Roman Khmaladze

Context & Role

The Washington Healthplanfinder is the state's health-benefits eligibility and enrollment system. The CMS Eligibility Solution program integrates Non-MAGI Medicaid programs to support federal ex parte renewal compliance, across a multi-agency landscape (WAHBE, DSHS, HCA) under state IT oversight. I serve as the independent, state-side architect — technical governance, vendor-deliverable oversight, and architecture decision ownership.

Signature Contributions

• Surfaced a systemic data-model limitation affecting ~162,000 dual-eligible individuals, reframing a vendor "no-impact" recommendation into an explicit, governed decision escalated to the steering committee.
• Drove redesign of the eligibility-service response from a person-level to a program-level structure across MAGI/Non-MAGI and QHP programs.
• Provide independent architectural review of systems-integrator deliverables across an environment serving ~358,000 Non-MAGI individuals and ~13 TB of core data.
• Authored state-owned canonical artifacts — risk register, interface inventory, ecosystem and data-flow diagrams.

Context & Role

VITL operates Vermont's statewide health information exchange, moving clinical and billing data among hospitals, practices, and state agencies. As principal enterprise architect I owned the data architecture end to end — the clinical data management platform, the analytics warehouse, the integration estate, and the technical roadmap I built alongside the CEO.

Signature Contributions

• Architected a new enterprise clinical-data-management system that cut processing time 40% while strengthening audit and data quality.
• Designed a Snowflake data warehouse with optimized ETL pipelines saving ~$1.2M annually; consolidated and migrated multiple data marts to AWS Redshift.
• Led FHIR-based integrations with Epic, Cerner, Athena and NextGen across 500+ Vermont healthcare organizations.
• Delivered hybrid AWS/GCP microservices on Terraform and Kubernetes, improving resilience and scalability ~65%.
• Supported state Medicare/Medicaid modernization — current-state review, ETL design, and NIEM-aligned modular components feeding the state data warehouse.

Context & Role

Horizon is New Jersey's largest health insurer. I owned the architecture for its interoperability program during the period when the CMS Interoperability and Patient Access rules moved from policy to enforced deadline — meaning compliance had to be delivered on a legacy estate, in production, without disrupting member service.

Signature Contributions

• Owned end-to-end architecture for interoperability initiatives ensuring Medicare/Medicaid compliance for 2M+ members.
• Led Athena and Epic EMR integration for prescription management (eRx), reducing medication errors 23%.
• Transitioned legacy Oracle systems to an AWS-based data lake, cutting operational costs 25%.
• Established SOPs for production FHIR solutions, improving reliability 40%; integrated partner and internal systems via microservices and FHIR.

Context & Role

CareFirst is the largest health plan in the mid-Atlantic. Over eleven years as principal healthcare architect I worked across the payer estate — member and provider data, claims, pharmacy benefits, care coordination — through a period that took the industry from early HIE connectivity to full CMS interoperability mandates.

Signature Contributions

• Led CMS interoperability-mandate implementation using FHIR-optimized data layers, achieving compliance while expanding member services.
• Aligned data models to FHIR, raising Master Patient Index accuracy 90%.
• Integrated with Maryland's HIE (CRISP) via CCD and HL7, enabling real-time patient-data access for 1,000+ providers.
• Built a PBM accumulator-tracking solution — real-time deductibles, out-of-pocket maximums, benefit thresholds — improving PBM efficiency 32% and reducing claim-processing errors 47%.
• Ran multiple Agile teams delivering the Patient-Centered Medical Home program (+28% care-coordination metrics) and PEGA paperless workflows under CMS guidelines.

Context & Role

Lead enterprise architect on Lithuania's national EMR program — a single clinical record spanning the country's public healthcare system. National-scale healthcare architecture is an unusual constraint set: there is no option to serve only the easy cases, every legacy facility system has to be reconciled, and terminology and coding have to hold across the whole estate.

Signature Contributions

• Architected a nationwide EMR serving 3.5M patients, ~20,000 providers, and ~1,500 healthcare facilities.
• Delivered HL7 v2↔v3 mapping, PACS integration, and ICD-9↔ICD-10 translation across the national estate.
• Led 20+ engineers across three cities and two countries.