eClinicalWorks Integration

Overview

The eClinicalWorks integration enables Vantrexia to read patient demographics from eCW and write RPM observation data back to patient charts in real time. This eliminates manual data entry for clinical staff and ensures that all remote monitoring readings are part of the patient's longitudinal health record.

Key capabilities:

• Patient Import — Search and import patient demographics from eCW into Vantrexia's patient registry
• Observation Push — Automatically sync RPM readings (blood pressure, SpO2, weight, glucose) to eCW as FHIR Observation resources
• Authentication — Dual authentication support: JWT Backend Services for automated sync and OAuth2 Standalone for interactive access
• Audit Trail — Every data exchange is logged with timestamps, resource IDs, and delivery confirmation for HIPAA compliance

Authentication Methods

Vantrexia supports two authentication methods for connecting to eClinicalWorks' FHIR API. The appropriate method depends on whether the access is machine-initiated (automated sync) or user-initiated (interactive workflows).

JWT Backend Services (Primary)

The JWT Backend Services flow uses the OAuth 2.0 client_credentials grant type with a signed JWT client assertion. This is the primary authentication method for all automated, machine-to-machine data exchange between Vantrexia and eCW.

The JWT assertion includes the following claims:

{
  "iss": "your-ecw-client-id",
  "sub": "your-ecw-client-id",
  "aud": "https://oauthserver.eclinicalworks.com/oauth/oauth2/token",
  "exp": 1738900500,
  "iat": 1738900200,
  "jti": "unique-request-id-uuid4"
}

OAuth2 Standalone (Interactive)

The OAuth2 Standalone flow uses the authorization_code grant with PKCE (Proof Key for Code Exchange) for user-interactive scenarios where a provider needs to authorize Vantrexia to access their eCW account. This flow is used during initial setup and for operations that require user consent.

Configuration

The following endpoints and configuration parameters are required to establish a connection with eClinicalWorks:

Required Scopes

The following FHIR scopes must be granted to Vantrexia's client application in the eCW developer portal:

system/Patient.read        # Read patient demographics
system/Observation.write   # Write RPM observation data
system/*.write             # Write clinical resources (Observations, DiagnosticReports)
user/Patient.read          # Read patients in user context (OAuth2 standalone)
user/Observation.write     # Write observations in user context (OAuth2 standalone)

Setup Steps

Follow these steps to configure the eClinicalWorks integration from scratch. Estimated setup time: 30–45 minutes.

# Generate 2048-bit RSA private key
openssl genrsa -out ecw_private_key.pem 2048

# Extract public key
openssl rsa -in ecw_private_key.pem -pubout -out ecw_public_key.pem

# Generate a key ID (kid) for JWKS
export KEY_ID=$(openssl rand -hex 16)
echo "Key ID: $KEY_ID"

# Verify the key pair
openssl rsa -in ecw_private_key.pem -check -noout

https://api.vantrexia.com/.well-known/jwks.json

curl -s https://api.vantrexia.com/.well-known/jwks.json | python -m json.tool

# eClinicalWorks Integration
ECW_CLIENT_ID=your-assigned-client-id
ECW_CLIENT_SECRET=your-client-secret
ECW_ENVIRONMENT=staging
ECW_PRACTICE_CODE=your-practice-code
ECW_APP_TYPE=backend_service

# For production, change ECW_ENVIRONMENT:
# ECW_ENVIRONMENT=production

# Test JWT token acquisition
curl -X POST https://api.vantrexia.com/api/v1/ecw/test/jwt/ \
  -H "Authorization: Bearer YOUR_VANTREXIA_TOKEN" \
  -H "Content-Type: application/json"

# Expected response:
# {
#   "status": "success",
#   "token_type": "bearer",
#   "expires_in": 3600,
#   "scope": "system/Patient.read system/Observation.write"
# }

# Test FHIR connection
curl -X POST https://api.vantrexia.com/api/v1/ecw/test/connection/ \
  -H "Authorization: Bearer YOUR_VANTREXIA_TOKEN" \
  -H "Content-Type: application/json"

# Expected response:
# {
#   "status": "success",
#   "fhir_server": "eClinicalWorks FHIR R4",
#   "capabilities": ["Patient", "Observation", "DiagnosticReport"]
# }

API Endpoints

Vantrexia exposes the following endpoints for managing the eClinicalWorks integration. All endpoints require authentication with a valid Vantrexia access token.

{
  "authorization_url": "https://staging-oauthserver.ecwcloud.com/oauth/oauth2/authorize?response_type=code&client_id=...&redirect_uri=...&scope=...&code_challenge=...&code_challenge_method=S256&state=...",
  "state": "random-state-token"
}

{
  "jwt_configured": true,
  "jwt_last_success": "2026-02-09T10:30:00Z",
  "oauth2_configured": true,
  "oauth2_token_expires": "2026-02-09T11:30:00Z",
  "fhir_base_url": "https://sandbox-api.eclinicalworks.com/fhir/r4",
  "scopes": ["system/Patient.read", "system/Observation.write"]
}

{
  "status": "success",
  "token_type": "bearer",
  "expires_in": 3600,
  "scope": "system/Patient.read system/Observation.write system/*.write"
}

{
  "status": "success",
  "fhir_server": "eClinicalWorks FHIR R4",
  "fhir_version": "4.0.1",
  "capabilities": ["Patient", "Observation", "DiagnosticReport", "Encounter"],
  "response_time_ms": 342
}

{
  "count": 2,
  "patients": [
    {
      "ecw_id": "Patient/12345",
      "first_name": "Jane",
      "last_name": "Doe",
      "date_of_birth": "1985-03-15",
      "gender": "female",
      "mrn": "MRN-001234",
      "phone": "555-0101",
      "already_imported": false
    },
    {
      "ecw_id": "Patient/67890",
      "first_name": "John",
      "last_name": "Smith",
      "date_of_birth": "1972-11-28",
      "gender": "male",
      "mrn": "MRN-005678",
      "phone": "555-0202",
      "already_imported": true
    }
  ]
}

{
  "patient_ids": ["Patient/12345", "Patient/67890"],
  "assign_to_provider": "dr-smith-uuid",
  "program": "RPM"
}

{
  "imported": 2,
  "skipped": 0,
  "patients": [
    {
      "vantrexia_id": "a1b2c3d4-uuid",
      "ecw_id": "Patient/12345",
      "name": "Jane Doe",
      "status": "imported"
    },
    {
      "vantrexia_id": "e5f6g7h8-uuid",
      "ecw_id": "Patient/67890",
      "name": "John Smith",
      "status": "imported"
    }
  ]
}

Data Flow

When an RPM observation is recorded in Vantrexia (either from MioConnect device data or manual entry), the following pipeline pushes it to eClinicalWorks:

{
  "resourceType": "Observation",
  "status": "final",
  "category": [{
    "coding": [{
      "system": "http://terminology.hl7.org/CodeSystem/observation-category",
      "code": "vital-signs",
      "display": "Vital Signs"
    }]
  }],
  "code": {
    "coding": [{
      "system": "http://loinc.org",
      "code": "85354-9",
      "display": "Blood pressure panel"
    }]
  },
  "subject": {
    "reference": "Patient/12345"
  },
  "effectiveDateTime": "2026-02-09T10:30:00Z",
  "component": [
    {
      "code": {"coding": [{"system": "http://loinc.org", "code": "8480-6", "display": "Systolic BP"}]},
      "valueQuantity": {"value": 138, "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]"}
    },
    {
      "code": {"coding": [{"system": "http://loinc.org", "code": "8462-4", "display": "Diastolic BP"}]},
      "valueQuantity": {"value": 88, "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]"}
    }
  ]
}

Troubleshooting

Common issues encountered during eClinicalWorks integration setup and operation: