Greenway Health Fuels EHR Innovation Using AWS HealthLake

Founded as Medical Manager in 1977, Greenway serves more than 42,500 providers with innovative solutions in EHR, practice management, and revenue cycle management. Greenway’s clients require efficient handling and analysis of large volumes of structured and unstructured patient data within EHRs, as well as seamless integration with a marketplace of applications such as telehealth services and scheduling modules. Additionally, Greenway must comply with the 21st Century Cures Act’s strict provisions as well as emerging regulations, requiring the implementation of a FHIR server to centralize and manage clinical data from its two EHR systems, Intergy and Prime Suite. 

Greenway initially worked with a third-party vendor to build a certified FHIR solution. However, the system struggled to scale as data volumes grew, resulting in slow transaction times. As Greenway engineers worked to address these scalability challenges, Greenway’s product team discovered HealthLake, a fully managed FHIR service optimized for transactional and analytics use cases, at AWS re:Invent 2022. Recognizing Greenway’s regulatory requirements and those of other EHR developers, AWS worked closely with Greenway to enhance existing HealthLake capabilities to address its FHIR server needs. “Like any complicated project dealing with hundreds of clients and large amounts of data, there were bumps and challenges,” says Philip Nick, vice president and distinguished engineer at Greenway. “The AWS team was with us the whole way as we worked as a group to build this solution together. Our success was largely due to that tight collaboration.”

After creating the HealthLake data stores, Greenway scheduled a 10-day timeframe to load all its data. However, it completed the data load in fewer than 4 days using HealthLake’s low- latency transactional FHIR APIs, achieving 8,000 transactions per second with no API errors. After ingesting 9.5 billion FHIR resources in the initial data load, the solution went live, integrating data from Greenway’s clients’ EHR systems and supporting seamless integration of third-party applications. For instance, physicians can now securely and seamlessly view patients’ growth charts using a third-party app integrated through FHIR APIs. “From a healthcare standpoint, the use of AWS HealthLake is a huge step forward in interoperability and standardization,” says Nick.

 As a fully managed FHIR service, HealthLake freed Greenway’s developers from labor-intensive and costly infrastructure management tasks. In fact, Greenway created 638 HealthLake data stores in a single production account in less than 1 day. “Owning, managing, and supporting a FHIR store is not our core business,” says Nick. “Each time we had to designate a developer to manage and support our FHIR store, it took away from our core healthcare mission.” 

Because the FHIR APIs use current data that loads in minutes—and not weeks—Greenway has seen an uptick in the development of third-party applications. As a result, Greenway can provide a marketplace of healthcare applications that providers can seamlessly integrate as needed. “Using AWS HealthLake, we are providing advanced security compared with how apps were integrating before,” says Nick. “The whole FHIR system greatly advances the provider’s control over how they access their data versus our legacy system. The provider is empowered with the ability to control what data is being accessed at a much more granular level.” 

Rather than investing in multiyear, costly FHIR server licensing contracts, Greenway can use HealthLake’s pay-as-you-go pricing structure. In addition to a projected reduction in operational overhead costs, Greenway expects to save approximately $1.9 million through 2025 in software and infrastructure spend.

As Greenway migrated its EHR FHIR solution on HealthLake, it also launched its first FHIR app, an electronic case reporting application that automatically generates and transmits reports from EHRs to public health agencies for review and action. Ultimately, Greenway wants to use HealthLake data as a foundation for value-based care analytics, so that it can see trends on regional population health in both anonymized and individual patient-level data.

Expanding on the original implementation of HealthLake as a clinical data analytics tool, Greenway plans to incorporate AWS generative artificial intelligence services to improve the overall EHR experience for providers and ultimately reimagine the patient experience. For example, Greenway envisions using HealthLake data to automate the search and summarization of patient information, alleviating providers from the need to comb through multiple pages to look up information.

In the meantime, Greenway’s high-performing FHIR store is attracting a growing number of customers who recognize the opportunity to select, integrate, and interact with applications to improve care delivery, with 47 third-party applications available on the store as of November 2024 and more in development. “Not only does AWS HealthLake facilitate the integration of third-party applications, but we can build on top of it and further our innovation,” says Nick. “We’re thinking about what other types of data we can bring in. What other solutions can we light up? We haven’t fully realized the potential that we can get out of this, and that’s the exciting stuff we want to do next.”