MedScrub connects to eClinicalWorks using SMART on FHIR Backend Services, pulling the complete USCDI v3 patient record — problems, medications, observations, referrals, immunizations, family history, social determinants, and coverage — into the MedScrub clinical data repository. Clinical skills run against the full longitudinal record, and the patient context flows into the self-hosted proxy for PHI de-identification before any data reaches a large language model.
Integration model
OAuth 2.0 client_credentials with an RS384-signed JWT assertion or client_secret Basic Auth, registered in the eClinicalWorks App Orchard. The FHIR base URL is practice-code-specific (fhir4.eclinicalworks.com/fhir/r4/{practice_code}); customers configure the full URL including their practice code. Rate limiting is 250 requests per minute per practice code. PHI flows from eClinicalWorks into the customer-hosted proxy; de-identification happens before any request reaches a large language model. Write-back (DocumentReference, Observation vitals, ServiceRequest referrals) requires a separate commercial agreement with eClinicalWorks.
Capabilities
MedScrub pulls the patient record from the EHR before the appointment and surfaces care gaps, screening recommendations, and overdue chronic-disease milestones for the loaded patient.
Drafts a structured SOAP note from the patient chart, with ICD-10 coding and E/M level analysis. After physician review and sign-off, the note writes back to the EHR as a FHIR DocumentReference.
Runs HEDIS / USPSTF / MIPS quality-measure gap analysis across patient panels — breast, cervical, colorectal, diabetes, blood pressure, and depression screening.
Batch pre-visit intelligence for the full clinic day, run overnight against the CDR, with delivery to mobile.
Automates payer chart-request response by searching the longitudinal record for measure-specific evidence.
Drafts prior-auth requests and denial appeals grounded in the patient chart, including evidence pulled from prior diagnostic reports and procedures.
Monthly chronic care management documentation for CPT 99490 / 99491 billing, generated from the longitudinal record.
2021-AMA MDM framework analysis flags under-coding opportunities with revenue-at-risk surfaced in the UI.
Data scope
Setup
01
Register MedScrub at fhir.eclinicalworks.com/ecwopendev/ as a provider-centric Backend Services app. Select the USCDI v3 read scopes required for the deployment.
02
Customer IT provides the practice-specific FHIR base URL (including practice code) and the OAuth token URL discovered from the SMART configuration endpoint. Configure the EHR_ECW_* environment variables on the MedScrub proxy.
03
Required USCDI v3 read scopes are approved in the App Orchard sandbox (staging-fhir.ecwcloud.com) before connecting to the production practice. Write-back scopes (DocumentReference, Observation, ServiceRequest) require a separate commercial agreement via interop@eclinicalworks.com.
Tier limitations
The embedded sidebar integration is the EHR vendor’s third-party app pattern. Some MedScrub workflows require deeper FHIR connectivity that this tier does not provide.