Notes on FHIR SDC form builders, terminology servers, master patient index tooling, and EHR development.
US specialty networks face a recurring architectural question as they grow: should the patient identity store be a single centralized MPI that every member site…
US specialty networks face a recurring architectural question as they grow: should the patient identity store be a single centralized MPI that every member site reads and writes, or a federated enterprise MPI that lets each site keep its ow
Da Vinci payer-provider workflows have a quiet architectural choice at their heart: should the terminology resolution happen against the EHR's built-in vocabulary tables or against a dedicated FHIR terminology server. Both can work. Both pr
Where the FHIR form layer lives is one of the quieter architectural choices US specialty practices make, and the one that quietly shapes everything else. Hosted platforms put the form server, terminology service, and rendering layer on some
US ACOs face a quiet architectural choice when their patient identity needs grow beyond what a single member EHR can handle. A FHIR-native MPI treats patient identity as a FHIR Patient resource problem from the start. A legacy MPI, often th
VSAC, the NLM-hosted Value Set Authority Center, is the canonical source for value sets used in US clinical quality measures. Locally authored value sets are the ones an organization writes itself when VSAC content does not quite fit a spec
Trauma centers in the US run on a documentation tempo that no other clinical setting matches. Primary surveys, secondary surveys, FAST exam findings, mechanism of injury notes, and trauma registry abstraction all happen within the same shif
Hospital-at-home programs have grown from a CMS Acute Hospital Care at Home waiver pilot into a real care model that many US health systems now operate at scale. Patient identity across the hospital-at-home program is uniquely complex. The
Hospice coding workflows are not a high-volume FHIR use case the way ED triage or ACO quality reporting are, but they are a high-precision one. Principal diagnosis ICD-10-CM coding, terminal prognosis documentation, hospice item set submiss
FHIR search parameters that perform well at production traffic often collapse at ten times production traffic. The performance curve is not linear; it has knees where index cache behavior, plan selection, and pool contention interact...
Accountable care organizations in the US live and die on the quality of their patient attribution data and the completeness of their initial assessments. ACO onboarding is the moment when a new attributed life either becomes a managed patie
