Nick Shepard, assistant vice president of data orchestration at Tacoma, Wash.-based MultiCare Health System, recently sat down with Healthcare Innovation to talk about the explosive growth the nonprofit health system has seen and the implications that has had for how it approaches data integration. He said the ultimate goal is to connect different sources of data and orchestrate between those systems to paint a more holistic picture for clinicians. 

Shepard has been with the organization for 27 years. After initially working in strategy and business development, he got another degree and joined IT leadership.

Healthcare Innovation: Before we get to talking about the concept of data orchestration, could you describe a little bit about the complexity of MultiCare's IT operations and the size of the health system overall?

Shepard: We’ve grown a lot over the last seven years. Explosive growth. When I started here, we were three hospitals. We are now 18 and we picked up an additional five a few weeks ago when we were granted the ability to affiliate with Samaritan Healthcare in Oregon, which opens a new market for us. 

HCI: Then that will raise even more issues around integration, right?

Shepard: Yes, it really does. MultiCare has previously had over 50 siloed data sources. And this is true for most of healthcare generally. There are so many different data sources, whether it's pharmaceutical or imaging or radiology data. You have different systems that collect different things, and those systems aren't necessarily meant to communicate with one another. They're not designed to be connected and then to be coordinated in how they think about the value of the data. We want to be able to connect all of those different sources of data together and orchestrate between those systems to paint a holistic picture. 

HCI: Can I ask about the EHR environment? Is there a unified EHR across the system or a variety at different hospitals and clinics? 

Shepard: MultiCare uses Epic. We've been on it a very very long time. As we've acquired or affiliated or done joint ventures, we had to ensure that there was a pathway to being able to bring those folks onto that Epic platform. MultiCare decided to become a Community Connect partner where we offer Epic to other health systems that may not have the infrastructure and resources to deploy Epic. Epic’s mantra is “one patient, one record.” In that scenario, you need to bring those legacy systems either into archival solutions, which we use ELLKAY for, or into the Epic data environment itself. We have well over 40 organizations that are Epic Community Connect customers.

HCI: Do you have to help them transition from what they were on before into Community Connect?

Shepard: Yes, that’s what we call data conversion vs. data archival. Data archival is one aspect. In the state of Washington, for example, we are required by law to retain data for 26 years. So imagine acquiring or affiliating with an organization that is on a legacy EMR that we're going to be converting to Epic. They have a requirement to maintain access to that data. So data archives are the way we accomplish that. Data conversion is the migration of the data from the legacy system into the Epic EHR, and we do that with ELLKAY as well. 

The bigger part of all of that is third-party integrations —  downstream integrations that need to connect into Epic. Whether it's a lab system, a pharmacy or radiological system or whether trying to have data flow so that you can manage your transfer center and admissions, discharges and transfers —  all those types of functions and capabilities require third-party integrations, and that's where you have to make sure that you have a good interoperability platform between those silos that I referenced before. It allows you to paint a holistic picture regardless of what system the data might be sourced from.

HCI: Before you partnered with ELLKAY, how was that work done previously? One interface at a time? Was that extra work for your IT team and IT budget?

Shepard: Yes, it definitely was. We've had some really good talent at MultiCare that enabled us to do this work. As we grew from three hospitals to 18 hospitals, we recognized the scope and scale was not there for us to continue to bring that talent pool in house. In 2001 we had six people on that team, and in 2021 we still had six people on that team.

We had to acknowledge that our growth was driving us toward a more platform-based approach, Going from the six FTEs to a team at ELLKAY of 900-plus is a huge difference for MultiCare. It allows us to grow with them, and that's what we've done. They've grown alongside us and continue to support us. But back to your question, previously we did have internal resources that would do all of those components: archival, then data conversion to get them off their legacy system. MPI [master patient index] data conversion is a very common one where you have to know the patients who are in that legacy system, and you've got to move them into the current system — transferring that demographic information, but also all the clinical data. It was very manual, and it was done by heroics, right?

Now it's done by an organization with enough people, tools, and capabilities to help streamline that work.

HCI: Is there also an enterprise data warehouse where you're pulling data from all those systems together, maybe for research purposes or for value-based care?

Shepard: Yes, you do that in parallel. MultiCare has a very large Azure-based enterprise data warehouse solution on Microsoft's Fabric. There are different lenses that people approach data with, and one of those is reporting. Enterprise data warehouses are generally where you're going to bring those siloed pieces of information together. You're going to create a taxonomy that allows for linking of the data based on patients, based on providers, and then you can report using Power BI, which is MultiCare's platform. We’re excited to be on Fabric from Microsoft because they enable some native capabilities in reporting. Soon we'll be looking at AI enablement in the native capabilities there, and allowing people to just chat with the data, which is an interesting way to think about it.

HCI: When you started working with ELLKAY, was there a transition period to make this happen?

Shepard: It was a transition. We started with the archival solution of ELLKAY first. We were on their archival platform for three and a half to four years. We got to know the leadership. We got to see their engagement with us. A powerful relationship started to be built, and problem solving really started to occur. 

We knew that they were one of the largest lab integration companies. We had the opportunity to utilize them as our integration engine for one of our sites, Forks Community Hospital. We'd never used them for integration or for interoperability, and that's where they kind of blew our socks off. They just really proved their capability in that space. The trial run was very successful, and we saw immediate benefit. Ultimately at the end of January 2026 I shifted all of my interface and integration team to ELLKAY folks.

I no longer have an interface team at MultiCare. ELLKAY, as my partner, is my interface or integration team, my data orchestration team. We rebadged several staff who were on the MultiCare side as ELLKAY employees. You don't do that with a vendor; you do that with a partner. I have staff who have been with me for 20-plus years who are now ELLKAY employees. Now every interoperability-based integration and third-party integration is managed within the ELLKAY platform.

HCI: You mentioned Samaritan in Oregon. Are there other projects on the drawing board?

Shepard: You think of it as dominoes, right? When the first domino falls, you know the trail that it leaves behind. We want to remain relevant as a health system. We want to remain locally governed and operated, and we want to grow such that we have the ability to continue to provide services. 

There are not too many independent solo hospitals anymore. That’s because they can't negotiate with payers, they can't provide the same level of services that you might expect. We really have a significant growth trajectory. We have a lot of second, third, and fourth dominoes that are planned, and we plan many years ahead. 

I was in strategy and business development the first 10 years of my career. What's really interesting is I've been executing now on the IT side the strategies that I once was a part of planning for. Our acquisitions, our affiliations and our joint ventures, our partnerships — we are open to every type of connective tissue you could think of to continue to expand and to be what we call the Pacific Northwest's highest value system of health, and and that really is our vision. 

MultiCare will continue to grow, and we couldn't continue to do it with the staff that we had. We had to scale up, and at this point I'm no longer concerned about any growth targets or planned growth activities, acquisitions, affiliations, or partnerships. I have the partner, and they have the scope and the scale to be able to meet our needs. We meet regularly in quarterly business reviews. They're a part of our strategic planning process. They get to learn right alongside us.