Can you handle legacy CDA documents?

Yes. We have lossless CDA-to-FHIR translators with full document round-tripping for audit.

How do you handle patient matching?

We combine probabilistic and deterministic matching with reviewer queues for low-confidence matches and full audit trails.

Healthcare / Interoperable Health Data Exchange

Interoperable Health Data Exchange

Q: Are you TEFCA / QHIN ready?

Yes. Our reference architecture aligns to QHIN requirements, and we have implementation experience supporting QHIN-aligned organizations.

We engineer FHIR-native health data exchange platforms that connect EHRs, HIEs, payers, and digital health partners — turning interoperability from a compliance line item into a competitive advantage.

Talk to a Solution Engineer View Case Studies

500k+

Daily exchange transactions per cluster

FHIR R4

Native, plus HL7 v2 + CDA bridges

TEFCA-Ready

QHIN-aligned reference architecture

Trusted by global innovators

Industry Overview

Interoperable Health Data Exchange: Engineered End-to-End

Interoperability is finally moving from theory to obligation. We build platforms that meet TEFCA, USCDI v3, and Information Blocking requirements while delivering real performance — not just policy compliance.

Industry Challenges

What Stops Most Teams From Solving This Today

Common friction points we hear from healthcare teams scoping this kind of platform.

CDA Document Tar Pits: Decades of CDA documents need to flow into FHIR without losing fidelity.
HIE Performance: Many HIEs return queries in seconds when modern apps expect milliseconds.
Schema Drift: USCDI versions and FHIR profiles change, breaking downstream systems if not handled with care.
Identity & Consent: Patient matching and consent management remain the hardest parts of any HIE program.

Our Approach

Our Engineering Approach

We engineer for the operational reality — not the demo.

FHIR-Native Core

FHIR R4 (and prep for R5) as the source of truth — not a translation tier.

Versioned Profiles

USCDI versioning, profile validation, and downstream change management baked in.

Identity & Consent

Probabilistic patient matching and consent ledgers that hold up under audit.

Capabilities

Production-grade features the platform ships with from day one.

FHIR R4 Server

High-performance FHIR server with bulk export, subscriptions, and SMART support.

HL7 v2 / CDA Bridges

Lossless ingestion and translation from legacy formats into FHIR.

Patient Matching

Probabilistic and deterministic matching with audit-grade resolution workflows.

Consent Management

Granular consent capture, policy evaluation, and revocation flows.

Audit & Lineage

Per-resource access logs and full lineage from source document to query response.

Bulk FHIR Export

Group and population-level exports for analytics and reporting workflows.

TEFCA / QHIN Connectors

Production-ready connectivity to QHIN and HIE networks.

Developer Portal

Self-service onboarding, app registration, and sandbox for integration partners.

How It Works

Reference Architecture

How data and decisions flow end-to-end.

Ingestion Layer

HL7 v2, CDA, FHIR, and bulk feeds normalized into FHIR resources.

Identity & Consent

Patient matching, consent evaluation, and policy decision points.

FHIR Core

High-performance FHIR R4 server with subscriptions and bulk export.

Federation

Connectivity to QHINs, HIEs, and partner organizations.

App Surface

SMART on FHIR app registry, developer portal, and consumer-facing experiences.

Engineering Stack

Technology Stack

A pragmatic stack chosen for reliability, speed, and ease of operation.

Standards

FHIR R4 / R5HL7 v2CDAUSCDI v3SMART on FHIR

Identity & Consent

OAuth 2.0OpenID ConnectUDAPPMI

Backend

HAPI FHIRAidboxJavaNode.js

Data

PostgreSQLElasticsearchIceberg

Infra

AWS HIPAAAzure HIPAAKubernetesVault

Federation

QHINCarequalityCommonwellDirectTrust

Measured Impact

Quantified outcomes from production deployments.

500k+

Daily exchange transactions

<200ms

Median FHIR query latency

99.99%

Uptime across deployed environments

USCDI v3

Compliant out of the box

Statewide HIE Modernization

A statewide HIE running on legacy CDA-centric infrastructure needed to modernize for TEFCA and USCDI v3. We delivered a FHIR-native core that runs alongside the legacy stack with bidirectional sync.

Within six months, the HIE was QHIN-ready, query latency dropped from 4 seconds to 180ms, and the developer portal onboarded 32 new integration partners in its first quarter.

Case Study

Use Cases

Where This Earns Its Keep

Common deployment patterns we see across customers.

TEFCA / QHIN Participation

Production-grade QHIN connectivity for HIEs and large health systems.

Provider Directory Services

Authoritative provider lookup with FHIR Practitioner/Organization resources.

Bulk Data for Analytics

Bulk FHIR export feeding population health and quality programs.

Payer-Provider Data Exchange

Prior auth and claims-clinical exchange with payers.

Consumer Apps

Power patient-facing apps with SMART on FHIR launch and OAuth flows.

Public Health Reporting

Automated case reports and ELR submissions to public health authorities.

Integrations

Integrates With Your Existing Stack

We connect to the systems your teams already know.

EHR

EpicCernerAllscripts

Network

CarequalityCommonwellDirectTrust

Analytics

Snowflake

Compliance-First Development Services Backed by Global Standards

We build secure, scalable products designed for privacy, interoperability, and regulatory readiness from day one across every sector we serve.

Health Insurance Portability and Accountability Act

Protect PHI with privacy-first architecture, encrypted storage and transmission, and strict access controls.

Service Organization Control 2

Verified controls for security, availability, and confidentiality of enterprise data systems.

Information Security Management

Adhering to the international gold standard for managing information security risks.

Health Information Trust Alliance

Healthcare-specific security controls and risk management practices trusted by global partners.

Fast Healthcare Interoperability Resources

Enabling standardized health data exchange through robust, modern API mappings.

Health Level Seven International

Supporting enterprise-grade interoperability for clinical messaging and record workflows.

Our Edge

Why Global Leaders Choose Us

We combine deep technical expertise with industry-specific knowledge to deliver solutions that aren't just functional, but transformational.

Enterprise-Grade Security

We implement rigorous security protocols and compliance standards (HIPAA, GDPR, SOC2) across all industrial solutions to protect sensitive data.

High-Performance Scaling

Our architectures are built to handle massive data loads and user bases, ensuring seamless performance whether you're serving ten or ten million.

Accelerated Time-to-Market

Leveraging our suite of internal tools and proven frameworks, we reduce development cycles and get your product to market 40% faster.

Embedded AI Integration

Beyond simple wrappers, we build deep-learning integrations and predictive analytics directly into the core of your industry-specific workflows.

Engagement Model

Predictable, structured delivery from kickoff through long-term ownership.

Discovery & Scoping

We map the existing systems, constraints, and stakeholders to scope a focused 8–12 week first delivery.

Architecture & Pilot

A working slice on a representative environment — proving the data flow end-to-end before scaling.

Production Engineering

Hardened services, observability, access controls, and audit logging go live behind your IAM.

Operate & Iterate

We stay on as the embedded engineering team — closing tickets, tuning models, and shipping new value.

Voices of Success

We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.

"I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly."

Aaron Phelan

Founder, Benchmark

"Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together."

Kim Smith

Founder, My Lauren

"Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective."