eClinicalWorks

eClinicalWorks offers solid FHIR R4 read coverage and reasonable write capabilities, but every write operation requires a separate contract. There are no webhooks — event-driven patterns require HL7v2 middleware.

Medium-High complexityContract-gatedFHIR R4HL7v2
FHIR Version
R4 (US Core 3.1.1 / 6.1.0)
Rate Limit
250 calls/min per practice code
Sandbox
Yes — portal signup required
ONC Certified
Yes

Capability Matrix

CapabilityReadWrite
Patients
Contract required via interop@eclinicalworks.com. Create + Update on v12.0.2/v12.0.3 only.
Appointments
Not available on eCW FHIR portal. Scheduling only via healow Developer Portal.
Only via healow Developer Portal, not the main eCW FHIR API.
Encounters
Contract required. Creates Telephone Encounter records only.
Clinical Notes
DocumentReference + DiagnosticReport read.
No clinical note write endpoint.
Document Upload
Contract required. C-CDA and PDF uploads via DocumentReference create.
Lab Results
Observation (Labs) + DiagnosticReport.
Medications
Contract required. MedicationRequest create; MedicationStatement reconciliation.
Allergies
Contract required. AllergyIntolerance create only — no update.
Conditions
Contract required. Condition create only — no update.
Immunizations
Contract required. Create only.
Vitals
Billing / Claims
Not documented in public FHIR documentation.
Coverage / Insurance
Coverage read on v12.0.2+ only.
Referrals
ServiceRequest read on USCDI v3 builds only.
Bulk Data Export
Via SMART Backend Services. Requires Registry Module for group definition.
Events / Webhooks
No FHIR Subscriptions or webhooks. HL7v2 ADT feeds available via middleware.
YesLimited (hover for details)No

What's hard about this EHR

  • All write APIs require a separate contract — no self-service write access
  • Two separate developer portals (eCW and healow) with different registration flows
  • No webhooks or FHIR Subscriptions — event-driven patterns require HL7v2 interface setup with middleware
  • Rate limit of 250 calls/min per practice is restrictive for high-volume operations
  • Each practice must individually activate FHIR APIs via On-Demand Activation
  • Practices must be on specific certified builds — older versions may not support required scopes or resources

When you might need Cobalt

  • Write access needed: All writes require contract negotiation with eClinicalWorks. Cobalt has existing write access.
  • Real-time data needed: No native webhooks. Cobalt provides real-time data feeds via HL7v2 integration.
  • Multi-practice deployment: Per-practice activation and build version management is complex. Cobalt handles multi-practice provisioning.
Talk to Cobalt