How OrthoNebraska Achieved 30% ROI by Modernizing Its Integration Strategy

OrthoNebraska is a physician-owned orthopedic hospital and musculoskeletal care network headquartered in Omaha, Nebraska. The organization delivers surgical and non-surgical care across inpatient, outpatient, and rehabilitative settings, operating a 24-hour hospital, multiple clinics, diagnostic imaging services, and six physical therapy locations across Nebraska and southwestern Iowa. 

In the past year alone, OrthoNebraska performed nearly 16,500 surgeries, supported more than 152,000 clinic visits, and delivered over 145,000 physical therapy visits, reflecting continued growth and rising demand for musculoskeletal care. 

As the organization expands through new Outpatient Surgery centers, additional clinics, and affiliated partnerships, the volume of data moving across systems, vendors, and care environments has increased significantly. At the same time, its lean IT team supports more than 30 systems spanning EHRs, imaging platforms, payment vendors, and laboratory systems. 

Ensuring reliable, real-time data exchange across this growing ecosystem, without expanding internal integration resources, has become critical to maintaining operational performance and supporting future digital initiatives. 

As OrthoNebraska expanded its surgical, clinical, and rehabilitation services, its reliance on digital systems increased just as rapidly. With a lean IT team and no dedicated integration engineer, managing dozens of system connections across clinical and operational platforms became increasingly complex. 

Because the organization relied on its EHR vendor’s native integration capabilities, visibility into interface performance was limited. 

“Without direct visibility into our integration environment, we often had to coordinate with both our EHR vendor and third-party partners just to understand what was happening,” said Lindsay Murdock, PACS Administrator and Senior Clinical Application Specialist at OrthoNebraska. “That made it difficult to quickly identify or clearly communicate the root cause of an issue and eroded the experience for patients and clinical teams left in wait mode.” 

When integrations failed or messages were delayed, troubleshooting required coordination across multiple external vendors, slowing resolution times and limiting the team’s ability to proactively identify or address issues. In some cases, disruptions went undetected for hours or even days. 

“We had no transparency into our integrations when they were down,” said Ann Wright, Director of IT & Informatics at OrthoNebraska. “We were relying on someone else to notify us, usually after the fact. No news was good news until it was disastrous news, and then we were tracking things back days later.” 

Building new integrations was equally challenging. Each request depended on external resources, creating unpredictable timelines and variable costs. Projects that should have taken days frequently stretched into months, making it difficult to onboard new solutions or respond quickly to changing priorities. 

For a specialty provider with fluctuating integration demand, hiring a full-time integration engineer wasn’t practical. 

“We didn’t have anyone internally dedicated to building integrations full time, and hiring an integration engineer wasn’t realistic for us,” said Wright. “Integration needs tend to fluctuate, so it’s difficult to justify a full-time role focused solely on integration management.” 

Without greater visibility, control, and predictability, OrthoNebraska faced increasing risk of workflow disruption, delayed initiatives, and continued dependence on external vendors—just as the organization was preparing to scale. 

To support continued growth without overextending internal resources, OrthoNebraska leadership began evaluating options that would allow the organization to gain greater visibility, scalability, and control over its integration environment, without increasing internal IT workload or hiring a full-time integration engineer. 

The goal was not simply to stand up new integrations more quickly, but to create a more sustainable approach to managing connectivity across clinical, financial, and operational systems as digital initiatives expanded. 

“We wanted the ability to manage and monitor our own interfaces without having to rely entirely on external vendors,” said Ann Wright, Director of IT and Informatics at OrthoNebraska. “At the same time, we needed an approach that would allow us to support integrations as they came up without hiring a full-time interface engineer.” 

After evaluating multiple platforms through a formal RFP process, OrthoNebraska selected Rhapsody Envoy iPaaS, an automated integration platform-as-a-service built for healthcare data environments. 

Envoy iPaaS enables healthcare organizations to accelerate onboarding new system connections while simplifying the ongoing monitoring and maintenance required to keep integrations running reliably. Delivered through a cloud-based deployment model, the platform supports HL7, FHIR and API-based interoperability workflows while allowing internal IT teams to retain real-time visibility into message flows and interface performance.

For OrthoNebraska’s small IT team, this balance between control and operational support was a critical differentiator. 

“We knew we would have an initial set of integrations to stand up, and then ongoing needs would come in waves,” Wright explained. “Envoy gave us a way to support that demand without having to build out a dedicated internal integration team.” 

Implementation began in 2022, with prioritization of key clinical and operational interfaces as part of OrthoNebraska’s transition away from reliance on its EHR vendor’s native integration capabilities. Once foundational data feeds were established within Envoy, OrthoNebraska was able to begin standing up new integrations more independently, while continuing to leverage Rhapsody’s managed services and platform support as needed. 

“Having the ability to see and understand what’s happening with our integrations in real time has made a significant difference,” said Murdock. “It allows us to get involved earlier, troubleshoot more effectively, and work collaboratively with our partners to resolve issues.” 

Today, OrthoNebraska uses Envoy iPaaS to centrally manage systems across clinical, imaging, laboratory, and revenue cycle platforms, giving its IT team direct visibility into the message flows that support day-to-day patient care and financial operations. 

That acceleration has translated into measurable financial and operational impact. By shifting away from a self-managed integration model, OrthoNebraska has achieved an estimated 30% return on investment, driven by reduced infrastructure overhead, lower reliance on dedicated integration resources, and improved operational efficiency.  

For many healthcare organizations, supporting integrations at this scale would require dedicated internal staffing to manage interface development, monitoring, and ongoing maintenance. With Envoy iPaaS, OrthoNebraska has been able to avoid adding that overhead, allowing its lean IT team to support growing integration demands without the need for additional full-time resources. 

“The speed to value for new integrations has improved significantly,” said Bill Citro, IT Systems Analyst at OrthoNebraska. “If we need to support a new vendor connection, we can now build from our raw feed and move forward as soon as connectivity is in place. What used to take months can now take days or weeks.” 

For an organization where integration demand fluctuates throughout the year, this model provides the flexibility to scale without committing to fixed internal costs or expanding the IT team. 

With a more scalable integration foundation in place, OrthoNebraska is now focused on extending connectivity across newly affiliated partner organizations within the Sequel Ortho network, which spans practices across Nebraska, Iowa, and Illinois. As the organization expands services and integrates with partner practices such as Fox Valley Orthopedics, IT leadership is exploring opportunities to standardize integrations across disparate clinical and operational systems.  

“Even within our broader organization, we have environments where clinic and surgery center systems don’t currently communicate,” said Wright. “Having a shared integration platform gives us the opportunity to connect those systems and create a more consistent experience for both patients and care teams.” 

The OrthoNebraska team is also evaluating API-based integrations and FHIR-enabled workflows, to support more advanced data exchange as new technologies are introduced.