EHR integration is where healthcare software lives or dies. The right architecture means your application reads patient data in seconds and ships features clinicians actually use. The wrong one means months of vendor onboarding, brittle interfaces, and angry support calls. Of Ash and Fire has spent more than a decade building integrations against Epic, Cerner (Oracle Health), Athenahealth, NextGen, Allscripts, Meditech, and dozens of niche EHRs — without the marketing gloss.
What We Offer
We deliver production EHR integrations end to end: discovery, vendor onboarding, interface engine work, FHIR and HL7v2 development, secure messaging, fax, and the BAA paperwork that makes everything legally usable. We are vendor-neutral by design. We will not push you into a custom build when an interface engine is the right call, and we will not push you into a SaaS iPaaS when your latency and PHI constraints rule it out.
Key Capabilities
- HL7v2 messaging: ADT, ORM, ORU, MDM, SIU, and DFT message flows over MLLP, with deep experience handling Z-segments and the version drift between hospital systems.
- FHIR R4 API development: Production-grade SMART on FHIR apps, server-side FHIR endpoints, bulk export, and the operational realities of mapping FHIR resources to your application schema.
- Epic App Orchard navigation: We have walked clients through Vendor Services, Showroom listing, sandbox provisioning, security reviews, and go-live activation across multiple Epic sites.
- Cerner Code / Oracle Health: Patient and Provider apps, Cerner Open Developer Experience, and tenant-specific OAuth flows.
- SMART on FHIR: EHR-launch and standalone-launch apps with proper scopes, refresh tokens, and patient context handling.
- IHE profiles (XDS, XDR, PIX, PDQ): For HIEs, document exchange, and cross-organization patient matching.
- Interface engines: Mirth Connect, Iguana, Rhapsody, NextGen Connect — channel design, transformer scripts, ack handling, and on-call runbooks.
- Secure messaging and fax: Direct messaging, secure fax integration (Updox, Concord, Documo, Phaxio), and audit-ready PHI handling.
Our Process
1. Discovery & Architecture
We start by mapping every system that needs to send or receive data, what messages they speak, who owns each one, and what the real-world latency and volume look like. We pressure-test whether you actually need a custom integration, an iPaaS platform like Redox or Health Gorilla, an interface engine, or a direct EHR connection — and we will tell you honestly which is the better fit. The output is an integration architecture document with vendor onboarding timelines, BAA requirements, and a phased rollout plan.
2. Design & Prototyping
Before we ship anything to production, we build a working sandbox integration against the EHR's test environment. We define message contracts, error handling, retry strategies, and the operational dashboards your team will need on day one. This is where Epic App Orchard timelines, Cerner Code provisioning, and Athena Marketplace approvals get unblocked — we have done these submissions before and know what reviewers flag.
3. Development & Integration
Engineering happens against real EHR sandboxes, not mocks. We build, test, and validate against the actual vendor APIs — including the undocumented quirks (Epic's ID prefixes, Cerner's CodeableConcept variations, Athena's pagination behavior). Every interface ships with monitoring, structured logging, and replay tooling so your team can debug a missed ADT without paging us.
4. Launch & Support
Go-live includes vendor coordination, hospital IT walk-throughs, and load testing against production volumes. We provide hypercare for the first 30 days, then transition to support agreements that match how your team actually wants to operate — managed services, training-and-handoff, or co-development.
Industries We Serve
- Hospitals & health systems: Connecting in-house applications, departmental systems, and population health platforms to the enterprise EHR.
- Telehealth providers: Pulling visit data, scheduling, and consult notes from EHRs to unify the patient record across virtual and in-person care.
- Medical device companies: ADT-driven device provisioning, ORU result push, and SMART on FHIR clinical decision support.
- Healthcare SaaS: Multi-tenant integrations against many EHRs at once, with per-customer configuration and routing.
- Life sciences research: De-identified bulk FHIR export, EHR-based eCRF capture, and trial recruitment integrations.