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athenahealth

athenahealth has the broadest API surface of the EHRs reviewed, with 800+ proprietary endpoints covering clinical, scheduling, and billing workflows. However, clinical notes write requires embedded SMART apps, and the push-based event system is still in alpha.

Medium complexitySelf-serveProprietary RESTFHIR R4HL7v2C-CDA
FHIR Version
R4 (US Core STU3.1.1)
Rate Limit
Not published — enforced via 403
Sandbox
Yes — auto-provisioned on app creation
ONC Certified
Yes

Capability Matrix

CapabilityReadWrite
Patients
Via FHIR or proprietary API.
Create + Update via proprietary API after contract + BAA.
Appointments
Full scheduling via proprietary API.
Book, update, cancel, check-in via proprietary API.
Encounters
Write primarily through embedded SMART on FHIR apps, not direct API.
Clinical Notes
DocumentReference + DiagnosticReport read.
Writing to encounter note sections possible via SMART on FHIR embedded apps. Scope approval required from athenahealth.
Document Upload
POST /patients/{id}/documents/clinicaldocument — PDF upload to patient chart.
Lab Results
DiagnosticReport + Observation via FHIR.
Medications
Write access restricted to specific partner types.
Allergies
FHIR + proprietary API.
No direct write endpoint in standard API. Possible via embedded SMART app pattern.
Conditions
FHIR + proprietary API.
Write possible via embedded SMART app pattern.
Immunizations
FHIR Immunization read.
Vitals
FHIR + proprietary API.
Write possible via embedded SMART app pattern.
Billing / Claims
Claims, charges via proprietary API.
Charge entry, claim creation, credit card payments via proprietary API.
Coverage / Insurance
FHIR Coverage + proprietary /insurances.
Capture patient insurance information via proprietary API.
Referrals
Bulk Data Export
EHI Export feature + Data View SQL editor for analytics.
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Events / Webhooks
Legacy polling-based Changed Data Subscriptions (production). FHIR push-based Event Subscriptions in limited alpha (v0.13).
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YesLimited (hover for details)No

What's hard about this EHR

  • Clinical notes write requires embedded SMART app pattern — no simple 'create note' API endpoint
  • FHIR event subscriptions are in limited alpha (v0.13) — not production-ready
  • Quarterly breaking changes with mandatory testing deadlines require ongoing maintenance
  • No published rate limits or uptime SLAs
  • Documentation is SPA-rendered, making automated discovery difficult
  • Two separate OAuth flows for proprietary vs. FHIR API tracks

When you might need Cobalt

  • Clinical notes write needed: Notes write requires SMART app embedding and scope approval. Cobalt provides a unified write interface.
  • Production-ready eventing needed: Push-based event subscriptions are alpha-only and scopes aren't self-service. Cobalt provides production-ready eventing.
  • Ongoing API maintenance: Quarterly breaking changes require continuous maintenance. Cobalt absorbs API version management.
Talk to Cobalt