About the project

Industry: Healthcare

Country: US

Project type: EHR Platform

Duration: 9 months

The mandatory implementation of the 21st Century Cures Act 2015 #170.315 – g(10) in the United States brought about a significant shift in the healthcare industry. This legislation made it obligatory for API-based healthcare solutions to adhere to strict privacy, security, and interoperability standards, including adopting the FHIR data standard. However, Elation Health found themselves in a challenging position as their existing EHR data did not align with the FHIR standards.

Complying with the new requirements meant our Elation Health would have to completely redesign their solution, a daunting and time-consuming task that simply wasn’t feasible given the pressing time constraints they faced. To overcome this hurdle, Elation Health turned to the expert team at Edenlab for a collaborative partnership to develop a solution that would not only meet the compliance standards of the 21st Century Cures Act but also be more efficient with time and resources.

Client Background

Elation Health is a revolutionary clinical-first EHR platform that’s transforming the landscape of primary care. With a track record of empowering independent practices across the United States, as well as collaborating with industry giants like Crossover Health, Cityblock Health, and Firefly Health, Elation Health is leading the charge in driving sustainable innovation in healthcare.

At the heart of Elation Health success is their cutting-edge platform, packed with features and tools designed to liberate clinicians from the burden of administrative tasks. By streamlining workflows and reducing paperwork, the Elation EHR platform enables healthcare providers to focus on what truly matters: delivering exceptional, personalized care to their patients. With a staggering network of over 24,000 clinicians collectively caring for millions of Americans, the platform is revolutionizing primary care one practice at a time.

Our Solution

Seamless Integration with Kodjin FHIR Server

Edenlab’s Kodjin FHIR Server was the key to seamlessly integrating the Elation EHR platform with the FHIR standards without the need for a complete redesign. Kodjin served as a smart storage solution for the EHR platform. This innovative integration provided a scalable and high-performance FHIR-compliant clinical data repository, ensuring a smooth transition while preserving the integrity of patient records and enabling faster and more efficient retrieval of patient information.

Ensuring Security and Privacy and Enabling SMART on FHIR Functionality

Security and privacy were paramount considerations in our solution. To guarantee the secure exchange of data between the Elation EHR platform and Kodjin, we meticulously set up an isolated Kubernetes environment in the AWS Cloud. By utilizing Kafka Mirror Maker, we established a one-way stream from the platform to Kodjin, allowing only authorized users to transfer data changes from the EHR. This approach ensured that patient information remained safeguarded at all times.

Another part of our security measures was the implementation of the out-of-the-box SMART on FHIR functionality to the EHR platform. This empowered clinicians to effortlessly connect and explore third-party healthcare apps tailored to their specific needs. By integrating SMART on FHIR support, we ensured secure authorization and authentication for these external app integrations, eliminating the need for additional development and simplifying the integration process. SMART on FHIR functionality opened the doors to a world of innovation and collaboration for our client and their user community.

Efficient Mapping of Clinical Data: Streamlining Data Exchange

The efficient mapping of clinical data to FHIR resources plays a pivotal role in streamlining data exchange between the Elation EHR platform and Kodjin. Our team rose to the occasion by developing a custom FHIR ETL solution. Leveraging templates compatible with USCORE 5.0.1 profiles, we successfully transformed large volumes of EHR data into the FHIR format. Additionally, we implemented a registry of data mapping connections, enabling seamless synchronization between the platform and Kodjin, even when objects were added or deleted. By efficiently transforming and mapping clinical data objects to the FHIR format, Edenlab enabled the platform to achieve a harmonious data exchange and interoperability with other healthcare systems.

Enhancing Efficiency and Responsiveness with System Optimization 

Given the intricate data flow between the Elation EHR platform and Kodjin, optimizing the system was our priority. Our engineers conducted rigorous load performance tests to identify areas of improvement. Through scaling various services and increasing the number of partitions in Kafka, we achieved remarkable performance enhancements. Initially averaging 300 RPS (Requests per Second) on the Kafka topic, our optimization efforts, including scaling the FHIR ETL to five parallel instances, raised the bar to an average of 840 RPS and a maximum of 1160 RPS.

Moreover, we prioritized the efficient consumption of infrastructure resources during idle times, reducing the overall load on the system. Our dedication to system optimization translated into a more efficient and responsive EHR system, allowing clinicians to access critical information swiftly and seamlessly, thereby saving valuable time and enhancing productivity.

Facilitating ONC Certification: Ensuring Regulatory Compliance 

In order to comply with the Acute Cure Act 2015 #170.315 – g(10) criterion and to achieve ONC certification, standardized APIs for patient and population services must undergo the rigorous Inferno Testing process as part of the ONC Health IT Certification Program.

Recognizing the importance of ONC certification for Elation EHR platform success and industry credibility, Edenlab’s team utilized our deep expertise in FHIR to provide comprehensive support. We worked closely with the Elation Health team to ensure their solution met the intricate requirements outlined in the 170.315(g)(10) criteria of the 2015 Edition Cures Update. Through meticulous preparation and diligent testing, we helped our client to achieve the ONC certification successfully.

By leveraging our FHIR expertise and navigating the complex certification process, Edenlab empowered Elation Health to solidify their position as a trusted provider in the industry, opening doors to new opportunities and building greater trust among clinicians and patients.


The collaboration between Edenlab and Elation Health resulted in significant results and delivered several benefits to the organization.

ONC Certification

Through Edenlab’s expertise and support, Elation Health successfully achieved ONC certification, specifically complying with the USCORE 3.1.1 standards. This certification solidified Elation Health industry credibility and demonstrated their commitment to meeting regulatory requirements.

USCORE 5.0.1 Support

Additionally, Edenlab implemented USCORE 5.0.1 support, ensuring our client’s solution remained up-to-date with the latest standards and was future-proofed for any changes in the healthcare landscape.

High Performance

The optimized system achieved an impressive high performance of a maximum of 1160 Requests per Second (RPS), indicating a substantial increase in performance compared to the initial average of 300 RPS. This enhanced system performance allowed clinicians to access critical patient information swiftly and seamlessly, improving efficiency and productivity.

SMART on FHIR Functionality

The integration of SMART on FHIR functionality brought further benefits to Elation Health by providing secure authorization and authentication for third-party app integrations, clinicians gained the ability to easily connect and explore a wide range of healthcare apps that best suited their needs.

Customizable ETL Mapping Templates

Lastly, Edenlab’s solution included the configuration and tunability of ETL templates and rules. This allowed Elation Health to customize and adapt their system according to their specific requirements, ensuring flexibility and scalability as their needs evolved.

Solution Highlights:

Built high-performance architecture with 1160 max RPS

Established an efficient ETL mapping process to FHIR

Enabled configurable and customizable mapping models and rules

Provided ONC certification (USCORE 3.1.1) assistance

Added USCORE 5.0.1 support

Built-in SMART on FHIR functionality

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We would be glad to share more details about our enterprise-level FHIR software solutions and other cases based on the HL7 FHIR standard.

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