In healthcare, patients with chronic conditions often see multiple specialists (ex., a cardiologist, nephrologist, neurologist, and more), each managing separate care plans with little visibility into what the others are doing. For rural communities across America, this fragmentation is even more pronounced. Many do not have access to local specialty care, and many small independent practices lack the technology infrastructure that large urban health systems take for granted.
Aspen Physician Network was founded to solve this exact problem. As the first clinically integrated network in the United States focused exclusively on specialist care, Aspen faced unique technological challenges: How do you create a unified patient view across dozens of independent practices using different electronic health record systems? How do you bring enterprise-grade healthcare technology to independent specialty practices? And perhaps most critically, how do you maintain complete control over sensitive patient data?
The answer came through an innovative implementation of Heroku, supercharging their Salesforce deployment into a flexible, scalable platform that’s changing how specialists coordinate care.
Clinically Integrated Networks (CINs): Unifying specialist care to improve patient outcomes
Healthcare regulations tightly control how independent practices can interact with each other, particularly around referrals and payments, under what are called Stark laws. A clinically integrated network (CIN) provides legal protection against antitrust concerns and allows independent practices to work together as a coordinated virtual health system.
For Aspen Physician Network Executive Director Danny Conaway, the vision was clear: enable independent specialists to act as if they’re part of a unified health system without requiring them to give up their independence. Unlike traditional CINs that focus on primary care physicians, Aspen broke new ground by creating the nation’s first specialist-focused CIN.
This distinction is crucial because patients with chronic conditions typically have three to five different specialists managing separate care plans. Without coordination, a cardiologist has no visibility into what a nephrologist or neurologist is prescribing, leading to potential conflicts, duplicate testing, and fragmented care.
“Your cardiologist has no idea what the nephrologist or the neurologist is doing with you. That’s part of what we’re looking to bring through here—to make those care plans visible to the whole care team so that they can know what each other are doing and can adjust their plans accordingly.”
— Danny Conaway, Executive Director, Aspen Physician Network
How Heroku helped Aspen regain data ownership
Aspen’s path to Heroku began with a serious setback. The organization had been using an older database solution to aggregate claims data and coordinate care across its physician network. When management changed at the service provider and the organization shifted priorities, it discontinued the database service.
For a clinically integrated network, losing access to patient data like this isn’t just inconvenient, it threatens the organization’s ability to meet regulatory requirements and fulfill its core mission. Aspen needed to replace the solution quickly, but this time it wanted complete control over their data and infrastructure. The experience of depending on a third party that could change direction or pricing at any time left a lasting impression. Aspen needed a solution it owned and controlled, one that could grow with their network and adapt to their specific needs.
“When you’re using a third party like that, you’re giving up control for what you hope is an acceptable solution. Our work with Heroku and Stratis has given us more control for building out the solution that works for us and gives us what we need: a competitive advantage.”
— Danny Conaway, Executive Director, Aspen Physician Network
Achieving a unified patient view How Heroku integrates disparate EHR data
One of Aspen’s biggest challenges was integrating patient data from dozens of independent practices, each using different electronic health record (EHR) systems specialized for their particular medical specialty. Directly interfacing with each individual EHR would have been a maintenance nightmare and wouldn’t provide the comprehensive patient view Aspen needed.
Instead, Aspen partnered with C3 HIE, a regional Health Information Exchange that connects to the national healthcare data framework. This single integration point gives Aspen access to far more comprehensive data than individual EHR systems could provide.
Through the HIE connection, Aspen receives notifications whenever one of their patients visits a hospital or healthcare provider anywhere in the country. It can retrieve those records and integrate them into its system, ensuring specialists have complete visibility regardless of where their patients receive care. The HIE also reveals which physicians (inside or outside the Aspen network) are treating their patients, providing invaluable insights for care coordination.
Working with implementation partner Stratis Global, Aspen uses Heroku Shield and Postgres to receive, normalize, and massage this data feed before pushing it into Salesforce Health Cloud through Heroku Connect. The architecture provides both the security and compliance required for HIPAA-regulated patient data and the flexibility to incorporate additional data sources as Aspen’s needs evolve.
If you want to learn more about Stratis Global and other work it’s won by recommending Heroku, we recommend you visit their customer story.
Salesforce Health Cloud and Heroku: the flexible platform for specialist care coordination
The challenge of creating this CIN is multifaceted: integrating disparate data sources, normalizing inconsistent data formats, managing HIPAA compliance requirements, and building a multi-tenant architecture that could serve dozens of independent practices. Health Cloud alone couldn’t solve these infrastructure challenges.
Heroku changed everything. By providing a platform to receive, clean, and normalize data before it entered Salesforce, Heroku allowed Aspen to build exactly the solution it needed rather than forcing its requirements into Health Cloud’s native capabilities.
“Prior to engaging Stratis, we were floundering with our implementation and very frustrated. After learning the benefits of Heroku, it sped up our implementation. We’re able to normalize data so we’re getting cleaner data into Salesforce, and we’re getting a more robust data set.”
— Danny Conaway, Executive Director, Aspen Physician Network
Under the hood: how Aspen uses Heroku to solve complex problems
Aspen’s implementation leverages four distinct Heroku patterns to solve complex healthcare coordination challenges:
- Data bridge architecture: Data flows from C3 HIE into Heroku Shield using Heroku Postgres, where it’s cleaned, normalized, and augmented before being transported into Health Cloud via Heroku Connect. Some data remains virtualized through Salesforce Connect, meaning it never enters Salesforce proper but can still be queried when needed, reducing data storage costs while maintaining access.
- Multi-tenant solution: Aspen serves multiple independent physician practices through a single Heroku-powered platform. Rather than each practice maintaining separate systems, they access Aspen’s shared infrastructure, dramatically reducing IT costs across the network while maintaining practice independence and data segregation.
- API access layer: Using AppLink, Aspen exposes patient data as secure APIs that member practices and external systems can query. This enables both Salesforce Health Cloud and third-party systems to access the unified patient view without complex point-to-point integrations.
- Future agentic AI capabilities: With Heroku’s Managed Inference and Agents, Aspen is developing agentic AI features that will proactively notify care team members when relevant patient events occur (such as an ER visit or new specialist consultation), along with AI-generated insights and care plan suggestions. All of this remains within Heroku Shield’s security boundary, ensuring HIPAA compliance.
The entire solution runs on .NET using Heroku’s native build packs, demonstrating the platform’s flexibility for enterprise healthcare applications.
Advancing healthcare equity for underserved patients with Heroku and Aspen
Aspen’s work extends beyond technology implementation—it’s about healthcare equity. Rural communities across Texas and the United States face significant healthcare access challenges. Small independent practices lack the resources to implement the sophisticated care coordination technology that large urban health systems deploy routinely. By building on Heroku and Health Cloud, Aspen brings enterprise-grade technology to these communities. Independent specialists can now coordinate care as effectively as their urban counterparts, with complete patient visibility across multiple providers and care settings.
C3 HIE, Aspen’s data exchange partner, recognizes this opportunity. It is currently exploring how to leverage Aspen’s Heroku-powered solution as a channel to serve other rural hospitals and clinics throughout its network, extending the platform’s benefits beyond Aspen’s direct membership. The model proves that rural healthcare providers can be “first-class citizens” with the same technological capabilities as major metropolitan health systems; they just need the right platform and architecture.
What’s next for Aspen?
While much of Aspen’s roadmap remains in development, the organization continues expanding its Heroku implementation. Beyond the core data integration and Health Cloud functionality already in production, Aspen is building out the agentic AI capabilities that will enable proactive, intelligent care coordination.
The vision includes AI agents that monitor patient data streams and automatically alert care team members to significant events, suggest care plan modifications based on emerging patterns, and identify gaps in care before they become critical. By leveraging Heroku’s managed inference capabilities with Managed Inference and Agents, all of this intelligence remains within the HIPAA-compliant Heroku Shield security boundary.
Aspen also continues onboarding new specialist practices to their network, demonstrating the scalability of their multi-tenant Heroku architecture. Each new practice that joins gains immediate access to the unified patient data platform without requiring separate integration work or infrastructure investment.
As Aspen proves the model works, it’s creating a blueprint for how specialist-focused clinically integrated networks can leverage Heroku and Health Cloud to transform care coordination.