Integration Ecosystem

Decision Framework: BUILD / BUY / HYBRID

Every integration decision is evaluated against three core questions:

#QuestionBUILD if…BUY if…
1Is this a competitive moat?Yes — core differentiator, build in-houseNo — commodity capability, buy
2Is there a certification barrier?No — or we already have the certYes — vendor has existing certification (NCPDP, Surescripts, HITRUST)
3What is the outage cost?High — we need full control over uptimeLow — vendor SLA is acceptable
BUILD = fully in-house   BUY = vendor SaaS / licensed   HYBRID = vendor core + custom integration layer

Eligibility & Prior Authorization

Vendor / StandardTypeRole
StediHYBRIDX12 270/271 eligibility, 278 prior auth translation layer
AvailityBUYMulti-payer portal, real-time eligibility, auth status
Da Vinci PAS / CRD / DTRBUILDFHIR-native prior auth, coverage requirements discovery, documentation templates

Claims & Revenue Cycle

Vendor / StandardTypeRole
WaystarHYBRIDClaim submission, ERA/EOB processing, denial management
AvailityBUYMulti-payer claim status, secondary clearinghouse
Internal Claim ScrubberBUILDPre-submission validation, CCI/MUE edits, payer-specific rules engine

eRx & EPCS

Vendor / StandardTypeRole
SurescriptsBUYNewRx, RxRenewal, RxChange, RxFill, formulary, medication history
DrFirst (standby)BUYBackup e-prescribing network, EPCS
ID.meBUYIdentity proofing for EPCS AAL3 enrollment
Drummond GroupBUYEPCS certification auditor

HIE / TEFCA

Vendor / StandardTypeRole
Kno2BUYDirect messaging, C-CDA document exchange
eHealth ExchangeBUYTEFCA Qualified Health Information Network (QHIN)
Surescripts (QHIN)BUYClinical data exchange via Surescripts network

Labs

VendorTypeRole
Health GorillaHYBRIDLab order aggregation, universal lab interface
Quest DiagnosticsBUYDirect lab interface, results delivery
LabCorpBUYDirect lab interface, results delivery

Imaging

VendorTypeRole
Ambra HealthBUYCloud PACS, DICOM routing, image sharing
Nuance PowerShareBUYRadiology image exchange network
Life ImageBUYCross-network imaging exchange

Patient Communications & Payments

VendorTypeRole
InstaMedBUYPatient payment processing, card-on-file, payment plans
Rectangle HealthBUYPatient payment terminal, text-to-pay
CareCreditBUYPatient financing for elective/out-of-pocket
TwilioHYBRIDSMS/voice reminders, two-factor auth, patient outreach
Direct TrustBUYSecure Direct messaging for provider-to-provider

Telehealth

VendorTypeRole
Zoom for HealthcareBUYHIPAA-compliant video visits, BAA, waiting room
LiveKit / Daily.coHYBRIDEmbedded WebRTC for custom telehealth UX, white-label
Doxy.me / MendBUYWebRTC telehealth alternatives

Devices & Peripherals

VendorTypeRole
Welch Allyn ConnexBUYVital signs monitors, auto-populate vitals
MidmarkBUYExam room devices, digital stethoscope
Cardio DayBUYECG/EKG device integration
SpirobankBUYSpirometry device integration
MasimoBUYPulse oximetry, continuous monitoring

IIS & PDMP

VendorTypeRole
Bamboo HealthBUYPDMP gateway, multi-state prescription monitoring
LogiCoyBUYImmunization registry (IIS) bidirectional interface
State Immunization Information SystemsHYBRIDHL7 v2 VXU immunization reporting — per-state direct connections; aggregator where available

Clinical Content

VendorTypeRole
IMO HealthBUYMedical terminology mapping (ICD-10, SNOMED, CPT)
UpToDateBUYClinical decision support content, point-of-care reference
Lexidrug / FDB / Medi-SpanBUYDrug databases, interaction checking, formulary data
HealthwiseBUYPatient education content library
MedlinePlusBUYFree patient education content — complementary
Internal CDS Hooks runtimeBUILDCDS Hooks 2.0 dispatcher
Internal DSI transparency surfaceBUILDHTI-1 model cards, drift, lineage — regulatory

AI Scribe & Coding QA

VendorTypeRole
NablaHYBRIDAmbient AI scribe, encounter summarization
CodaMetrix / Fathom / NymHYBRIDAI-powered coding QA, auto-coding suggestions

Compliance & Security

VendorTypeRole
Drata / VantaBUYContinuous compliance monitoring, evidence collection
HITRUSTBUYCSF certification framework
Auth0 / WorkOSBUYSSO federation, SAML/OIDC, enterprise directory sync
VerifiableBUYProvider credentialing verification

Excluded Vendors

Change Healthcare: Excluded due to 2024 breach and ongoing risk profile. Replaced by Waystar + Stedi + Availity for claims/clearinghouse functions.

Stripe / Square: Excluded — not healthcare-specific. InstaMed and Rectangle Health provide HIPAA-compliant payment processing with healthcare-native features (ERA posting, patient responsibility estimation).

White-label EHR resellers: The platform is sold direct; OEM is out of scope at launch per the v1.0 non-goals.

Integration Health Flow

graph TD
  subgraph Inbound["Inbound Data"]
    LAB["Lab Results
(Health Gorilla, Quest, LabCorp)"]
    IMG["Imaging
(Ambra, Nuance, Life Image)"]
    HIE["HIE/TEFCA
(Kno2, eHealth Exchange)"]
    RX["Rx History
(Surescripts)"]
    DEV["Devices
(Welch Allyn, Masimo)"]
  end

  subgraph Core["REV.health Core"]
    GW["Integration Gateway"]
    FHIR["FHIR R4 Facade"]
    AI["AI/ML Pipeline"]
    RULES["Rules Engine"]
  end

  subgraph Outbound["Outbound Actions"]
    ERX["eRx/EPCS
(Surescripts)"]
    CLAIM["Claims
(Waystar, Availity)"]
    ELIG["Eligibility
(Stedi, Availity)"]
    NOTIFY["Notifications
(Twilio)"]
    TELE["Telehealth
(Zoom, LiveKit)"]
  end

  LAB --> GW
  IMG --> GW
  HIE --> GW
  RX --> GW
  DEV --> GW
  GW --> FHIR
  FHIR --> AI
  FHIR --> RULES
  RULES --> ERX
  RULES --> CLAIM
  RULES --> ELIG
  AI --> NOTIFY
  FHIR --> TELE