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
| Capability | Read | Write |
|---|---|---|
| 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.
- [Vendor]eCW FHIR Developer Portal
- [Vendor]eCW FHIR Documentation
- [Vendor]healow Developer Portal
- [Vendor]healow FHIR Documentation
- [Vendor]Interoperability Overview
- [Vendor]ONC Certification Page
- [Vendor]EHI Export Documentation
- [Third-party]Zus Health — eCW Integration
- [Third-party]Iguana — eCW Integration Guide
