiologists and administrative staff constantly switched between multiple interfaces and manually verified patient data across different applications. 

This fragmented workflow led to inefficiencies, increased risk of human error, and delays in patient service. 

Recognizing these challenges, our customer envisioned a unified solution that would seamlessly connect all critical systems, streamline daily tasks, and minimize errors. More importantly, they saw an opportunity to transform their internal improvement into a scalable product that could benefit many other clinics facing the same issues.  

In this post, we share how we brought that vision to life, detailing the key decisions, technical milestones, and lessons learned as we built a platform ready for both their team and the broader healthcare community. 

Radiology process overview

To fully understand the challenges our customer encountered, it is important to have a clear picture of the detailed patient workflow in their radiology center: 

1. Appointment scheduling: Patients schedule their radiology exams through an online booking system. At this stage, patient information and appointment details enter the Radiology Information System (RIS). 

2. Conducting the imaging exam: Patients visit the clinic, where radiologists perform diagnostic imaging using specialized equipment, such as MRI or CT scanners. Images captured during the procedure are stored in a separate system known as PACS (Picture Archiving and Communication System). 

3. Interpretation and dictation: Radiologists review the images using a dedicated image viewer. Once the images are analyzed, they dictate their findings into specialized radiology dictation software, converting spoken analysis into text. 

4. Generating the clinical report: Finally, a medical report summarizing findings is created. This report is signed electronically by the radiologist and made available to the patient and referring physician. 

Key challenges in the original workflow

The customer’s radiology center struggled with disconnected software systems. Each major step in their workflow relied on a separate specialized application: 

• Radiology Information System (RIS): Managed scheduling and patient data but was isolated from imaging, dictation, and documentation tools. 

• Picture Archiving and Communication System (PACS): Stores diagnostic images, such as DICOM (Digital Imaging and Communications in Medicine) files, and provides access through an image viewer. 

• Dictation software: Used by radiologists to document their interpretations. 

• Reporting System for Radiologists: Handled the creation, review, and management of clinical reports. 

This fragmentation created significant inefficiencies and frustration: 

• Radiologists constantly switched between multiple applications and screens to access all necessary patient data. 

• Staff spent considerable time manually cross-checking patient information and status updates across systems to prevent errors. 

• These manual tasks increased the risk of data inconsistencies and mistakes, potentially affecting patient safety and service quality. 

Customer’s vision for a unified solution

Recognizing these challenges, the сustomer envisioned a unified platform to integrate their fragmented systems into a single, coherent interface. They wanted a solution that would: 

• Provide radiologists with a single workspace, aggregating essential data from RIS, PACS, Reporting System for Radiologists, and dictation software. 

• Significantly reduce human error by automatically synchronizing patient and exam data between applications. 

• Streamline the radiology workflow, enabling staff to focus fully on patient care and diagnostics rather than administrative tasks. 

• Be flexible and scalable enough to offer as a standalone product to other clinics facing similar challenges, effectively turning their internal solution into a marketable offering. 

This clear vision set the stage for our collaboration, and our team began designing and implementing the customer’s ideal integrated solution. 

Designing the integrated command center

We developed the Integrated Command Center for Radiologists to provide a unified environment for managing the entire diagnostic workflow. Radiologists and administrators can visualize and interact with up-to-date patient data, imaging studies, and clinical reports in real time. 

End-to-end workflow management

The command center includes extensive configuration options, allowing administrators to tailor the system to clinic-specific processes and user roles.

Key features include: 

• Dynamic worklists: Automatic task and patient prioritization based on customizable rules, including SLA tracking and color coding for urgent cases. 

• Exam lifecycle management: Real-time status tracking for each exam, from scheduling and patient arrival through to imaging, reporting, and completion. 

• User and role management: Centralized control over user access, roles, and permissions, supporting secure multi-tenant deployment for different clinics. 

• HL7 message monitoring: Detailed logs for all incoming HL7 messages, with processing status, timestamps, patient attributes, and troubleshooting details. HL7 is a standard protocol for exchanging medical data between healthcare systems, and in the next section, we provide an in-depth look at how we handle HL7 integration. 

• Interface and data source configuration: Flexible management of integration points with external systems (such as RIS, PACS, and dictation software), with support for mapping incoming data fields according to clinic-specific requirements. 

• Customizable workflow and rules: Management of priority rules, exam status transitions, and automation of notifications and escalations. 

• Single sign-on (SSO): Integration with Active Directory for secure authentication and seamless user access across all components. 

• Audit trails and system monitoring: Full visibility into user actions and system events to support compliance and operational oversight. 

Integration and data flow

To support a unified radiology workflow, we designed flexible integrations between the command center and a wide range of clinical systems used across different clinics. All connections can be easily configured and managed within the command center’s settings. Users access synchronized data and external tools directly from the command center.  

The key integration points in our customer’s setup included: 

• Radiology Information System (RIS): Using HL7 messages, the command center automatically pulls patient data, scheduled exams, and real-time status updates to populate accurate worklists. 

• PACS and image viewer: We integrated the command center with PACS and the image viewer, allowing radiologists to access and review images directly from the command center interface. 

• Reporting and dictation software: From the command center, radiologists open the clinical report form and activate the dictation tool, which transcribes spoken findings directly into the appropriate fields. The completed report is then signed electronically and saved, with its status synchronized back to the command center for final review. 

• Active Directory integration: Authentication and authorization are managed through the existing Active Directory setup, supporting secure access and permission management in multi-tenant environments, as required for commercial distribution. 

Outcomes

The command center brings together all essential tools and configurations in a single platform, allowing clinics to automate the full radiology workflow, reduce errors, and easily adapt the system to new operational needs. All clinical data and workflow actions are synchronized and accessible within one unified workspace, removing the need to switch between multiple applications and simplifying daily tasks for radiologists. 

From MVP to scalable multi-tenant architecture

We approached this project in two major phases. First, we developed a minimum viable product (MVP) to quickly implement, test, and stabilize the core functionality of the Integrated Command Center. The MVP allowed us to integrate the essential components (RIS, PACS, reporting, and dictation software) and deliver a working prototype that aggregated patient information, exam statuses, and clinical tools in a single interface. This early version gave the customer an immediate opportunity to validate the concept and refine the workflow based on real feedback from radiologists. 

Once the core feature set was confirmed, we moved to the next phase: upgrading the system architecture and iteratively enhancing the UI and user experience of the command center. Our focus shifted to making the solution scalable, flexible, and robust enough to support commercial deployment for a broad range of clinics. 

In this stage, we implemented several key improvements: 

Microservices architecture

We separated the system into independently deployable services for integration logic, data ingestion, workflow orchestration, user management, and the user interface. 

Modern technical stack

We chose Node.js for backend services, AWS for infrastructure, and a combination of Redis and Amazon SQS for caching and messaging to ensure speed and reliability. 

Scalability and performance

We engineered the solution to reliably process over 1,000 HL7 messages per second, supporting smooth operations in high-volume environments. 

Multi-tenant architecture

We built in tenant separation for easy configuration, data security, and resource management for each clinic. 

These architectural decisions provided a solid foundation for a scalable and flexible solution, enabling our customer to offer the command center as a commercial product for diverse clinical environments. 

Universal HL7 message handling

HL7 (Health Level Seven) is the widely adopted standard in healthcare for exchanging patient information among clinical systems. It defines how healthcare data, such as patient demographics, exam orders, and clinical observations, should be structured, formatted, and transferred between systems.  

In our system, the HL7 protocol is used to deliver patient and exam information from the Radiology Information System (RIS) to our Integrated Command Center for Radiologists.  

Technical complexity of custom HL7 mappings

Despite being a standard, HL7 implementations vary significantly across different clinics: 

• Clinics often use different HL7 protocol versions (HL7 v2.x, HL7 v3, and FHIR), each with unique data formatting and message structures. 

• Many clinics further customize their HL7 message formats to fit their specific workflows, creating a variety of non-standard field mappings. 

To support our customer’s goal of offering this solution to a wide range of other clinics, our system needed the flexibility to interpret and correctly process these diverse messages without extensive manual adjustments. 

Creating a flexible HL7 normalization engine

We overcame these challenges by developing a flexible and robust HL7 integration layer capable of accurately processing custom and modified HL7 messages. Key features of our solution include: 

• Dynamic HL7 message parsing and mapping: Our solution adapts in real-time to different message versions and customized fields without additional manual configuration. 

• Data normalization engine: We implemented logic to convert diverse data formats into standardized internal representations, ensuring consistent data handling and validation. 

• High-speed processing: Our platform efficiently processes over 1000 HL7 messages per second, essential for real-time clinical workflows. 

Our adaptive approach guarantees seamless integration with diverse client infrastructures, making our solution truly scalable for commercial deployment. 

For a deeper technical dive into HL7 integration strategies, challenges, and detailed implementation approaches, please refer to our dedicated technical blog post. 

Your trusted healthcare development service partner

The project delivered immediate and measurable benefits for our customer. The integrated command center eliminated manual data reconciliation, reduced errors, and streamlined the radiology workflow.  

Our flexible approach to HL7 integration, robust multi-tenant design, and deep experience in healthcare data workflows mean we are ready to help other clinics and healthcare organizations overcome similar challenges. Whether you are facing fragmented software, custom HL7 environments, or the need to automate complex diagnostic processes, we can support you. 

ABCloudz combines technical expertise in healthcare software, integration, and scalable architecture with an understanding of real-world clinical operations. If your organization is looking to drive digital transformation in healthcare, modernize its healthcare IT landscape, streamline radiology or other medical workflows, or build a product that can scale across diverse clinical environments, we are ready to help. 

Contact us to discuss how our experience and solutions can support your next project.