Epic MyChart and Care Everywhere: SMART on FHIR APIs, Carequality, TEFCA, and Clinical Research Workflows

What Are Epic MyChart and Epic Care Everywhere? Overview and Operator

Epic MyChart is the patient-facing portal, mobile engagement platform, and consumer API gateway developed by Epic Systems Corporation (Verona, Wisconsin), while Epic Care Everywhere is Epic’s built-in Health Information Exchange (HIE) network embedded directly inside the Epic Electronic Health Record (EHR). Together, MyChart and Care Everywhere form the two primary external interoperability layers of the Epic ecosystem: MyChart governs patient-mediated access, eCheck-In, research recruitment, and third-party consumer app authorization via HL7 SMART on FHIR R4, whereas Care Everywhere governs provider-to-provider, cross-EHR, Carequality, and national TEFCA clinical record exchange.

Architecture and Scope: MyChart, Care Everywhere, and Happy Together

Across academic medical centers and integrated delivery networks (see our institutional comparison of Epic vs. Oracle Health [Cerner] and our guide to the de-identified research database Epic Cosmos), Epic separates patient-facing and inter-organizational data flows into distinct architectural components:

Epic Interoperability Component	Primary User / Direction	Core Technical Standards	Clinical & Research Function
Epic MyChart (Portal & Mobile App)	Patient-mediated (Consumer access & input)	OAuth 2.0 / OpenID Connect, SMART on FHIR R4, QuestionnaireResponse	Viewing OpenNotes/labs, scheduling, eCheck-In, patient-reported outcomes (ePROs), and clinical trial recruitment invitations
MyChart API (`open.epic.com`)	Patient-authorized third-party applications	ONC 45 CFR § 170.315(g)(10) FHIR R4, US Core / USCDI profiles	Allowing patients to pull longitudinal health records into mobile apps or decentralized clinical trial (DCT) platforms
Epic Care Everywhere	Provider-to-provider / System-to-system HIE	IHE XCPD / XCA, HL7 C-CDA, HL7 FHIR R4, Direct Secure Messaging	Querying and retrieving outside clinical summaries, imaging links, and immunization records across Epic and non-Epic sites
Happy Together	Unified clinician & patient chart reconciliation	Deduplicated composite view across internal Chronicles DB + external Care Everywhere feeds	Merging external medications, allergies, problems, and notes alongside local EHR records (and linking multi-site accounts via MyChart Central)
Epic Nexus (QHIN)	Nationwide TEFCA cross-network exchange	TEFCA Common Agreement & QHIN Technical Framework (QTF)	Connecting participating Epic health systems to other Qualified Health Information Networks (QHINs) nationwide

How Does Epic Care Everywhere Exchange Records Across Health Systems?

Unlike a centralized state data warehouse that copies all regional records into a single third-party database, Epic Care Everywhere operates on a federated, peer-to-peer architecture where patient records remain stored inside each originating hospital’s or clinic’s EHR until queried for treatment or authorized exchange purposes:

1. Demographic Patient Discovery (Phone Book Lookup): When a patient registers or arrives at an emergency department or clinic, Care Everywhere executes a demographic matching query (using name, date of birth, sex, address, telephone number, and optional identifiers) across participating Epic organizations, Carequality implementers, and TEFCA networks to identify outside institutions where the patient has an existing medical record.
2. Automated and On-Demand Document Retrieval: Once a high-confidence patient match is established (and any state-specific patient consent rules are satisfied via Care Everywhere’s automated Rules Engine), the receiving Epic system queries the outside system for structured HL7 Consolidated Clinical Document Architecture (C-CDA) summaries and discrete FHIR R4 resources.
3. Happy Together Chart Reconciliation: Rather than forcing clinicians to open separate PDF attachments from outside hospitals, Epic’s Happy Together interface weaves external problems, medications, allergies, immunizations, and encounter notes directly into the clinician’s native Epic chart workflow with visual source attribution badges, allowing one-click reconciliation into the local chart.
4. Event-Driven Push Notifications: When a patient is admitted to or discharged from an outside emergency department or inpatient unit, Care Everywhere can transmit automated admission/discharge notifications and discharge summaries back to the patient’s primary care home.

How Do Third-Party Apps Integrate With Epic MyChart via SMART on FHIR?

Under the ONC 21st Century Cures Act Information Blocking and Standardized API rules (45 CFR § 170.315(g)(10)), Epic provides free developer access to its patient-facing FHIR R4 APIs through open.epic.com (and enterprise vendor workflows through the Epic Showroom / Connection Hub). Building and deploying a patient-facing SMART on FHIR application follows six documented steps:

1. Register at open.epic.com: Create a developer account on Epic’s open portal, register a new application targeting the Patients audience (for MyChart patient-mediated access) or Clinicians audience, and obtain non-production and production client_id identifiers.
2. Select FHIR R4 Resources and SMART Scopes: Configure US Core FHIR R4 resource permissions using granular SMART v1/v2 scopes—such as patient/Patient.read, patient/Observation.read (vitals and labs), patient/Condition.read, patient/MedicationRequest.read, patient/AllergyIntolerance.read, patient/DocumentReference.read, and patient/Immunization.read, plus launch/patient and openid fhirUser.
3. Test Against the Epic FHIR Sandbox: Point the application to Epic’s public R4 FHIR sandbox endpoint (`https://fhir.epic.com/interconnect-fhir-oauth/api/FHIR/R4/`) using Epic’s published test MyChart personas to validate resource parsing and error handling.
4. Discover Health System Endpoints Dynamically: Because each health system hosts its own Epic Interconnect / FHIR server URL, consumer apps consume Epic’s published JSON bundle of production endpoints (`EndpointsJson`) so patients can search and select their home health system inside the app.
5. Execute the MyChart OAuth 2.0 Authorization Code Flow: When the patient selects their health system, the app redirects them to that institution’s MyChart OAuth 2.0 authorization screen. The patient signs in with their MyChart credentials, reviews the specific data categories requested, and grants access; Epic returns an authorization code that the app exchanges at the token endpoint for an access token and patient FHIR ID.
6. Query US Core FHIR R4 Endpoints: Using the Bearer token, the application queries discrete FHIR R4 resources (e.g., GET /Observation?patient={id}&category=laboratory) to populate personal health records or consented clinical research databases.

How Does Care Everywhere Connect to Carequality and TEFCA?

A frequent misconception is that Epic Care Everywhere only exchanges records with other hospitals running Epic. In practice, Care Everywhere exchanges millions of daily records with non-Epic EHRs (such as Oracle Health/Cerner, MEDITECH, eClinicalWorks, athenahealth, NextGen, and the Veterans Health Administration) through two nationwide interoperability frameworks:

• Carequality Framework: Epic is a founding implementer of Carequality. Through Carequality’s common legal terms and technical directory, Care Everywhere uses Integrating the Healthcare Enterprise (IHE) profiles—specifically Cross-Community Patient Discovery (XCPD) and Cross-Community Access (XCA), alongside Carequality FHIR Implementation Guides—to query any participating non-Epic EHR or regional HIE seamlessly.
• TEFCA and Epic Nexus (QHIN): Under the federal Trusted Exchange Framework and Common Agreement (TEFCA) authorized by the 21st Century Cures Act, Epic established Epic Nexus, an ASTP/ONC-designated Qualified Health Information Network (QHIN). Health systems participating in Epic Nexus can query and respond across all other designated QHINs nationwide under the standardized TEFCA Common Agreement for authorized Exchange Purposes including Treatment and Individual Access Services (IAS).

Where Epic MyChart and Care Everywhere Matter for Clinical Research

• MyChart Research Recruitment and eConsent: Academic medical centers use Epic’s research modules to identify potentially eligible study participants via SlicerDicer or EHR phenotype queries and send IRB-approved study invitations directly to the patient’s MyChart Research tab, enabling remote pre-screening, electronic informed consent (eConsent), and longitudinal ePRO questionnaire collection.
• Participant-Mediated EHR Data Pulls in Decentralized Trials: Using the Cures Act MyChart SMART on FHIR API, consented participants in a multi-site or decentralized clinical trial can authorize the study’s data platform to pull verified laboratory results, concomitant medications, and hospitalization records directly from their local health system’s MyChart account without requiring site-to-site medical record fax requests.

Frequently Asked Questions

How does Epic Care Everywhere exchange records across health systems?

Epic Care Everywhere is Epic’s native federated health information exchange (HIE) module. It performs demographic patient matching across participating health systems, retrieves HL7 C-CDA clinical summaries and FHIR R4 resources on demand or via admission/discharge triggers, and reconciles external medications, allergies, problems, and notes into the clinician’s chart via Epic’s Happy Together view.

How do third-party apps integrate with Epic MyChart via SMART on FHIR?

Developers register their application on open.epic.com, configure SMART on FHIR R4 scopes (patient/*.read) aligned with ONC 45 CFR § 170.315(g)(10) and US Core profiles, and use the OAuth 2.0 authorization code flow where patients authenticate with their own MyChart credentials to grant read access to their clinical records.

How does Care Everywhere connect to Carequality and TEFCA?

Care Everywhere connects to non-Epic EHR vendors and regional HIEs through the nationwide Carequality framework (using IHE XCPD/XCA and FHIR standards) and participates in the federal Trusted Exchange Framework and Common Agreement (TEFCA) via Epic Nexus, Epic’s designated Qualified Health Information Network (QHIN).

Sources

• Epic Systems Corporation. open.epic — Developer Documentation, SMART on FHIR R4 Specifications, and ONC 45 CFR § 170.315(g)(10) APIs. https://open.epic.com/
• Epic Systems Corporation. Care Everywhere & Interoperability Overview. https://www.epic.com/careeverywhere/
• Assistant Secretary for Technology Policy / Office of the National Coordinator for Health Information Technology (ASTP/ONC). Trusted Exchange Framework and Common Agreement (TEFCA) Qualified Health Information Networks (QHINs). https://www.healthit.gov/topic/interoperability/policy/trusted-exchange-framework-and-common-agreement-tefca