Written by Technical Team | Last updated 15.11.2025 | 11 minute read
Nervecentre has evolved from a mobile clinical application into a full-scale, cloud-native Electronic Patient Record (EPR) platform used widely across the NHS. It underpins patient safety, patient flow and regional collaboration, and it is often deployed as a software-as-a-service (SaaS) platform across multiple trusts and Integrated Care Systems (ICSs).
As its footprint grows, the demands on integration architecture increase dramatically. Nervecentre must reliably exchange data with Patient Administration Systems (PAS), laboratory and radiology systems, prescribing and medicines management platforms, national services such as PDS, GP Connect and NHS 111, and a growing ecosystem of third-party digital health solutions. Many of these touchpoints rely on modern interoperability standards such as HL7 FHIR, alongside established HL7 v2, MESH messaging and proprietary APIs.
This article explores how to design and operate a secure, scalable integration architecture around Nervecentre. It focuses on patterns, principles and practical considerations for NHS digital, technical and architecture teams tasked with embedding Nervecentre into a heterogeneous estate while meeting demands for real-time data, cyber resilience and regional interoperability.
To design the right integration architecture, it is essential to understand Nervecentre’s role in the wider digital landscape. Unlike monolithic EPRs that largely replace existing systems, Nervecentre is often deployed incrementally, starting with high-value workflows such as observations, deteriorating patient management, hospital-at-night, patient flow and electronic case notes. Over time, these modules may evolve into a “next generation EPR” spanning multiple care settings, but they must coexist and interoperate throughout that journey.
This incremental deployment model usually means that Nervecentre needs strong, bidirectional integrations with an incumbent PAS or EPR, departmental systems and national services from day one. Real-time ADT (admission, discharge, transfer) feeds from PAS, order and result messaging, bed state synchronisation and task management integration quickly become business-critical. When Nervecentre becomes the de facto operational source of truth on the ward, clinicians expect it to reflect patient status across the trust in real time — and this expectation drives integration strategy.
Because Nervecentre is delivered as a cloud-based or SaaS platform, its integration touchpoints must span network boundaries. Some components are hosted within secure cloud environments, while others — such as integration engines or edge connectors — sit in on-premise data centres or regional platforms. This hybrid topology introduces constraints around latency, firewall configuration, private networking and the placement of security controls. Designing clear demarcation between trust, regional and vendor responsibilities becomes a core architectural activity.
It is equally important to understand how Nervecentre supports modern interoperability standards. HL7 v2 messaging is widely used across the NHS for PAS, pathology and radiology systems, and Nervecentre deployments commonly ingest ADT and order/result messages. However, FHIR is increasingly adopted for new national APIs and emerging digital systems, and many trusts are beginning to integrate Nervecentre using FHIR resources for demographics, encounters and certain ED workflows.
Nervecentre also operates in the middle of complex care-coordination workflows that span multiple organisations within an ICS. Patient flow dashboards, discharge coordination tools and collaborative care planning rely on real-time data from both Nervecentre and external systems. Integration architecture therefore must not only handle traditional system-to-system messaging, but also regional collaboration and varying organisational policies around data sharing and governance.
A robust Nervecentre integration strategy begins with a clear architectural blueprint. Rather than creating point-to-point interfaces between Nervecentre and every other system, most trusts benefit from deploying an integration engine or interoperability layer that acts as a central hub. This approach decouples Nervecentre from downstream systems, allowing message formats to be normalised, complex workflows orchestrated and consistent logging and error handling applied. It also reduces the risk that changes in one system will cascade into widespread interface failures.
Within that hub, it is sensible to standardise on a small number of integration paradigms. HL7 v2 remains deeply embedded across many PAS, pathology and radiology systems, and Nervecentre often consumes HL7 ADT and result messages. FHIR, meanwhile, is becoming the default for national APIs and many modern systems; designing the integration engine with native FHIR support — including terminology services and resource mapping — creates long-term flexibility.
In a hybrid cloud environment, layered architecture is highly effective. One common pattern is to position an on-premise integration engine to consume PAS HL7 feeds, transform them into FHIR or a canonical data model, and then expose outbound APIs or queues to Nervecentre’s cloud environment via secure, mutually authenticated channels. This pattern also works in reverse, ensuring that updates from Nervecentre back into legacy systems pass through a controlled DMZ without exposing internal systems directly to cloud endpoints.
Real-time integration should be the default for operational data such as bed state, observations, referrals and task allocations. Nervecentre’s effectiveness depends on providing clinicians with accurate information at the point of care; batch feeds or delayed synchronisation undermine this trust. Where event-driven integration is not possible, it may be necessary to derive events from periodic polling or data extracts, ensuring updates flow with minimal delay.
To guide interface design, many trusts categorise integrations into repeatable patterns based on business capability. For example, you might establish patterns for patient identity, clinical orders and results, medication and prescribing, care plans and documentation, or national service interoperability. Each pattern includes well-defined message types, data contracts and orchestration rules that can be reused across projects.
A practical early step is to create a comprehensive interface catalogue. This catalogue documents each integration — including systems, message types, transport mechanisms, data items and ownership — and becomes an essential resource for impact analysis during upgrades or new implementations.
A number of design principles are especially effective:
Together, these principles help create an integration fabric that is resilient, flexible and future-proof.
Security is paramount in any Nervecentre integration architecture. Given the system’s central role in patient safety and increasingly complex cyber threats facing the NHS, integrations must be designed with security at their core rather than added as an afterthought.
Security-by-design begins with well-defined boundaries. Nervecentre’s cloud platform, trust infrastructure and any regional layers should be treated as separate security zones. Only essential connectivity should be permitted between these zones, and all data transfers should be encrypted using modern protocols. Mutual authentication should be enabled wherever possible to ensure both endpoints are validated.
Authentication and authorisation deserve particular attention. Nervecentre’s RESTful APIs, national services such as PDS and GP Connect, and third-party integrations may use different security models — such as OAuth 2.0, smartcard-based authentication or app-based token issuance. A coherent approach ensures that tokens are scoped according to least-privilege principles, that they are stored securely, and that their rotation is handled through privileged secrets management rather than manual configuration.
Minimising data exposure is another important practice. Many integrations do not require full patient demographics, clinical notes or sensitive indicators. Redacting unnecessary fields — either at source or within the integration engine — helps to reduce risk and maintain compliance with data protection policies. Sensitive datasets, including those governed by enhanced confidentiality rules, should be handled consistently across all interfaces.
Comprehensive logging and audit trails underpin security monitoring and clinical safety investigations. Audit should extend beyond simple delivery confirmation to capture the full lifecycle of a transaction: who initiated it, which systems processed it, what transformations were applied and where the data was delivered. When integrated into the trust’s monitoring or SIEM tools, this audit trail improves detection of anomalous behaviour or unauthorised access.
Security also spans the integration lifecycle. Specifications should undergo security review; test cycles must include negative testing and API penetration testing; and change management processes should ensure that certificates, tokens, firewall rules and network paths are updated correctly. Clear shared-responsibility models between the vendor, trust and regional organisations ensure that patching, vulnerability management and incident response operate seamlessly across boundaries.
As Nervecentre deployments expand from single-site solutions into trust-wide platforms and then regional ecosystems, scalability becomes a strategic requirement. Scalability does not merely mean higher throughput; it also encompasses architectural flexibility, operational consistency and the ability to support organisations with different levels of digital maturity.
From a technical perspective, the integration engine or interoperability layer should be designed for horizontal scaling. Containerised or clustered deployments allow additional capacity to be introduced during peak periods. Message queues, event streams and asynchronous workflows decouple systems and prevent bottlenecks when message volumes spike — for example, during morning ward rounds or high-volume ED activity.
Nervecentre itself is designed for regional use, with multi-organisation capabilities and a cloud-native architecture well suited to ICS-level deployments. Integration architecture should complement this by centralising certain integrations — such as national API calls — while allowing trust-specific integrations, such as PAS interfaces, to remain local. This avoids duplication across the ICS while retaining the flexibility to support diverse local systems.
Consistency in data modelling is critical when scaling across multiple organisations. If each trust maps clinical observations, encounters or patient statuses differently, regional analytics and shared-care workflows become difficult to implement. Establishing ICS-wide data definitions and terminology standards, then implementing them within the integration layer, supports that consistency. A shared FHIR profile or canonical model provides a backbone for this standardisation.
Operationally, a federated support model is highly effective. A central integration team within the ICS can maintain shared components and architectural patterns, while local teams focus on trust-specific workflows and systems. This balance ensures consistency across the region without constraining local autonomy.
Not all trusts will be ready to adopt advanced integration patterns simultaneously. Your architecture should allow incremental adoption, enabling less mature organisations to start with simpler HL7 or batch-based integrations while still providing a clear pathway towards modern, event-driven models. This avoids forcing widespread redesign while supporting long-term modernisation.
As Nervecentre absorbs more workflows — such as medicines management, full documentation or patient engagement modules — message volumes and complexity will escalate. Regular performance testing, capacity planning and resilience reviews help ensure the integration estate continues to perform under growing demand.
Even the strongest architecture requires disciplined governance, proactive monitoring and continuous improvement to deliver long-term value. Nervecentre sits at the centre of patient safety and operational workflows, meaning integration failures are impactful and often immediately visible on the ward. Effective governance structures prevent issues where possible and enable rapid resolution where needed.
Clear ownership is the foundation of good governance. Every Nervecentre integration should have both a technical owner within the integration team and a business owner within the relevant clinical or operational group. These owners work together to agree data contracts, prioritise enhancements and ensure the integration remains aligned with evolving workflows. Regular governance forums maintain alignment between integration, clinical, information governance and Nervecentre product teams.
Change management must be rigorous. As a SaaS platform, Nervecentre receives more frequent updates than traditional on-premise EPRs. This creates opportunities for rapid innovation but also demands robust regression testing and well-structured release coordination. Non-production environments should reflect the live integration estate closely, enabling thorough testing of new Nervecentre features and local system upgrades before going live.
Monitoring is central to reliable integration operations. A comprehensive monitoring stack should offer real-time visibility of message throughput, errors, queue depths, API response times and connectivity. Dashboards for both technical teams and operational colleagues facilitate quick diagnostics — for example, highlighting a drop in bed state messages that may indicate a broken PAS feed.
Beyond basic monitoring, aim for true end-to-end observability. Correlation IDs that travel across Nervecentre, the integration engine and downstream systems allow engineers to trace a single event — such as a transfer, referral or new observation — across its entire pathway. This dramatically reduces time spent investigating issues reported by clinical staff.
A set of repeatable operational practices will keep the integration estate healthy:
Through strong governance, robust monitoring and continuous development, organisations can ensure that their Nervecentre integration landscape remains safe, adaptable and capable of supporting long-term digital transformation.
By treating Nervecentre as a strategic platform and investing in a secure, scalable integration architecture, NHS organisations can unlock the full value of real-time, mobile-first clinical workflows. The most successful programmes combine strong technical patterns — hub-based integration, FHIR-first design, layered security and hybrid connectivity — with effective governance, regional collaboration and a relentless focus on patient safety. When these elements align, Nervecentre becomes not just another clinical system but the backbone of a connected, data-driven and clinically intuitive digital ecosystem.
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