Fasten Connect — Patient Health Record Ingestion

Connects patient-authorized real EHR data into HealthClaw Guardrails via Fasten Connect. Once ingested, all records flow through the full guardrail stack: PHI redaction, audit trail, step-up authorization, and tenant isolation.

Two modes:

• Standard — patient authenticates with their EHR portal (Epic, Cerner, Athena, etc.)
• TEFCA IAS — single identity verification (CLEAR / ID.me) retrieves records from all QHINs the patient has records at, without per-provider logins

Environment Variables

Integration Flow

1. Embed the Fasten Stitch Widget

<!-- Standard mode -->
<fasten-stitch-element public-id="your_public_test_key"></fasten-stitch-element>

<!-- TEFCA IAS mode — identity-verified, multi-provider -->
<fasten-stitch-element public-id="your_public_test_key" tefca-mode="true"></fasten-stitch-element>

<link rel="stylesheet" href="https://stitch.fastenhealth.com/v0.4/bundle.css">
<script src="https://stitch.fastenhealth.com/v0.4/bundle.js"></script>

2. Handle the Widget Callback

document.querySelector('fasten-stitch-element')
  .addEventListener('widget.complete', async (event) => {
    const { org_connection_id, endpoint_id, tefca_directory_id,
            platform_type, connection_status } = event.detail;

    // Register connection with HealthClaw Guardrails
    await fetch('/fasten/connections', {
      method: 'POST',
      headers: {
        'Content-Type': 'application/json',
        'X-Tenant-Id': YOUR_TENANT_ID,
      },
      body: JSON.stringify({
        org_connection_id,
        endpoint_id,
        tefca_directory_id,  // use this as stable ID in TEFCA mode
        platform_type,
        connection_status,
      }),
    });
  });

3. Configure Your Webhook

In the Fasten Developer Portal, set your webhook URL:

https://your-domain.com/fasten/webhook

The webhook fires patient.ehi_export_success when the export is ready. HealthClaw automatically downloads and ingests the FHIR NDJSON files.

4. Trigger an EHI Export (optional — Fasten may auto-trigger)

curl -X POST https://api.connect.fastenhealth.com/v1/bridge/fhir/ehi-export \
  -u "public_test_XXX:private_test_XXX" \
  -H "Content-Type: application/json" \
  -d '{"org_connection_id": "your-org-connection-id"}'

5. Monitor Ingestion

# List jobs for your tenant
curl /fasten/jobs -H "X-Tenant-Id: tenant-001"

# Poll a specific job
curl /fasten/jobs/<task_id> -H "X-Tenant-Id: tenant-001"

Job status lifecycle: pending → downloading → ingesting → complete | failed

HealthClaw API Endpoints

Guardrails Applied to Ingested Data

Fasten imports pass through the full HealthClaw guardrail stack. Once a resource is ingested, all existing guardrails apply automatically:

TEFCA IAS Specifics

• Enable with tefca-mode="true" on the Stitch widget. HealthClaw's /connect page sends it only when FASTEN_TEFCA_MODE=true; live mode needs Fasten to enable TEFCA IAS for the account, and the embed needs third-party cookies
• Use tefca_directory_id (not endpoint_id) as the stable identifier
• Scope is always patient/*.read — no narrower scope negotiation
• Identity verification via CLEAR (phone + email) or ID.me (username/password)
• May return tefca_no_documents_found when health systems have no records
• Additional live-mode fees apply — test with synthetic patients first

TEFCA Test Patients

# CLEAR verification (test mode)
Phone: (from Fasten test patient credentials page)
Email: (from Fasten test patient credentials page)

# ID.me verification (test mode)
Username: (test patient email)
Password: IDme2026!!

# CCDA fixture override (API-mode testing)
POST /v1/bridge/fhir/ehi-export
{"org_connection_id": "...", "fixtures": {"tefca_ccda": "myra-jones.xml"}}

Post-Import Curatr Workflow

After ingestion completes, run Curatr evaluation on clinical resources:

1. GET /fasten/jobs/<task_id>          → wait for status: "complete"
2. fhir.search(patient, Condition)     → list ingested Conditions
3. curatr.evaluate(Condition, id)      → check each for coding issues
4. Present issues to patient in plain language
5. Patient approves fixes
6. curatr.apply_fix(resource, fixes)   → apply with Provenance trail

Curatr checks ingested resources for:

• Deprecated code systems (ICD-9-CM flagged as critical)
• Invalid RxNorm, LOINC, SNOMED, CVX codes
• Missing US Core required fields (clinicalStatus, verificationStatus, etc.)

Webhook Events

Note: Never log raw webhook payloads — patient.request_support events explicitly may contain PHI per Fasten documentation.

File Size Handling

Fasten exports range from ~30MB to 3GB+. HealthClaw uses HTTP streaming (httpx stream()) to handle large files without loading them into memory. Progress is committed to the database every 50 resources.

Vercel limitation: Serverless functions timeout before large downloads complete. Railway or any persistent server deployment is required for production use with Fasten Connect. See railway.toml for Railway deployment config.

Setup

# Local development
export FASTEN_PUBLIC_KEY=public_test_XXX
export FASTEN_PRIVATE_KEY=private_test_XXX
export FASTEN_WEBHOOK_SECRET=whsec_XXX  # from Fasten Developer Portal
export FASTEN_CURATR_SCAN=true

docker-compose up -d --build

# Test webhook locally (use Fasten webhook simulator or ngrok)
# Fasten Webhook Simulator: https://docs.connect.fastenhealth.com/guides/webhook-debugging-simulator.md

Known Limitations

• Background download uses a daemon thread — if the process restarts mid-download, the job remains in downloading status (re-trigger by calling the Fasten API again)
• Download links expire after 24 hours — webhook triggers immediate download
• TEFCA live mode has additional per-use fees (test mode is free with synthetic patients)
• Upstream tenant isolation is local only — Fasten does not enforce tenant boundaries