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Practice Fusion is a multi-tenant, cloud-based ambulatory Electronic Health Record (EHR) platform (operated by Veradigm) designed for independent medical practices and community research sites. Alongside peer ambulatory platforms—including CharmHealth, CureMD, PrognoCIS, Amazing Charts, PCC EHR, SimplePractice, and Jane App—Practice Fusion illustrates how outpatient clinical software architectures split between ONC-certified medical EHRs exposing standardized HL7 FHIR Release 4 (R4) and laboratory interfaces, and specialty practice-management systems built around scheduling and intake workflows.
Overview: Independent Ambulatory EHR Architecture
Unlike enterprise hospital health-system installations (such as Epic or Oracle Health), independent ambulatory EHR platforms serve solo practitioners, multi-provider outpatient clinics, and community-based clinical trial sites that lack dedicated on-premise server infrastructure. Evaluating an EHR versus a standalone practice EMR for clinical operations or pragmatic research requires verifying two technical layers:
- Regulatory API Certification (45 CFR § 170.315(g)(10)): Under the Office of the National Coordinator for Health Information Technology (ONC) 21st Century Cures Act Final Rule, certified health IT modules must expose a standardized HL7 FHIR R4.0.1 API conforming to the HL7 FHIR US Core Implementation Guide, the SMART App Launch Framework (OAuth 2.0 and OpenID Connect), and the HL7 FHIR Bulk Data Access (
$export) specification. - Ancillary Clinical Interfaces: Real-time connectivity for diagnostic laboratory orders and results, radiology/imaging reports (HL7 v2 messaging), electronic prescribing (NCPDP SCRIPT), and national health information exchange frameworks such as Carequality and CommonWell.
Types of Independent and Specialty Ambulatory EHR Platforms Compared
The table below compares the primary ambulatory EHR and practice management platforms across architecture, target clinical setting, ONC § 170.315(g)(10) FHIR R4 support, and integration boundaries as documented in each vendor’s API specifications and ONC Certified Health IT Product List (CHPL) disclosures.
| Platform | Primary Architecture & Scope | Best Fit Setting | API & Interoperability Capabilities | Technical Limits & Integration Considerations |
|---|---|---|---|---|
| Practice Fusion EHR (Veradigm) | Browser-based multi-tenant cloud ambulatory EHR with integrated e-prescribing and charting | Small-to-midsize independent primary care and outpatient specialty clinics | ONC § 170.315(g)(10) FHIR R4 API (US Core), SMART on FHIR OAuth 2.0, centralized HL7 v2 lab/imaging network | Cloud-only multi-tenant model means custom database-level SQL access is unavailable; third-party apps must use published FHIR R4 endpoints |
| CharmHealth (MedicalMine) | Cloud EHR, practice management (PM), patient portal (CharmPHR), and telehealth suite | Independent multi-specialty clinics, integrative medicine, and distributed outpatient groups | ONC-certified FHIR R4 / US Core APIs, Bulk FHIR $export, plus proprietary RESTful Charm EHR API for scheduling, billing, and inventory |
Developers must distinguish between ONC read-only US Core FHIR resources and CharmHealth’s separate commercial REST API for write operations |
| CureMD | All-in-one cloud EHR, practice management, specialty templates, and revenue cycle management | Multi-specialty ambulatory practices requiring integrated clinical charting and medical billing | ONC § 170.315(g)(10) Standardized FHIR R4 API, SMART App Launch (patient and clinician scopes), HL7 v2 lab and immunization interfaces | App registration and production client credentials require developer portal onboarding and scope verification per practice tenant |
| PrognoCIS (Bizmatics) | Customizable cloud EHR and practice management platform with specialty workflow engines | Primary care, occupational medicine, pain management, and multi-specialty clinics | ONC-certified FHIR R4 APIs, USCDI clinical data classes, C-CDA document exchange, and bidirectional lab/radiology interfaces | Custom clinic form fields outside standard USCDI data elements require custom interface mapping if needed for external analytics |
| Amazing Charts (Harris Healthcare) | Clinician-designed primary care EHR (cloud-hosted or local server deployment options) | Independent family medicine, internal medicine, and small primary care practices | ONC § 170.315(g)(10) FHIR R4 API (US Core profiles, SMART App Launch, Bulk Data export) and C-CDA transitions of care | Practices using legacy on-premise installations must ensure gateway/API modules are active and network-accessible for cloud app connections |
| PCC EHR (Physician’s Computer Company) | Specialty-dedicated pediatric EHR and practice management system | Independent pediatric and adolescent medicine practices | ONC-certified FHIR R4 APIs, bidirectional HL7 v2 state immunization registry links, pediatric growth/vital tracking, and lab interfaces | Purpose-built for pediatric workflows and immunization forecasting; not designed for adult inpatient or non-pediatric surgical specialties |
| SimplePractice | Cloud practice management, telehealth, client portal, and documentation platform | Behavioral health, psychotherapy, speech/occupational therapy, and cash/outpatient allied health | Built-in telehealth, intake questionnaires, insurance claim filing (EDI), and calendar/webhook workflow integrations | Not an acute-care medical EHR; lacks hospital HL7 v2 lab/imaging order networks and full medical USCDI Bulk FHIR clinical trial pipelines |
| Jane App | Cloud clinic management, online booking, charting, and integrated payments platform | Multidisciplinary allied health clinics (physical therapy, chiropractic, counseling, rehabilitation) | Partner integrations (e.g., exercise prescription, payment processing, insurance clearinghouses, and analytics exports) | Focused on allied-health scheduling and charting; does not provide ONC § 170.315(g)(10) medical FHIR R4 endpoints or e-prescribing of controlled substances |
How Does Practice Fusion’s Cloud EHR Architecture Handle Lab and Imaging Interfaces?
Because Practice Fusion operates as a single, centrally managed cloud application rather than isolated clinic servers, it maintains a shared integration hub connecting participating practices to diagnostic laboratories and imaging centers across the United States:
- Electronic Order Transmission (HL7 v2 ORM): When a clinician places a lab or imaging order inside a Practice Fusion encounter note, the platform packages patient demographics, insurance guarantors, ordering provider NPI, CPT/test codes, and ICD-10-CM diagnosis pointers into a structured electronic requisition transmitted to the connected reference lab or radiology facility.
- Discrete Result Ingestion (HL7 v2 ORU): Completed diagnostic results return electronically into the practice’s centralized task queue. Structured numeric and coded results map to standard LOINC observation codes, allowing clinicians to review abnormal flags, sign off on results, trend longitudinal lab values across visits, and release verified results to the patient portal.
- Downstream FHIR Mapping: Once laboratory and imaging results are ingested into the Practice Fusion chart, they become queryable through Practice Fusion’s ONC-certified FHIR R4 API as standardized
DiagnosticReportandObservationresources conforming to US Core profiles.
How Do Independent Practice EHRs Like CharmHealth and CureMD Expose FHIR R4 APIs?
Independent ambulatory EHRs certified under 45 CFR § 170.315(g)(10)—including Practice Fusion, CharmHealth, CureMD, PrognoCIS, and Amazing Charts—implement a uniform technical stack so third-party clinical decision support tools, patient health apps, and research Electronic Data Capture (EDC) connectors can query data without building custom screen-scrapers:
- SMART App Launch & OAuth 2.0 Security: Applications authenticate via OAuth 2.0 and OpenID Connect using either a Patient Standalone Launch (where a study participant authorizes a mobile app to pull their own longitudinal medical record) or an EHR Launch (where a clinician launches a clinical tool directly from inside the Practice Fusion, CharmHealth, or CureMD chart session with
launch/patientcontext). - US Core Resource Coverage: Exposed FHIR R4 endpoints return JSON payloads mapped to USCDI data classes:
Patient,AllergyIntolerance,Condition(problems/diagnoses),Encounter,Immunization,MedicationRequest,Observation(vital signs, smoking status, laboratory results),Procedure,DocumentReference(clinical notes), andProvenance. - Population-Level Bulk Data Access (
$export): For clinical registries, quality reporting, and multi-patient research cohorts, § 170.315(g)(10) requires support for the HL7 FHIR Bulk Data Access specification, which asynchronously exports newline-delimited JSON (.ndjson) files for a defined patient group using backend service authentication (system/*.readscopes).
In addition to its ONC-mandated read-only FHIR R4 endpoints, CharmHealth also publishes a separate commercial REST API (the Charm EHR API) that allows authorized clinic integrators to create appointments, update patient intake demographics, manage inventory, and post billing records—capabilities that sit outside the baseline read-only US Core specification.
What Integration Options Exist for Specialty Ambulatory Platforms Like SimplePractice and PCC EHR?
When clinical informatics teams or decentralized trial sponsors integrate with specialty outpatient practices, they must distinguish between ONC-certified medical specialty EHRs and allied/behavioral-health practice management platforms:
- PCC EHR (Pediatric Specialty Certified EHR): Because pediatric primary care relies heavily on immunization forecasting, newborn screening, growth percentiles, and Medicaid/CHIP quality reporting, PCC EHR maintains ONC Health IT certification. It exposes § 170.315(g)(10) FHIR R4 endpoints alongside automated bidirectional HL7 v2 connections to state Immunization Information Systems (IIS) and reference labs.
- SimplePractice and Jane App (Behavioral & Allied Health Platforms): Behavioral health therapists, physical therapists, and cash-pay allied-health clinics frequently operate outside Medicare MIPS promoting-interoperability mandates. Platforms such as SimplePractice and Jane App prioritize HIPAA-compliant video telehealth, customizable intake and consent forms, progress-note templates, automated appointment reminders, and 837P electronic claim submission rather than hospital-grade HL7 v2 lab hubs or ONC Bulk FHIR APIs. Research teams collecting patient-reported outcomes or behavioral therapy logs from these clinics typically use structured CSV/document exports or patient-authorized record requests rather than SMART-on-FHIR app launches.
How to Choose and Verify an Ambulatory EHR Integration Path
Before designing a clinical data integration, registry feed, or EHR-to-EDC research workflow across independent ambulatory clinics, verify four items on the vendor’s developer portal and the ONC CHPL registry:
- Confirm Active § 170.315(g)(10) Certification on CHPL: Search the ONC Certified Health IT Product List for the exact software edition used by the clinic to verify active 21st Century Cures Act API certification and obtain the vendor’s public Service Base URL list.
- Distinguish Patient-Access vs. Clinician/Backend Scopes: Patient-authorized FHIR access (
patient/*.read) must be enabled by certified EHRs without special integration fees under ONC information-blocking rules, whereas backend system exports (system/*.read) or proprietary write APIs (such as scheduling or order creation) require practice administrator provisioning. - Check Document vs. Discrete Data Availability: Verify whether clinical progress notes are exposed as discrete coded observations or as unstructured text/PDF attachments inside FHIR
DocumentReferenceresources or C-CDA summaries. - Verify Lab and E-Prescribing Network Coverage: For clinical trials or specialty care clinics ordering local diagnostics, confirm whether the practice’s specific regional reference lab has an active bidirectional HL7 v2 interface with the cloud EHR.
Frequently Asked Questions
How does Practice Fusion’s cloud EHR architecture handle lab and imaging interfaces?
Practice Fusion operates a multi-tenant, browser-based cloud EHR architecture that connects to national, regional, and hospital reference laboratories and diagnostic imaging centers through centralized electronic order and result interfaces (primarily HL7 v2 ORM/ORU messaging). Clinicians transmit structured requisitions with ICD-10 diagnosis codes directly from the patient chart, and discrete diagnostic results—tagged with LOINC observation identifiers—flow back into the chart for clinician sign-off and automated mapping to US Core FHIR Observation and DiagnosticReport resources.
How do independent practice EHRs like CharmHealth and CureMD expose FHIR R4 APIs?
To satisfy the ONC 21st Century Cures Act certification criterion 45 CFR 170.315(g)(10) (Standardized API for Patient and Population Services), independent ambulatory EHRs such as Practice Fusion, CharmHealth, CureMD, PrognoCIS, and Amazing Charts expose RESTful HL7 FHIR Release 4 (R4) endpoints profiled to the HL7 US Core Implementation Guide. These endpoints use the SMART App Launch Framework with OAuth 2.0 and OpenID Connect token authentication for patient-facing and clinician-facing applications, alongside FHIR Bulk Data Access ($export) for population-level cohorts.
What integration options exist for specialty ambulatory platforms like SimplePractice and PCC EHR?
Integration architecture depends on whether the specialty platform maintains ONC Health IT certification. Pediatric-focused PCC EHR maintains ONC certification and provides standardized 170.315(g)(10) FHIR R4 patient/population APIs, bidirectional immunization registry interfaces, and HL7 v2 laboratory connections. By contrast, behavioral-health and allied-health practice management platforms such as SimplePractice and Jane App focus on scheduling, telehealth, client intake portals, and partner/webhook workflows rather than full ONC Bulk FHIR clinical data pipelines.
Sources
- Office of the National Coordinator for Health Information Technology (ONC) — 45 CFR § 170.315(g)(10) Standardized API for Patient and Population Services Test Method & Certification Guide
- Practice Fusion (Veradigm) — Practice Fusion FHIR API Specifications and Certified Health IT Developer Documentation
- CharmHealth (MedicalMine Inc.) — CharmHealth FHIR R4 API and Developer Resources
- CureMD Healthcare — CureMD ONC (g)(10) Standardized FHIR API Documentation
- Amazing Charts & PCC EHR — ONC FHIR API Documentation and PCC Pediatric EHR Interoperability Documentation
