Enabling regulatory-compliant interoperability for Elation EHR through an ONC-certified end-to-end FHIR solution

Turnkey ONC compliance and certification support with a secure, end-to-end FHIR interoperability solution

4 months

time savings on ONC certification

4x higher

system performance after optimization

Project summary Business goal Solution Innovation Value delivered

Project summary

Elation Health, a US EHR platform for primary care serving thousands of clinicians, partnered with Edenlab to transform its proprietary data model into HL7 FHIR and achieve ONC certification under the 21st Century Cures Act. Edenlab provided turnkey support across all stages, including FHIR solution design and implementation, third-party testing. We helped the company achieve ONC certification three times faster than the market average while strengthening the EHR’s interoperability and performance.

Location

USA

Partnership period

9 months

Industry

Healthcare

Client type

IT Vendor

Associated services

Health data exchange regulatory compliance Interoperability HL7 FHIR solution development services Healthcare data platform development  EHR software development Healthcare data migration services

The teams knowledge and expertise both technical and in healthcare was incredibly valuable and was shared openly with our team. This had a strong impact on the overall results of the project.

Troy Schuetrumpf

VP Platform Engr at Elation Health

Business goal and challenge

Elation Health needed to comply with the U.S. 21st‑Century Cures Act’s FHIR mandate while preserving the clinician‑first experience of its EHR platform, which serves a nationwide network of providers.

Their existing data structure wasn’t FHIR‑compliant, and rewriting the platform was not viable, so they sought a scalable solution to convert legacy records to US Core profiles, enable secure interoperability (including SMART on FHIR apps), and maintain high‑performance access for clinicians.

The solution

The Edenlab team built a FHIR‑native backend that connects Elation’s EHR to the HL7 FHIR standard, providing clinicians and developers with a secure, high‑performance environment for exchanging patient data without rewriting Elation’s core system. By leveraging a scalable Kodjin FHIR Server, customizable ETL templates, and a secure architecture, the solution meets ONC certification requirements.

Key features of the solution for ONC compliance include:

Scalable FHIR server

Integrates Kodjin FHIR Server as a high‑performance clinical data store, ensuring quick and accurate retrieval of standardized patient data.

Real time data mapping

Provides a custom ETL pipeline with templates aligned to US Core profiles and a mapping registry, ensuring seamless transformation and synchronization of EHR data to FHIR resources. 

SMART on FHIR functionality

Includes out‑of‑the‑box SMART on FHIR capabilities, allowing clinicians to connect trusted third‑party apps with secure authorization and authentication.

Benefits for end-clients (specialty practices):

Regulatory compliance

Quickly meet 21st‑Century Cures Act requirements.

Secure third‑party integration

Connect billing, telehealth, care‑coordination, or analytics apps while maintaining stringent authorization and authentication.

Real‑time data exchange

Enable high-performing synchronization of patient data across systems for seamless care coordination and analytics.

Future‑proof interoperability

Ensure data remains compatible with evolving FHIR standards, supporting long‑term innovation.

ONC certification facilitation:

Readiness assessment

Evaluated existing interoperability capabilities and mapped gaps against ONC §170.315(g)(10) requirements.

Certification roadmap

Defined testing scope, documentation package, and milestones for third-party validation.

Pre-certification testing

Internally validated FHIR API endpoints, including AuthN/AuthZ and performance tests, to ensure compliance readiness.

Third-party coordination

Guided Elation Health through the Inferno testing process and external validation with certification bodies.

Successful validation

Achieved 100 % pass rate across all FHIR API, AuthN, and AuthZ tests on the first attempt.

Edenlab’s innovation

Edenlab engineered a future-proof FHIR architecture designed not just to pass certification, but to perform reliably under real-world clinical loads. The system combines event-driven data streaming, dynamic mapping, and modular FHIR components to make interoperability practical at scale.

Challenges Solutions

Challenge

Legacy EHR architecture

Exposing FHIR APIs would normally require a costly core system redesign.

Solution

Event-driven FHIR layer

Edenlab implemented a real-time streaming model that transforms EHR events into FHIR resources on the fly, ensuring compliance and data freshness without rewriting or overloading the core system.

Challenge

High performance under clinician load

The initial event stream throughput (~300 RPS) risked bottlenecks in production use.

Solution

High-throughput elastic design

Optimized Kafka partitions and parallel ETL instances increased throughput to 840 RPS on average and up to 1,160 RPS peak, ensuring responsiveness even during heavy workloads.

Challenge

Maintaining data integrity and security

Real-time integration with patient data required strong protection and reliable access for external apps.

Solution

Isolated and secure cloud architecture

The FHIR backend runs in an isolated AWS Kubernetes cluster with one-way Kafka Mirror Maker streaming to prevent reverse data flow. Built-in SMART on FHIR uses OAuth-based authorization for third-party app connectivity, ensuring both interoperability and strict privacy protection.

Challenge

Keeping data consistent across EHR and FHIR systems

Continuous updates in the EHR made it difficult to keep FHIR data synchronized.

Solution

Real-time mapping registry and custom ELT

Edenlab built an ETL pipeline that reads events from the EHR stream, transforms them into FHIR resources, and keeps a mapping registry linking both sides. When data changes or is deleted in the EHR, the corresponding FHIR resource is updated automatically, keeping systems synchronized.

Business value delivered

Edenlab helped Elation Health meet U.S. interoperability mandates without rewriting its core EHR. Through a collaborative effort spanning analysis, architecture, development, and implementation, the team delivered a secure, FHIR‑compliant backend on time and on budget.

Accelerated certification with zero rework

Edenlab guided Elation Health through the entire ONC certification process, from planning to third-party testing, helping the company avoid months of rework and cost overruns, cutting the certification timeline to one-third of the industry average. The FHIR APIs passed validation on the first attempt.

Built for real-world interoperability

Instead of designing a solution solely for compliance, Edenlab engineered an architecture that performs reliably in production. The system supports continuous, secure data exchange under real clinical load, enabling true interoperability between the Elation and the wider healthcare ecosystem.

Future-proof foundation for evolving standards

By implementing support for US Core 5.0.1 and a flexible data mapping structure, Edenlab ensured that Elation’s FHIR platform can easily adapt to new regulatory requirements and data formats without costly redevelopment.

Related tags

ONC Certification §170.315(g)(10) 21st Century Cures Act Compliance EHR Optimization FHIR Data Mapping SMART on FHIR Integration Inferno Testing Process FHIR for EHR FHIR Compliance Readiness ONC Certification Accelerator

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Enabling regulatory-compliant interoperability for Elation EHR through an ONC-certified end-to-end FHIR solution

4 months

4x higher

Project summary

Business goal and challenge

The solution

Key features of the solution for ONC compliance include:

Benefits for end-clients (specialty practices):

ONC certification facilitation:

Readiness assessment

Certification roadmap

Pre-certification testing

Third-party coordination

Successful validation

Edenlab’s innovation

Legacy EHR architecture

Event-driven FHIR layer

High performance under clinician load

High-throughput elastic design

Maintaining data integrity and security

Isolated and secure cloud architecture

Keeping data consistent across EHR and FHIR systems

Real-time mapping registry and custom ELT

Business value delivered

Accelerated certification with zero rework

Built for real-world interoperability

Future-proof foundation for evolving standards

Related tags

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