Hospital-to-post-acute
Discharge to skilled nursing, home health, or rehab with warm handoffs.
Care Coordination Platform
Care coordination software development
We build care coordination platforms that keep patients from falling through the cracks at transitions: real-time ADT event feeds, post-acute handoffs, and closed-loop referrals on a shared FHIR care plan.
HIPAA-ReadyFHIR R4Direct Secure MessagingAudit Logged
Trusted by global innovators
What is care coordination software development?
Care coordination software development is building the tools that keep a patient's care connected across hospitals, clinics, post-acute facilities and home: shared care plans, tasks, referrals and alerts. Agnotic Technologies builds it on HL7 v2 ADT feeds, FHIR care plans and Direct Secure Messaging, with HIPAA safeguards designed in.
Handoffs between settings, such as hospital to skilled nursing, are where patients get lost. ADT feeds and FHIR Subscription notifications tell the care team the moment a patient's status changes.
We build coordination as an interoperable layer that shares care plans across organizations and proves each handoff completed.
What it is
What does a care coordination platform connect?
Care coordination platforms connect the people and organizations involved in a patient's care so transitions between settings are planned, tracked, and completed rather than left to chance.
The value is in the seams: the discharge that triggers a follow-up, the referral that closes with an outcome, the post-acute stay that stays visible to the primary team. We build those seams as reliable, event-driven infrastructure.
How does care coordination data flow?
An event-driven coordination layer wired to ADT feeds and shared care plans, so transitions trigger action instead of getting missed.
What goes into a care coordination platform?
Each capability pairs a transition workflow with the standard that makes the handoff reliable.
Real-Time ADT Event Feeds
HL7 v2 ADT (A01/A03/A04) ingestion and FHIR Subscription notifications trigger care-team action the moment a patient is admitted, discharged, or transferred.
Shared Care Plans Across Settings
FHIR CarePlan and CareTeam resources shared across organizations, so the receiving facility sees the same goals and interventions as the sender.
Direct Secure Messaging
Provider-to-provider Direct messaging and C-CDA transition-of-care summaries so referrals and discharge documents move through a compliant, auditable channel.
Post-Acute Coordination
Track patients into skilled nursing, home health, and rehab with structured handoffs, medication reconciliation, and follow-up task assignment.
Closed-Loop Referral Tracking
Every referral carries a status through completion with a documented outcome written back to the referring provider, no open-ended handoffs.
Risk & Readmission Signals
Utilization patterns and ICD-10 problem lists flag high-readmission-risk patients so transitional care management effort lands where it matters.
Where it fits
Which coordination scenarios do we support?
ED-to-primary-care
Post-ED follow-up routing to close the loop with the PCP.
ACO / value-based networks
Coordination across a risk-bearing provider network.
Transitional care management
TCM programs with structured post-discharge outreach.
Complex case management
Multi-specialist patients with a shared coordinated plan.
Payer-provider collaboration
Health-plan coordinators working shared member panels.
How do we close care gaps at transitions?
Most care gaps happen at transitions. We instrument those moments with real-time feeds and closed-loop tracking.
Real-time
ADT-driven transition alerts via HL7 v2 and FHIR
Closed-loop
Referrals tracked to a documented outcome
Direct
Provider-to-provider secure messaging and C-CDA exchange
Compliance-First Healthcare App Development Services Backed by Global Standards
15-Minute Scoping Call01
HIPAA
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, strict access controls, and traceable audit logs.
02
GDPR
General Data Protection Regulation
Implement lawful consent flows, data minimization, retention controls, and secure processing for sensitive health data.
03
FHIR
Fast Healthcare Interoperability Resources
Enable standardized health data exchange across apps, care teams, and systems through standards-based FHIR APIs.
04
HL7
Health Level Seven International
Support enterprise-grade interoperability with HL7-based integrations for records, events, and clinical messaging workflows.
05
HITRUST
Health Information Trust Alliance
Align security programs to healthcare-specific control and risk management practices trusted by providers and ecosystem partners.
06
HITECH
Health Information Technology for Economic and Clinical Health Act
Design with breach notification readiness, digital record safeguards, and operational controls that support regulated care programs.
07
SaMD
FDA Software as a Medical Device
Plan software quality, traceability, and documentation pathways for products that may require SaMD review and submission.
08
MDR (EU)
Medical Device Regulation (European Union)
Prepare EU market-ready processes for risk classification, evidence tracking, and lifecycle governance under MDR expectations.
09
SAMHSA
Substance Abuse and Mental Health Services Administration
Apply confidentiality controls and consent-aware sharing models for behavioral and mental health data experiences.
Standards and compliance
Which standards do we build on?
HL7FHIRC-CDADirectHIPAA
Our Process
How do we deliver a care coordination build?
We treat event feeds, shared care plans, and cross-organization messaging as parallel workstreams from discovery.
1.
Discovery & Transition Mapping
We map your referral network, transition points, and ADT sources, then design the event model and shared care-plan structure.
Event-driven design
2.
Core Build & Feeds
We build ADT ingestion, FHIR Subscription notifications, and the coordination workspace your care teams work from.
Real-time triggers
3.
Interoperability
We wire Direct Secure Messaging, C-CDA exchange, and FHIR care-plan sharing across your partner organizations and EHRs.
Cross-org exchange
4.
Rollout & Loop Closure
Phased go-live with closed-loop referral dashboards, network onboarding, and tuning as transition volume grows.
Measured loops
Facts and sources
Which rules shape care coordination?
Short facts we design around, each linked to its primary source.
The HIPAA Security Rule requires administrative, physical and technical safeguards for electronic protected health information.
Source: 45 CFR Part 164 Subpart C (eCFR)The information blocking regulations restrict practices by health care providers, certified health IT developers and health information networks that interfere with access, exchange or use of electronic health information.
Source: 45 CFR Part 171 (eCFR)HHS adopts the United States Core Data for Interoperability (USCDI) as the standard set of health data classes and data elements for certified health IT.
Source: 45 CFR 170.213 (eCFR)A HIPAA covered entity may share protected health information with a business associate, such as a software vendor, only under a business associate agreement that commits the vendor to safeguard it.
Source: 45 CFR 164.502(e) and 164.504(e) (eCFR)
Featured case study
Read Case StudyLera Health: compliant women's health platform
Related proof of compliant delivery: Lera Health shows how we build privacy-first, longitudinal care experiences on a HIPAA-ready foundation. It is not a care-coordination product, but the same interoperability and data-layer discipline underpins our coordination work.
Why Partner With Us
15-Minute Scoping CallWhy choose Agnotic for care coordination?
Coordination lives or dies on interoperability. We have the standards depth to make cross-organization handoffs reliable.
Interoperability-First
ADT feeds, Direct Secure Messaging, and C-CDA exchange are engineered as core infrastructure, not bolted on late.
Cross-Setting Workflow Depth
We design for how acute, post-acute, and ambulatory teams actually hand off, so transitions complete instead of stalling.
Closed-Loop by Default
Every referral and transition carries a status to completion with a documented outcome: accountability is built in.
Compliant Data Handling
PHI moves through auditable, encrypted channels across organizations, with consent and access controls at the data layer.
Our relevant experience
Transitions that complete, because the handoff is engineered.
Frequently Asked Questions
Yes. We connect to HIEs through the interfaces they support, such as HL7 v2 ADT feeds, C-CDA document exchange, Direct Secure Messaging or FHIR APIs.
Yes. Care plans, referrals and ADT events are PHI, so Agnotic signs a business associate agreement before any PHI is shared with our team.
The number of ADT sources, partner organizations and EHR integrations. A coordination workspace with ADT feeds, shared care plans and one EHR integration is a typical first release; networks with Direct messaging and C-CDA exchange add scope. We scope against your network before quoting.
It depends more on ADT feed access and partner onboarding than on the coordination screens, so we secure feed access and interface agreements early. We give you a timeline after the scoping call.
Buy if an off-the-shelf coordination tool matches your network and EHR. Build when you need shared care plans across specific organizations, custom transition workflows, or closed-loop tracking a vendor does not support. We frequently build the differentiated coordination layer and integrate existing systems around it.
We ingest HL7 v2 ADT feeds for real-time events, exchange C-CDA transition summaries, and share FHIR R4 CarePlan and CareTeam resources across organizations. Provider-to-provider communication runs over Direct Secure Messaging so exchange stays compliant and auditable.
Every referral and transition carries a status from initiation through completion, with the receiving provider's outcome written back to the sender. Coordination dashboards surface open and overdue handoffs so nothing sits unresolved.
Ready to close the loop on care transitions?
Tell us about your referral network and transition points. We'll return a phased plan with ADT feeds, shared care plans, and closed-loop tracking.
contact@agnotic.com
Partnerships
contact@agnotic.com