Building EHR Integrations: 6 Things to Get Right Before Writing Code

Connecting an application to an Electronic Health Record (EHR) system can be more complex than it appears. While one might expect a straightforward process involving API discovery, authentication, and data fetching, real-world healthcare integrations often encounter issues such as incomplete data, timeouts causing duplicate records, differing formats between systems, and unauthorized access.

These problems are frequently identified before any code is written. For those developing telehealth platforms, patient portals, healthcare SaaS products, or clinical applications, here are six crucial aspects to consider before beginning an EHR integration.

1. Grasp the Data Flow Prior to Selecting an API. Before choosing an API, it's essential to understand the data flow required by the application. For instance, a telehealth platform may need to retrieve patient demographics, medical history, medications, allergies, clinical observations, encounter details, and be able to send consultation notes to the EHR or create/update relevant clinical records.

This process involves different API resources, permissions, and write operations. Before implementing, document for each data type: the source (which system owns the information), the direction (read, write, or synchronize), and the timing (immediate, periodic, or on-demand availability). This helps establish integration boundaries and prevents treating every connected system as an interchangeable database.

A helpful approach is to define the workflow first, then identify the necessary API operations to support it.

2. Understand FHIR and the EHR's Actual Implementation. FHIR (Fast Healthcare Interoperability Resources) is a standard for exchanging healthcare information, offering resources such as Patient (demographics), Observation (measurements), Encounter (healthcare interactions), Condition (diagnosis), MedicationRequest (medication orders), DiagnosticReport (diagnostic findings), among others.

While FHIR facilitates interoperability, it doesn't ensure all EHRs implement resources uniformly. A vendor may support a particular resource but restrict certain operations, or require specific profiles, search parameters, or authorization scopes. Before coding, verify: the supported FHIR version, available resources and operations, any vendor-specific implementation guides, mandatory fields, supported search parameters, pagination behavior, required authorization scopes, and review sandbox/test data if available. Don't solely build upon the FHIR specification; integrate it with the actual EHR implementation.

3. Design Patient Matching and Data Mapping Carefully. Establishing whether two records represent the same patient is a critical integration decision. An application might use an internal patient ID, while the EHR employs its own identifier. Names and dates of birth alone may not reliably confirm identity. A safer approach involves using the appropriate identifiers and agreed-upon matching rules for the integration.

For example, maintain a mapping between your internal patient record and the corresponding identifier in the external system. Account for multiple identifiers based on workflow requirements. Data mapping is equally important. An application field might not directly correspond to an EHR field. Clinical concepts may utilize standardized codes, specific units, or vendor-defined profiles.

Before implementing transformations, establish rules for identifier mapping, field-level mappings, required/optional values, terminology and unit handling, and define behavior for missing or conflicting data. Avoid making assumptions when a record cannot be confidently matched; instead, follow a defined exception-handling process to prevent attaching information to a potentially incorrect patient.

4. Plan Authentication, Authorization, and Audit Logging. An integration requiring patient information must also enforce appropriate access restrictions. Authentication methods may include OAuth 2.0, SMART on FHIR, or other supported mechanisms. While successful authentication doesn't guarantee authorization for every request, several implementation details should be considered: token management (secure storage and handling of token expiration and refresh), requesting only necessary scopes, enforcing permissions on the server, handling revoked access and authentication failures explicitly, and recording relevant access and modification events with sufficient context for troubleshooting.

For US healthcare applications subject to HIPAA, these controls must adhere to applicable security and privacy requirements, with API integration not automatically establishing compliance.