Migrating to Mirth 4.6.2 for Scalable RCM Operations

Client Overview

A leading U.S.-based, tech-enabled business solutions provider specializing in Revenue Cycle Management (RCM) and advisory services for facility-based physician specialties such as anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Headquartered in Dallas, Texas, the company partners with private practices, hospitals, health systems, and ambulatory surgery centers to streamline financial and operational workflows, enabling clinicians to focus on patient care.

They offer end-to-end RCM support encompassing billing, coding & claims management, denial management, payer contracting, credentialing, provider education, data & analytics, patient engagement, and more.

Objective

The client needed to replace their existing interface engine with the latest version of Mirth while maintaining uninterrupted operations. With a high volume of live interfaces in production, they required a future-ready architecture that could scale effortlessly. As a first step, we onboarded a new client that was a large healthcare provider with 500+ facilities and over 10,000 providers onto Mirth to validate the design. This provider’s size and scale made it an ideal benchmark to test scalability and efficiency before migrating all interfaces from the old engine.

Key goals:

Architect Mirth for long-term scalability and high availability.
Onboard a new facility as a proof-of-concept using a modernized integration framework.
Migrate hundreds of existing interfaces without disrupting live operations.
Automate deployments through CI/CD pipelines for faster updates.

Challenges

Unstable Interface Engine (Old): Frequent interface disruptions required manual intervention, impacting operational efficiency and increasing downtime risk.
Limited Scalability for Growth: Existing architecture struggled to manage more than 1.5 million HL7 messages per month, especially when onboarding new facilities/interfaces.
Architectural Constraints: Lack of flexibility to implement clustering, load balancing, and other high-availability strategies limited performance optimization.

InterfaceOps Engagement

KPI engaged the client with our InterfaceOps framework, combining multiple service bundles to deliver tailored integration solutions.

Quick Start (IQS): Rapid onboarding of a new client’s interfaces in Mirth Connect within a defined go-live window.
Interface Engineering & Design (IED): Architecture consulting to define clustering strategy, channel design, and database management best practices.
Migration Services: Seamless transition of interfaces from Iguana to Mirth, ensuring minimal downtime.

Approach & Solution

Usingthe InterfaceOps framework, we implemented a robust Mirth Connect based integration architecture designed for high scalability, fault tolerance, and minimal development overhead when onboarding new client interfaces. The architecture supports the first client with over 500 facilities, along with several other clients, serving more than 10,000 providers. It processes messages from various specialties, including Home Medical, Emergency, Radiology, and Anesthesia, at a volume of more than one million HL7 messages per day.

Interface Strategy & Architecture
1. Initial Discovery
  1. Conducted comprehensive discovery and mapping of the existing integration engine landscape.
  2. Identified redundancies, latency issues, and non-standard implementations affecting scalability.
2. Architecture Design
  1. Designed a scalable, high-availability Mirth Connect 4.6.2 setup, assessing clustering and queuing needs, optimal channel design (by facility and message type), and best practices for database management, pruning, and performance monitoring.
3. Execution
  1. Installed and configured Mirth Connect 4.6.2 for a new customer.
  2. Developed HL7 message mappings and transformations for ADT, MDM, ORU, ORM, and DFT interfaces.
  3. Built, tested, and deployed integration channels, leveraging a CI/CD pipeline with MirthSync and Jenkins to automate deployments, ensuring consistent, traceable configuration syncs across Dev, QA, and Prod environments. This reduced manual effort, minimized errors, and streamlined interface management, followed by post-Go-Live support.
  4. Proof of concept: Onboarded a new facility on the 4.6.2 framework to validate the architecture before large-scale migration.
  5. Standardized protocols across HL7, FHIR, and APIs for consistent, maintainable integrations.
  6. Delivered a future-state design, migration plan, impact analysis, and comprehensive technical documentation to guide execution.
Interface Migration
1. Transitioned all active interfaces from old interface engine to Mirth Connect 4.6.2.
2. Ensured minimal downtime and precise message delivery during cutover.
3. Improved maintainability with standardized templates and reusable components.

Key Architecture Highlights

Scale & Sources

500+ facilities with 10K+ providers, sending ~1M HL7 messages/day from multiple specialties (e.g., Home Medical, Emergency, Anesthesia). Message types include ADT, MDM, DFT, ORU, and ORM over TCP/IP.

Integration Layer

Mirth Connect 4.6.2 cluster (two active production nodes) with clustering plugin for shared queues, channel states, and processing load. Azure Load Balancer directs traffic to healthy nodes via health checks.

Channel Design

Distinct channels for each Speciality–message type pair, each listening on specific TCP/IP ports (or shared ports with internal routing logic) for modularity and maintainability.

Data Handling

Processed messages stored in facility- and specialty-specific folder structures:

/sftp/<Speciality>/ 
<FacilityID>/ 
<MessageType>/

Shared Infrastructure

Centralized PostgreSQL DB for clustering, Azure File Share for file storage, HL7 Spy for validation, pgAdmin for DB management, and Mirth Sync for CI/CD.

Monitoring & Management

Cluster-wide dashboards with alerts for channel failures, queue growth, and performance, with integration support for third-party monitoring tools like Grafana.

Development Methodology

Agile delivery with comprehensive documentation and post-Go-Live support.

Results & Impact

Accelerated Onboarding: Standardized architecture and reusable templates reduced new client interface onboarding time by 40–50%. Implementation of a CI/CD pipeline further shortened deployment timelines and ensured error-free releases, eliminating the delays and issues common with manual deployments.
Seamless Migration: After a successful pilot at one facility, our team migrated all interfaces from Iguana to Mirth 4.6.2—cutting migration timelines from weeks to days.
High Availability: Implementation of failover clustering ensured minimal downtime for critical healthcare data exchange.
Future-Ready Scalability: The optimized interface strategy supports 2× more concurrent interfaces without significant infrastructure changes.
Operational Efficiency: Segregating interfaces by message type and applying our monitoring best practices reduced troubleshooting and resolution time by 30%.

Conclusion

By leveraging the modular InterfaceOps framework, the client gained control and clarity over their integration projects. Each service bundle, whether for strategy, architecture, migration, or ongoing support, was selected based on their specific goals with scope, timelines, and deliverables defined upfront. This ensured predictable outcomes, minimized surprises, and kept integration work focused and efficient. The client was able to scale their integration efforts confidently, accelerate decision-making, and achieve seamless onboarding and modernization while maintaining alignment and avoiding wasted effort.