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
A practice administrator opens Admin → Product Activation in the eCW EMR, activates FHIR APIs (included for eCW customers at no cost), and opens Settings to reach the FHIR APIs dashboard.
02
Choose the app category — Backend/Bulk Access for the nightly sync, or Provider-Centric for in-chart launch — then Add New App and enter the App Activation Code MedScrub provides. Click Activate once MedScrub has enabled your practice on their side (a two-sided handshake).
03
Activation alone is not enough: enable each provider (Provider-Centric apps) or configure the patient group (Backend/Bulk apps). Skipping this yields a "FHIR App not enabled for this user" error at launch.
04
Read your base FHIR URL and practice name from the FHIR APIs config screen (routing is per practice code) and hand them to MedScrub. Write-back to the chart requires a separate contracted agreement with eClinicalWorks — read access is self-service.
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.