CASE STUDY
From Messy Charts to Teachable Insights
Transform chart noise into resident-ready insights, multiplying your impact with curated practice advisories delivered at the point of care through Epic CDS Hooks integration.Epic EHR Integration
CDS Hooks
Medical Education
The Challenge
Attending physicians know which clinical scenarios make the best teaching moments. But residents rarely see their attending's curated guidance at the right time—when they're reviewing a similar patient's chart.The problem isn't creating educational content. Attendings have years of clinical wisdom. The problem is delivery: how do you surface the right teaching moment when a resident opens the right patient chart?Teaching hospitals needed a way to embed clinical education directly into the EHR workflow—not as another app residents have to remember to open, but as contextual guidance that appears automatically when it matters most.Our Approach
We worked with Dr. Clarkson and his clinical team to build eSpiral Healthcare as an Epic-integrated CDS Hooks application that delivers teaching moments exactly when residents need them.The core innovation: attendings curate clinical scenarios and guidance once. eSpiral analyzes patient charts in real-time and surfaces relevant advisories when residents open similar cases—turning every chart into a potential teaching moment.Epic CDS Hooks Integration
Built native CDS Hooks integration that triggers when residents open patient charts in Epic. No separate app to remember, no context switching—just-in-time guidance that feels like it's part of the EHR.Clinical Context Matching
Developed algorithms to match patient charts with curated teaching scenarios based on diagnosis codes, medications, lab values, and clinical context—showing residents exactly the right guidance for the case they're reviewing.Attending Curation Workflow
Built an intuitive interface where attendings can create clinical scenarios, attach teaching points, and tag relevant clinical criteria—turning their expertise into structured, reusable educational content.SMART on FHIR Architecture
Leveraged SMART on FHIR standards for secure authentication and data access, ensuring eSpiral integrates seamlessly with Epic's security model and data access controls.Technical Implementation
Building a CDS Hooks application that works reliably in Epic's clinical workflow required deep expertise in FHIR standards, Epic's integration ecosystem, and real-time performance optimization.CDS Hooks Service Implementation
Implemented the CDS Hooks specification (patient-view hook) to receive context from Epic when residents open charts, process clinical data in real-time, and return relevant cards with teaching content—all within the 5-second Epic timeout requirement.FHIR Data Processing
Built FHIR resource parsers to extract clinical context (Condition, MedicationRequest, Observation) from Epic's FHIR API, normalize data across different Epic configurations, and match against curated scenarios with sub-second performance.Epic Sandbox Testing & Validation
Worked through Epic's integration requirements, tested in sandbox environments, debugged Epic-specific quirks, and validated clinical workflows with actual attending physicians and residents before production deployment.Performance & Reliability
Optimized API response times, implemented caching strategies, designed graceful degradation for Epic timeouts, and built monitoring to ensure the service maintains 99.9% uptime during clinical hours.Impact & Results
eSpiral turned teaching hospitals into learning environments where clinical wisdom flows naturally through the EHR—no extra apps, no interruptions, just better resident education.Epic NativeCDS Hooks integration feels like native Epic functionality
Zero TrainingResidents see guidance automatically—no new workflow to learn
TrustedEarned physician trust that takes vendors years to build
"When we started this partnership, I didn't know what FHIR or CDS Hooks were. Now I understand why they matter—and why having a team that truly knows these technologies makes all the difference. Clint and his engineers navigated integration challenges I didn't even know existed. They worked through the nuances of our Epic environment, educated our providers on what the system could do, and earned trust that usually takes vendors years to build. The result is a product that fits our clinical workflow so naturally that attendings forget it's there. They just know their guidance reaches residents at exactly the right moment. That's not easy to build. eSpiral far exceeded what I thought was possible."Dr. ClarksonPhysician & Healthcare Leader
Technology Stack
Epic EHR
CDS Hooks
SMART on FHIR
FHIR R4
Node.js
React
PostgreSQL
Redis
Docker
AWS
HIPAA Compliance
Epic Sandbox