University of Michigan

The Department of Anesthesiology at the University of Michigan depends on high-performance, scalable integration to support clinical care, operations, and research across a complex technology environment. Since 2009, Iguana has served as the department’s trusted engine for managing real-time message routing between bedside devices, EMRs, pharmacy systems, and enterprise platforms.

At the heart of this ecosystem are more than 60 CapsuleTech servers, each managing connections to dozens of bedside devices. Iguana is deployed on each Capsule VM, acting as a real-time message router and traffic controller between the devices and downstream systems such as IBM's Integration Bus and Epic. While Capsule handles initial data capture, Iguana adds essential capabilities like message tracking, lightweight transformation, and fault-tolerant delivery, ensuring the reliability and observability required in high-acuity clinical environments.

The department processes over 160 million HL7 messages per day, and Iguana’s performance at this scale is key to maintaining continuity across critical workflows.

Beyond its foundational role in device integration, Iguana has become central to several high-impact initiatives:

• Controlled Substance Toolkit (CST): A custom web application used to reduce narcotic diversion in surgical environments. Iguana aggregates and transforms HL7 data from the Centricity EMR, Pharmacy Information System (PIS), and Omnicell automated dispensing cabinets to power real-time reporting and audit trails. The system pulls patient identifiers, visit information, and appointment scheduling data from Centricity, and stores it in Microsoft SQL databases for reconciliation and audit support.
  
  
• FHIR-based architecture: As part of its strategy to reduce vendor lock-in (including a migration from Centricity to Epic), the department is developing a FHIR API layer that exposes structured medication, appointment, and staff data. Iguana provides the transformation logic to map HL7 and SQL-based data into FHIR resources—such as MedicationDispense, Procedure, and AuditEvent — without requiring application-level changes to upstream systems.

The department’s work showcases how Iguana evolved from a data passthrough engine to a strategic integration platform, enabling:

• High-throughput data exchange with minimal message loss
• Real-time observability and simplified troubleshooting
• System decoupling and modernization using FHIR-based APIs
• Flexible support for both legacy and future-ready infrastructure

As healthcare IT continues to evolve, the University of Michigan's Department of Anesthesiology continues to rely on Iguana as a key pillar of its digital ecosystem — one that scales with demand and adapts to the future of care delivery.