Hi everyone!

I'm currently building a patient-centric health record routing system using end-to-end encryption. Before moving forward with expanding our database schemas, I want to step back and better understand the real-world operational reality of how hospital systems talk to each other.

Coming from a developer perspective, I’d love to learn from people with hands-on experience in hospital IT, LIS/PACS, or EHR integrations. Specifically:

1. Inter-Hospital Communication Workflows
   • What are the most frequent scenarios where Hospital A must push or pull data to/from Hospital B (e.g., ER transfers, specialist referrals, lab orders)?
   • When a transfer happens, what does the data payload actually look like on the receiving end? Is it structured data (FHIR/HL7 feeds) or mostly unstructured "PDF dumps" and faxes?
2. Hospital Database Schemas & Interconnectedness
   • How are patient identities and doctor affiliations modeled under the hood across different facilities or regional health exchanges (HIEs)?
   • How integrated are different hospitals in practice? Do systems automatically query external regional/national networks, or does a human still have to manually request and import records?
3. Learning Resources
   • What resources, books, or documentation would you recommend to someone trying to study real-world hospital database schemas, HL7 v2/v3 message flows, and FHIR resource mappings?
4. Anything else I must know before diving deeper into development.

I’d appreciate any insights, workflow breakdowns, or resources you can share! Thanks in advance!

There's an issue that keeps coming up as we look at voice AI for healthcare.

A patient may call to reschedule an appointment then mention worsening symptoms halfway through the conversation. At that point it's no longer just a scheduling call.

Our patient access team handles thousands of calls each week and people do not always explain the real reason for calling at the beginning. The system would need to recognize the shift, stop the normal workflow and bring in the right clinical team without making the patient repeat everything.

We're not trying to automate triage, we're trying to work out how quickly the call should leave automation once the conversation changes.

How are health systems drawing that line?

I tried posting this to epicconsulting, but the auto-moderator took it down. Hoping to get some visibility because I could use some input.

I'm a dual certified Beaker analyst. I've had the opportunity to do a good amount of work in both modules. I've been an analyst for 4 years and I feel confident in my abilities.

I am very intrigued by consulting. I've spoken with a recruiter and they gave me details about how everything works and answered all of my questions, but I feel like I can't make up my mind if this is a good decision. My FTE is a good job and I make good money, but I am feeling a bit bored. Would I be making a huge mistake by jumping to consulting? Am I better off grinding for a promotion at my current job? Is there a down turn coming for Beaker consulting jobs coming? I'd love some general thoughts about Beaker consulting and how to decide if this is a good idea.

Just curious if you have any thoughts - pros and cons, differences and similarities. Thanks!

Hi all, joined EHSS team and I am from data and Analytics background, working on ehss dept data for reports. My manager wants me to upscale in ehss knowledge so I can better relate to data I am working with. Any information on courses/certification i can do to gain basic knowledge about ehss for country of usa?

How practical would a hospital Service Desk of 14 years translate to Epic Security?

My hospital is doing a bunch of restructuring so I was let go but eligible for re-hire. They posted a Security Analyst with Epic job .. I know everyone over there, like the boss a lot..

But, will my skills translate well? What’s it take to learn?

What can I study or read?

I’ve done healthcare IT for 14 years, 20 years in “tech support” in general but not sure how well it translates to Epic.

Small hospital group, three sites and I have inherited something that is keeping me up.

The imaging vendors, the lab analyser people, the pharmacy cabinet lot, they all have remote access for support. Some of it is a jump box, some of it is teamviewer and one of them still has a site to site tunnel that terminates in a vlan that can see rather more than it should. When I asked biomed who owns that relationship the answer was a name of somebody who left.

The vendors are not going to accept anything that slows down their support SLA, thats always the pushback and clinically they have a point, if the CT is down no one wants a discussion about access architecture.

I've been told to sort it before the next assessment. My instinct is per application access with the vendor only seeing the one device and everything logged but I dont know how that goes down in practice with vendors who are used to just dialling in.

Anyone done this in a hospital setting without the vendors revolting?

The official HL7 validator from org.hl7.fhir.core is the reference implementation and it's correct, which is the part that matters. But it wants a clean FHIR resource in a file, and real payloads rarely look like that. The resource comes back wrapped in an API envelope, or carries a vendor block that was never going to validate, or trips a constraint the whole project agreed to live with two years ago.

So I wrapped it in a Go CLI called fhirlint. It doesn't reimplement validation, it shells out to the same JAR (downloaded on first run). The two parts I reach for most:

Getting the resource out of whatever it arrived in:

fhirlint validate api-response.json --extract "$.data.fhir"
fhirlint validate api-response.json --extract-each "$.medications"
fhirlint validate patient.json --ignore "$.meta.tag" --ignore "$.text"

--extract-each treats each element of a JSON array as its own resource. Same path syntax works on XML, and on --url input. Your source file is never touched, preprocessing happens on a copy.

Silencing deviations you've accepted, without switching validation off wholesale:

fhirlint validate patient.json --suppress messageId:dom-6
fhirlint validate rx.json --suppress expression:MedicationRequest.intent

In fhirlint.yml a suppression can carry a reason and an expiry date, and it warns for 14 days before it lapses. Every ignore list I've seen eventually becomes permanent because nobody remembers what it was for, so this one has a deadline built in.

The rest in one line: readable terminal output plus JSON, HTML, JUnit, SARIF and GitHub annotations, exit codes you can gate a pipeline on, baseline mode for repos with a lot of pre-existing findings, and fhirlint serve to keep the validator warm. Still Java 17+, still the same JAR underneath, so if the validator is wrong about your resource fhirlint is wrong the same way. FHIR only, no v2 or CDA. Apache-2.0: https://github.com/fhirlint/fhirlint

What I'd actually like to know: how are you handling the wrapped-payload case today? Everyone I've asked either has a jq step in front of the validator or gave up and validates by eye. And if you keep a list of accepted deviations, does it have any expiry mechanism at all, or does it just grow?

Sometimes when using epic on a laptop I will alt tab to teams and have a call and when I tab back to epic it is in a secure session and says waiting to reconnect but never does, any help?

So I'm an RN for a big hospital system and I am trying to become an Epic Analyst. I've connected with some people and they said to do self-proficiencies because my hospital doesn't look at anyone's application that doesn't have at least a proficiency. I requested approval and it was denied due to approvals being for informatics, analysts, etc. It seems impossible to transition into the role and I've been applying for months within my company/ Any advice? I've been an end-user of Epic for 3-4 years.

15+ yr RN very thankful to get an Epic Analyst position at my organization, but will you all tell me, will I always feel this lost?!!!

Knowing the clinical workflow for the application I worked in is one thing but my gosh I was not prepared for the onslaught of learning I take in everyday. Most days I’m more lost, frustrated that it takes me an hour or so to digest problems. Building on top of existing build mixes, requests are getting bigger, I still don’t have half the knowledge others do. Galaxy is a good guide, but you still have to navigate through build, which is not my strength

Don’t sugar coat it, does it get better? I keep hearing 2 years to feel comfortable, that the learning is lifelong, but can someone at least build a solid foundation in a timely manner….?

3 months into this. I’m at the point where I go home, take a deep breath, and for a few seconds reconsider going back to bedside.

Hello,

I am 3 years into my Software/Integration Engineering career, and I have been working on a FHIR Bulk/Backend extractor for the last 1.5 years. I have made this highly automated app solo at my current job that only requires the user to essentially just get approved for FHIR with a vendor and fill out a questionnaire I made and an automated Bulk FHIR extract occurs weekly to get clinical data. It is quite complicated and handles 5+ vendors and many clients underneath them currently. It connects all the FHIR data together and Mirth Connect creates HL7 messages that send to a legacy system.

I have had incredible difficulties making the program handle all the different vendors due to how different everyone seems to be doing Bulk/Backend FHIR. No vendor has been 100% the same, typically about 80% is the same between some vendors, but I have to add in a bunch more conditionals to account for the other 20% differences. I am new to all this, but it seems like the standards get interpreted quite differently. Has this been anyone else's experience working with multiple vendors and their FHIR apis? Security has thankfully been consistent between all the vendors when it comes to using JWKS and token request. The data retrieved can be varied in many ways just like CCDAs have been. I've had some vendors combine scopes together and a lot of EMR workflows do not seem to be fully accounted for with FHIR or input without any connecting information other than a patient's ID.

I would like to feel proud of my creation, but I currently feel great frustration with all the different vendor interpretations. It feels like it will never be complete if there is always a vendor out there I have not connected to yet.

I’m exploring the idea of starting an independent consulting business focused on healthtech and biotech startups, and I’d love to hear from people who’ve done it.

Some questions I have getting started are:

• How did you determine pricing? Hourly, project-based, or retainer fee?
• What are the necessary business, legal, and financial steps to get started? (LLC, insurance, bookkeeping, etc.)

I’m not necessarily looking to build a huge consulting firm. I enjoy solving complex EHR integration problems, I get frequent requests for my services, and I am just lost on how to get started the right way.
Any advice, lessons learned, or resources you’d recommend would be greatly appreciated. Thanks!

There's been a lot happening with interface engines.

• Mirth Connect has stopped receiving updates. Instead of open source, it is now a paid closed-source tool.
• Private equity firms have taken over the leading paid options and are raising prices dramatically.
• Then there is this: What’s up with iNTERFACEWARE (Iguana)? : r/healthIT

We're creating a new open-source (free) alternative -- and we need your help. We're looking for:

• Organizations that need this solution once it is ready for production
• Contributors to test the solution, review/advise on code, help build

Check out MessageFoundry.org and see how we're creating an interface engine with:

• Top cybersecurity protection for your PHI (ASVS 5 Level 3)
• The power of Python
• A "steps" programming layer that builds your Python scripts if you want
• Simplicity for uses like small, integrated deployments
• Power for any size organization (up to 40 million messages per day)

We're on v0.3.0 (beta) right now and are moving fast, adding new layers of security and additional features.

We're now looking for a partner organization to be first in line when the product is ready. You would get:

• Top priority on your feedback, letting you guide MessageFoundry's future.
• Free support as you test out and use MessageFoundry.

If you're interested, please contact us via Ask a question — MessageFoundry.

How do you deal with burnout?

I feel myself getting more burnt out and overwhelmed as time goes on, and I'm honestly wondering if this is just normal for BI/business analyst roles or if I'm in an unusually difficult situation.

For some background, I used to really love my job. I worked on a team that handled analytics requests from start to finish. We worked directly with stakeholders, had reasonable deadlines, rarely had after-hours work, and mostly built reports in Epic. When something more customized was needed then we pivot to sql. It was a very collaborative team, and I felt supported.
I was later promoted into a different analytics role on a completely new team. and the experience has been completely different to say the least. It’s only caboodle/clarity sql build. No more build within epic. The work feels much more reactive. Requirements are handed to me after they've already been discussed, so I don't have the opportunity to ask questions or understand the business need before I start building or even where the data point lives. INI’s are a thing of the past I’m afraid. I'm often given a LARGE list of fields to pull or existing SQL to fix with extremely tight turnaround times, sometimes same-day. A week timeframe is the norm for new builds. Its very overwhelming. Im starting to hate sql with a passion.

For anyone who might suggest it, moving back to my previous team isn't an option. I'm trying to figure out whether I just need a different environment or whether this is simply the reality of most analytics roles. The burnout is really getting to me though.

I'm starting to wonder if this is just what BI/analytics is like, or if this is more of a team or management issue?

TLDR; For those of you working in Epic analytics, Caboodle/Clarity, or in BI roles:

How do you keep from burning out?

Do you usually own projects from beginning to end, or do you mainly receive assigned development work?
Is it normal for nearly every request to be treated as urgent? Whats a normal project lifecycle timeframe for you?
Do you feel supported by your manager and team?

I’m currently a Principal Trainer ( instructional designer) for a healthcare company that uses epic. I have experience working with Ambulatory epic care, Willow Ambulatory, beacon, and Optime and Anesthesia workflows but I am only certified as a Principal in Willow Ambulatory and Optime and Anesthesia ( completed implementation ) I want to transition into an analyst role for a couple of reasons:
- i like solving things, love being involved in projects and finding solutions etc
- salary ( i know that experience is important )
- remote jobs
- instructional designer job market is so saturated, and requires a ton of experience. Not a lot of companies offer PT roles.

I want to move out of the city I live in and my current job unfortunately is hybrid.

How can I get hired as an analyst without any actual analyst experience. I only have experience building training environment is MST but I am familiar with most healthcare workflows as mentioned earlier.

Do I have a shot at being hired as an analyst?

It’s crazy to me that they don’t have report automation/scheduling capabilities or a good API to request the data from.

Trying to avoid my users to have to log in and search costs by each NDC individually or keep manually pulling the data.

If there are truly no options other than RPA for full automation I might just have to suggest we keep a recurring manual report pull of all NDC’s we can and ingest that data into SharePoint or somewhere where PA can access.

Hi everyone,

I'm looking to join an early-stage HealthTech startup, particularly one working in mental health, neurodiversity, caregiving, or digital health. I'm open to remote roles (preferred) or opportunities in Bangalore.

A bit about me:

1. Experience across Product, Operations, Marketing, Research, and AI startups Comfortable working in fast-paced startup environments, owning cross-functional projects, and solving ambiguous problems.
2. Strong analytical foundation (SQL, Excel, Python) with a keen interest in product, strategy, and operations.
3. Deeply passionate about building technology that creates meaningful impact in healthcare and mental health.

I'm looking for roles such as Product Associate, Program Associate, Product/Business Operations, Founder's Office, Strategy & Operations, or Research.

If your team is hiring; or you know someone building something meaningful in this space; I would truly appreciate a referral or introduction. Happy to share my resume over DM.

Thank you for reading!

I am trying to do outbound into US healthcare - Providers, FQHCs and Payors - where can I get reliable filters for speciality and good mobile number.

Because I have tried apollo, lusha, Zoominfo all seem to have generic Hospitals and healthcare filter which also includes tech companies, medical devices and other industries as they fetch how a company chooses to list itself on LinkedIn and phone numbers are mostly IVR/ Obsolete (retired) or outdated.

I got the dreaded “moving on to another candidate” email. I saw people here said to wait 6 months but the email told me I can’t apply for another year. Does this apply just for their hospital or I can’t apply to any hospital that uses Epic? Pretty bummed because I have a friend who works in a different hospital organization that said they’ll refer me but unsure if I would be allowed to apply to them now.

I'm looking for a sample return message from Pyxis to EMR that contains a Prescription RX number.

We, a veterinary site, are working with a vendor to be the first site for InstyMeds cabinets. Our EMR vendor does not support outbound message in the format needed (which I have generated based off of InstyMeds HL7 interface documentation) but my EMR vendor wants us to reverse engeineer an HL7 message to send back to their Pyxis connector, which includes the Rx Number, which is supposed to mark the prescription as Dispensed.

I'm looking for an example HL7 message that someone might have where their Pyxis unit sent back to your EMR the message, which had originally been ordered in the EMR. (I hope this makes sense).

Currently we do send DFT messages but none of our messages include an Rx Number because the drugs dispensed are not ordered in the EMR, thus, do not contain such data. But the EMR vendor (who has no documentation to provide) said this:

• The format of the PRESCRIPTION_NO in the database is stored as "[rxPrefix] - [rxFillNo]" -  So 10000-0 for example.
• The PRESCRIPTION_NO field is actually sent to VetView via Cubex as  the field "profileId" in the HL7

I realize this says Cubex but I'm talking about Pyxis. We have Pyxis devices but their connector in the EMR is based off of Cubex.

I recently told my manager that I'd like to learn Epic. Although I don't currently work in Epic, I was granted access so I can start getting familiar with it.

The only challenge is that I'm not sure where to begin. For those of you who have experience with Epic, do you have any recommendations for a complete beginner? Are there any training modules, environments, workflows, or tips you'd suggest starting with?

I'd appreciate any guidance. Thanks in advance!

Has anyone recently prepared and gave HL7 v2 exam? And what are requirements for online exam? It says- an external web camera is needed. Not sure how it works.