A scale‑up in chronic condition management expanding beyond diabetes. The platform offered CGM‑driven coaching and outcomes analytics and needed to embed results directly into clinician workflows in Epic and Oracle Health (Cerner) to win payer/provider contracts.

The client’s previous EHR integrations averaged 16–20 weeks per site. Variability in site capabilities (read‑only vs partial write‑back), partial FHIR coverage, and legacy HL7 v2 feeds led to rework, duplicate records, and stalled go‑lives. Without write‑back of outcomes (e.g., Time‑in‑Range, hypoglycemia events), clinicians had to leave the EHR, and payer teams challenged auditability. Key pain points: - Inconsistent write paths across sites; some read‑only, some with limited flowsheet writes. - Fragmented feeds (FHIR + HL7 v2) → duplication and reconciliation issues. - TIR math drift from unit mismatches (mg/dL↔mmol/L), sensor warm‑ups, and backfills. - No runtime way to adapt to site‑specific throttles, quotas, and filtering rules.

We delivered a reusable integration accelerator: a capability‑driven EHR broker, a standardized outcomes engine for TIR/TBR/TAR, and a clean, auditable path from vendor CGM data to EHR Observations. What We Built - Capability Matrix per Site — A runtime config that switches behavior among read‑only, partial write‑back, and full write‑back; controls bulk/export availability, rate limits, and patient‑context quirks. - EHR Broker — Unified interface for Epic and Oracle Health with SMART (user and Backend Services), FHIR R4/R5, and HL7 v2 fallbacks (ORU^R01). Includes idempotent message keys and duplicate suppression. - Outcomes Engine — Canonical TIR/TBR/TAR computation with device‑specific warm‑up exclusions, short/long gap policies, timezone normalization, and explicit unit provenance (mg/dL↔mmol/L). - Observation Model — Standardized FHIR Observation for aggregated windows with effectivePeriod, method, and Provenance linking to raw data. Optional write‑back to flowsheets or notes when allowed. - Bulk & Cohort Path — SMART Backend Services + Bulk $export for nightly payer dashboards and backfills. - Observability & QA — Quotas, end‑to‑end latency, error budgets, and a validation suite covering unit/clock/gap edge cases and negative write tests.