Interoperability
Paloma is the operating record. Specialized systems connect to it.
An agency already uses a payroll provider, an accountant’s ledger and a screening service, and its pharmacies and payers have systems of their own. The job of an operating system is to run the agency’s work and connect to those, without becoming a second copy of any of them.
Two ways to get this wrong
The first is to treat the agency’s systems as equals that exchange copies. The clinical system sends visits to the billing system, which sends hours to payroll, which sends totals to accounting. Each holds its own version of the visit. When they disagree, a person reconciles them, and the agency’s staff become the integration.
The second is to promise that one product replaces everything. Payroll tax filing, claim routing between thousands of payers, criminal-record searches and laboratory analysis are specialized work done by organizations built for it. Rebuilding them inside an operating system produces a worse version of each.
Paloma takes a third position. There is one operating record of the agency’s work. Specialized systems are connected to it: each is given the part of the record it needs, and what it returns is attached to the record it concerns.
- The operating record
- What the other system needs
- The other system does its work
- Its answer, with source and date
- Back on the record it concerns
The vocabulary
Say plainly what kind of connection it is.
“Integration” is used loosely in healthcare software. A spreadsheet mapped into a system and a live connection between two systems are different things. Paloma uses five terms, on this site and in the product, and does not let one stand in for another.
| Kind | What it is | How it runs | Examples |
|---|---|---|---|
| Import or migration mapping | A file from another system is uploaded, its columns matched to Paloma’s fields, and every row checked before anything is saved | Once, or whenever a person chooses to bring a file in | Patients, staff, pharmacies, physicians, authorizations and history from a previous system |
| Export | Paloma produces a file from the canonical record for another system or for the agency’s own use | On request, or on a schedule the agency sets | Reports, a payroll file for a pay period, billing lines, a copy of the agency’s data |
| Native integration | A working connection that Paloma itself operates as part of the product | Continuously, as part of ordinary work | Reading documents, sending and receiving email, looking up a provider in the national registry, the join between Paloma Clinical and Paloma Talent |
| Custom integration | A connection to a system one agency depends on, built on request where that system offers a way to connect and its owner allows it | As designed for that agency’s need | A particular payroll provider, screening service, clearinghouse, pharmacy system, laboratory or accounting ledger |
| Connector | A direct, recurring connection between Paloma and one named system. The word is reserved for this | Without a person moving a file | Used only where such a connection exists |
The distinction matters most at the moment of buying. An agency that is told a system “integrates with payroll” and then learns it means downloading a spreadsheet has been misled, even if the spreadsheet is useful. An import is honest work and should be called an import.
What comes in keeps its source and its date
The value of a connection is not that data moved. It is that the agency can later show where a fact came from. Every fact that enters the operating record from outside carries three things: the source it came from, the date and time it was obtained, and what was returned.
This is what separates verification from data entry. A license status that the issuing board returned on a date is a check with the source. The same status typed from a wallet card is a report. A screening result delivered by the screening provider is the provider’s result; a note saying the screening was clear is a note. Stored alike, they cannot be told apart at survey. Stored with their source, each supports exactly what it should.
The same rule governs imports. A visit history brought across from a previous system is recorded as imported history from that system on that date. It informs the chart. It does not become a visit made in Paloma, a note reviewed in Paloma or a credential verified in Paloma.
Moving from another system
Changing systems is the point at which an agency is most likely to lose history or, worse, to gain history that was never true. A migration is therefore treated as a mapped import with a preview. The file from the previous system is uploaded. Its columns are matched to Paloma’s fields. Every row is checked: a date that is only a date stays a date and is not shifted by a time zone, a person who already exists is matched instead of duplicated, and a row that cannot be placed is set aside with the reason. Nothing is saved until a person has seen what will be saved.
What crosses over is marked as having come from that system on that day. The agency keeps its patients, staff, pharmacies, physicians and past activity, and can always tell which records it created in Paloma and which it brought with it.
What goes out is the canonical record
When Paloma sends something to another system, it sends from the one record: the reviewed note to the pharmacy that requires it, the billing lines to a clearinghouse, the hours and mileage to payroll. There is no separate “export copy” that can drift from what the agency sees on screen. If the record is corrected, the correction is a new event, and what was sent earlier remains readable as it was sent.
The systems around an agency
What each one is for, and where the line sits.
| System | What it does that Paloma does not | What the operating record gives it | What comes back |
|---|---|---|---|
| Payroll provider | Calculates withholding, files payroll taxes, pays employees | Hours, visits, rates and mileage for the pay period, from completed and reviewed work | Confirmation that the period was processed |
| Screening provider | Searches criminal records and other background sources under its own legal framework | The candidate and the searches the role requires, requested inside the hiring file | The provider’s result, dated, attached to the person’s file |
| License and exclusion sources | Hold the authoritative status of a license or an exclusion | The person and license to check | The status the source returned, the date, and when it should be checked again |
| Clearinghouse | Routes eligibility requests, claims, claim status and remittances between providers and payers | Billing lines formed from the one billing record | Acknowledgments, status and remittance, matched back to the lines |
| Pharmacy systems | Dispense, manage inventory and bill for the drug | Reviewed nursing documentation and visit status for that pharmacy’s patients | Referrals and orders, kept with the document they arrived in |
| Laboratories | Analyze specimens and issue results | The order and the collection details | The result, attributed to the laboratory and dated |
| Accounting ledger | Keeps the general ledger, the tax position and the financial statements | Invoices, payments and adjustments as events | Nothing the operating record depends on |
| Fax and electronic signature services | Carry documents and capture signatures | The document and its recipient | Delivery evidence, or the signed document with who signed and when |
A connection to someone else’s system always depends on that system: whether it offers an interface, on what terms, and what its owner permits. That is answered system by system. A catalog of logos says less than one plain sentence about what a specific connection actually does.
Commitments
How outside data is treated.
Nothing arrives anonymous
Each fact from outside carries its source, its date and what was returned. A fact without provenance is a report.
Software proposes; people confirm
A document may be read and a match suggested. A person confirms what becomes the record, and the document stays attached.
The least that is needed leaves
A system is sent the part of the record its work requires and no more. A staffing search carries a role, skills and a place, never a patient’s identity.
One record goes out
Notes, lines and hours are sent from the canonical record, so what another system holds is what the agency sees.
An import never upgrades a fact
Imported history remains imported history. It does not become verified, reviewed or delivered by being loaded.
The agency’s data is the agency’s
What an agency has recorded can be taken out as files it can read.
Why this is one of the six engines
Interoperability is often treated as a list of partners. In Paloma’s architecture it is an engine with a defined job: to keep the operating record the single place where the agency’s work is known, while letting specialized systems do what they do best. The other engines depend on it. Workforce relies on what a license source returned. Revenue cycle relies on what a clearinghouse acknowledged. Continuous compliance relies on being able to show, for any fact, where it came from.
An agency should be able to ask of any connection: is this an import, an export or a live connection; what leaves; what comes back; and how would I show a surveyor where this fact came from. Those four questions have answers here before anything is built.
The six engines of the platform → Continuous compliance → Revenue cycle →
Paloma Cares
Need Paloma connected to a system you already use
Tell us which one. It will be assessed and described plainly as an import, an export or a connection that can be built. Paloma Cares shows what the product connects to, with its published price.
From Paloma Cares
What Paloma Cares supports today
This list is published by Paloma Cares and was last verified on 2026-10-10. palomacares.com is the source for what the product does now.
- Native integrations (document reading, email, provider registry, Talent)LiveSee it in Paloma Cares →
- Data import from a previous systemIn progressSee it in Paloma Cares →Pharmacy and physician imports are proven. Patient, staff, authorization and visit-history imports are being re-proven after correction.
- Exports and a verified agency backupLiveSee it in Paloma Cares →
- Custom integrations with a customer's systemsPlatform direction
- Licence monitoring against the authoritative sourcePlatform direction
- Electronic payer claims, eligibility and remittancePlatform direction
- Pharmacy portal for pharmacy partnersLiveSee it in Paloma Cares →Read-only governed access for pharmacist, case-manager and billing-contact roles. Sending orders, messaging and downloads are under development.
Questions
Interoperability: common questions
What is the difference between an import and an integration?
An import maps a file from another system into Paloma’s fields, checks it and saves it once. An integration is a working connection between two systems that carries information as part of ordinary work. Both are useful. They are different things and are named differently so a buyer knows which one is on offer.
What does Paloma mean by a connector?
A direct, recurring connection between Paloma and one other named system, operating without a person moving a file. The word is reserved for that. A spreadsheet upload is an import, and a file produced for another system is an export.
Can Paloma connect to a system an agency already uses?
Where the other system offers a way to connect and its owner permits it, a custom integration can be built for an agency’s operational need: a payroll provider, a screening service, a clearinghouse, a pharmacy system, a laboratory or an accounting ledger. Whether a given system can be connected is answered case by case, plainly, as an import, an export or a connection.
Why does data from outside keep its source and date?
Because a fact is only as strong as where it came from and when. A license status returned by the issuing board on a date is evidence of a check. The same status typed by a coordinator is a report. If the two are stored identically, nobody can later show a surveyor or a payer which one the agency relied on.
Does Paloma replace payroll, accounting or a clearinghouse?
No. Those are specialized services that do their work well. Paloma is the operating record of the agency: it holds the hours, the visits, the billing lines and the credentials, and passes each service what it needs. The service’s answer comes back attached to the record it concerns.
Can an agency take its data out?
An agency’s records are its own. An export is the same canonical record in a file: reports, a payroll file for a pay period, billing lines, or a copy of the agency’s data.
How is a migration from another system handled?
As a mapped import. A file from the previous system is uploaded, its columns are matched to Paloma’s fields, every row is checked and shown before anything is saved, and what is saved is marked as imported from that system on that date. History brought across remains history: it does not become a visit made or a credential verified in Paloma.
The products
The software doing it.
Use either independently. Use them together when you want patient demand and workforce supply to work from the same context.