A unified EMR for a multi-site hospital network

Northline had grown by acquisition. Fourteen hospitals inherited four different EMRs, three billing systems and a patchwork of manual reconciliations between them.

Clinicians were re-entering the same patient data across systems three times per encounter. Billing errors were compounding into a seven-figure annual write-off. A regulator's on-site audit was scheduled for the following spring, and the outcome of that audit was going to shape the network's operating license.

The team knew the destination: one unified clinical record on FHIR. What they needed was a partner who could build the spine, migrate the history, and land it without asking the hospitals to stop admitting patients.

We built a FHIR-native clinical platform on Next.js and Postgres (the same technology stack Northline's own team could maintain) with Kubernetes for the deployment envelope and a hardened event bus for the write path.

Migration was the harder half of the work. We wrote a lossless ETL for every legacy record, ran it against a shadow production for three months, and shipped the cutover as a rolling wave: hospital by hospital, service line by service line, always with a same-day rollback path.

Clinicians were in the design reviews from week two. The interfaces we shipped were the interfaces they asked for, not the ones we thought were tidiest.

The whole network runs on one record now. Clinicians see the full patient history in a single view, orders route to the right department without a phone call, and billing closes in hours instead of weeks.

The regulator audit passed with no findings. Northline's own engineering team owns and extends the platform. We handed over the code, the runbooks and a two-week walkthrough, and stepped back.

The release cadence hasn't broken since go-live. Northline ships to production every Wednesday.