BI Consulting Services · Integration concept

Physicians East: NextGen + InstaMed + ADP → one executive view

Prepared for Heather Roebuck, Director of Operations
with Evolve Digital Marketing · September 2026
Concept only — no pricing, no commitments

The problem

Physicians East runs 100+ providers across 12 sites and 15 departments on NextGen Enterprise, takes patient payments through two InstaMed portals, and runs payroll on ADP Workforce Now. Each system reports well on itself and none of them reports on the practice: to know last month's visits, no-show rate, days in A/R and labor cost by site, someone exports three reports and rebuilds the spreadsheet by hand. Meanwhile the website's appointment-request form was returning an HTTP 500 during our review, and even when it works nobody can see how many requests each location receives or how long they wait for a reply.

How it fits together

SOURCE SYSTEMS (THEIRS) INTEGRATION LAYER (AZURE, BICS-BUILT) WHAT LEADERSHIP SEES NextGen Enterprise EHR/PM visits, schedule, no-shows, charges, A/R, wRVU visits, schedule, no-shows, charges, A/R, wRVU · SQL/ODBC or FHIR NextGen PxP patient portal enrollment, messages, appointment requests InstaMed (2 portals) payments, payment plans, self-pay collected · export/API ADP Workforce Now labor cost, FTE by department · ADP API Clearinghouse / RCM (to confirm) first-pass denials, payer mix · plus Google ratings by site Azure Data Factory / Functions nightly pulls (hourly for the schedule) · HIPAA BAA in place Azure SQL — practice data model one row per visit, claim, payment and pay period, keyed to site / department / provider / month Power Automate thresholds → Teams/email alerts · web form → NextGen task HIPAA-compliant appointment request form on physicianseast.com (Evolve) → NextGen task, by site Power BI executive dashboard visits, no-show, days in A/R, collections, wRVU/FTE, labor % by site · see dashboard.html Automated alerts "Kinston no-show above 15% this week", "A/R over 45 days at Beulaville", "denials up" Site-manager scorecard one page per site, Monday 7am, in Teams Web-lead report by location requests, time-to-callback, conversion to visit

What changes on day one

  • One screen, all 12 sites. Leadership opens Power BI on Monday and sees last week's visits, no-show rate, new patients and days in A/R by site and department — no exports, no spreadsheet.
  • The appointment form works and is measured. Requests from the website land as tasks in NextGen for the right site, and Operations sees how many arrived and how fast each site called back.
  • Exceptions find you. A Teams alert fires when a site's no-show rate, A/R or denial rate crosses a threshold you set, instead of surfacing at month-end.
  • Labor cost sits beside revenue. ADP hours and cost by department next to NextGen net revenue gives labor-as-%-of-revenue per site for the first time.
  • Site managers get their own page. Each site lead receives a one-page scorecard every Monday with the same numbers leadership sees.

As-is vs. to-be

As-isTo-be
Monthly network viewNextGen reports per practice/site, rebuilt by hand in ExcelPower BI model refreshed nightly, all sites, drill to provider
Web appointment requestsForm on the site (returned HTTP 500); no count by locationHIPAA form → NextGen task; volume and callback time by site
No-showsKnown per department after the factWeekly by site and weekday; alert at threshold; reminder outcomes tracked
Patient payments (InstaMed)Two portals, two reports, reconciled manuallySelf-pay collected joined to visits and A/R in one model
Labor costADP reports, separate from clinical volumeLabor % of net revenue per department, per month

Phased approach

Discovery
Weeks 1–3
  • Confirm NextGen data access path (SQL/ODBC vs FHIR API) with Brian Walker (Network Administrator) and NextGen support
  • InstaMed and ADP API credentials; BAA and Azure tenancy
  • Agree the 12 KPIs and thresholds with Operations
Build
Weeks 4–9
  • Azure SQL model and nightly pipelines; validate against three closed months of NextGen reports
  • Power BI executive view + site scorecard
  • Appointment form on the Evolve-hosted site writing to NextGen; alert flows in Power Automate
Go-live
Weeks 10–12
  • Leadership and site-manager training (Power BI Pro licences per viewer, or the no-licence web version)
  • Two weeks of parallel run against manual reports
  • Hand-over, documentation, monthly check-in
Also worth knowing: BICS runs a private AI server option for practices that want to query their own data in plain language without any PHI leaving their tenancy, and builds Power Apps for front-desk workflows (callback queues, no-show outreach) on the same Azure foundation. Systems marked to confirm were inferred from public sources and will be verified in Discovery.
BI Consulting Services · Mooresville, NC · Microsoft Partner · powerbiconsultingservices.comIn partnership with Evolve Digital Marketing · Greenville, NC