feat: HL7/FHIR, e-prescribing & insurance claims integrations

Real, standards-compliant integration clients that the clinic points at
its own (sandbox or production) endpoints — no mock data.

backend:
- `integrations` table (per org+type) storing endpoint + encrypted
  credentials (reusing the AI-key crypto) + status; Drizzle migration
- services/integrations:
  - fhir.ts — FHIR R4 REST client (pull lab Observations → patient
    record), HL7 v2 ORU parsing, capability-statement connection test
  - eprescribe.ts — NCPDP SCRIPT NewRx message build + transmit
  - claims.ts — X12 837P claim generation + 835 remittance parsing
- `/api/integrations` route: config GET/PUT (owner/admin), connection
  test, and the FHIR sync / HL7 ingest / e-Rx send / claim submit actions,
  RBAC-gated (lab/patient, prescription, invoice)

frontend:
- lib/integrations.ts client
- Settings → Integrations tab to configure endpoints/credentials/enable
  + test each integration
- on-page actions, shown only when the integration is enabled:
  Lab page → FHIR "Sync results" card; prescription sheet → "Send to
  pharmacy"; invoice sheet → "Submit claim"

Production e-Rx/claims routing requires the clinic's own Surescripts /
clearinghouse credentials; the code transmits real messages once supplied.

Co-Authored-By: Claude Opus 4.8 <noreply@anthropic.com>

backend/src/services/integrations/fhir.ts

@@ -0,0 +1,242 @@
+import { HttpError } from "../../lib/http-error.js";
+import type { Lab, LabFlag } from "../../types/patient.js";
+import { appendLabs, getPatient } from "../patients.js";
+import {
+  getConfig,
+  getCredentials,
+  getEndpoint,
+  markStatus,
+} from "./config.js";
+
+// A real HL7/FHIR R4 lab integration. The clinic configures a FHIR base URL
+// (e.g. a HAPI FHIR or SMART Health IT sandbox, or a production lab gateway)
+// and an optional bearer token; this client speaks plain FHIR REST + can ingest
+// raw HL7 v2 ORU result messages. No mock data — it reads/writes whatever
+// conformant server the endpoint points at.
+
+type FhirCredentials = { token?: string };
+
+function bearer(raw: string | null): string | null {
+  if (!raw) return null;
+  try {
+    const parsed = JSON.parse(raw) as FhirCredentials;
+    return parsed.token ?? null;
+  } catch {
+    // Stored as a bare token string.
+    return raw.trim() || null;
+  }
+}
+
+function headers(token: string | null): Record<string, string> {
+  return {
+    Accept: "application/fhir+json",
+    "Content-Type": "application/fhir+json",
+    ...(token ? { Authorization: `Bearer ${token}` } : {}),
+  };
+}
+
+function trimSlash(url: string): string {
+  return url.replace(/\/+$/, "");
+}
+
+// FHIR interpretation code (v3 ObservationInterpretation) → our LabFlag.
+function flagFromInterpretation(code: string | undefined): LabFlag {
+  switch ((code ?? "").toUpperCase()) {
+    case "H":
+    case "HU":
+      return "high";
+    case "L":
+    case "LU":
+      return "low";
+    case "HH":
+    case "LL":
+    case "AA":
+    case "PANIC":
+      return "critical";
+    default:
+      return "normal";
+  }
+}
+
+type FhirObservation = {
+  resourceType: "Observation";
+  code?: { text?: string; coding?: { display?: string; code?: string }[] };
+  valueQuantity?: { value?: number; unit?: string };
+  valueString?: string;
+  effectiveDateTime?: string;
+  issued?: string;
+  interpretation?: { coding?: { code?: string }[] }[];
+};
+
+type FhirBundle = {
+  resourceType: "Bundle";
+  entry?: { resource?: FhirObservation }[];
+};
+
+function observationToLab(obs: FhirObservation): Lab | null {
+  const name =
+    obs.code?.text ??
+    obs.code?.coding?.[0]?.display ??
+    obs.code?.coding?.[0]?.code;
+  if (!name) return null;
+  const value =
+    obs.valueQuantity?.value != null
+      ? `${obs.valueQuantity.value}${
+          obs.valueQuantity.unit ? ` ${obs.valueQuantity.unit}` : ""
+        }`
+      : obs.valueString;
+  if (!value) return null;
+  const when = obs.effectiveDateTime ?? obs.issued;
+  const takenAt = when
+    ? new Date(when).toLocaleDateString("en-US", {
+        month: "short",
+        day: "2-digit",
+        year: "numeric",
+      })
+    : new Date().toLocaleDateString("en-US", {
+        month: "short",
+        day: "2-digit",
+        year: "numeric",
+      });
+  return {
+    name,
+    value,
+    flag: flagFromInterpretation(obs.interpretation?.[0]?.coding?.[0]?.code),
+    takenAt,
+  };
+}
+
+// Probe the server's capability statement. Returns a short status line.
+export async function testConnection(
+  endpoint: string,
+  token: string | null,
+): Promise<{ ok: boolean; message: string }> {
+  if (!endpoint) return { ok: false, message: "No endpoint configured." };
+  try {
+    const res = await fetch(`${trimSlash(endpoint)}/metadata`, {
+      headers: headers(token),
+    });
+    if (!res.ok) {
+      return { ok: false, message: `Server returned ${res.status}.` };
+    }
+    const body = (await res.json().catch(() => null)) as {
+      resourceType?: string;
+      fhirVersion?: string;
+    } | null;
+    if (body?.resourceType !== "CapabilityStatement") {
+      return { ok: false, message: "Not a FHIR endpoint (no CapabilityStatement)." };
+    }
+    return {
+      ok: true,
+      message: `Connected to FHIR ${body.fhirVersion ?? "server"}.`,
+    };
+  } catch (err) {
+    return { ok: false, message: (err as Error).message };
+  }
+}
+
+// Pull a patient's laboratory Observations from the configured FHIR server and
+// append them to the local record. Matches the patient by their MRN
+// (file number) via `patient.identifier`.
+export async function syncLabs(
+  orgId: string,
+  fileNumber: string,
+): Promise<{ imported: number }> {
+  const config = await getConfig(orgId, "fhir");
+  if (!config.enabled) {
+    throw new HttpError(400, "The FHIR integration is not enabled.");
+  }
+  const endpoint = config.endpoint;
+  if (!endpoint) {
+    throw new HttpError(400, "No FHIR endpoint configured.");
+  }
+  const patient = await getPatient(orgId, fileNumber);
+  if (!patient) throw new HttpError(404, "Patient not found.");
+  const token = bearer(await getCredentials(orgId, "fhir"));
+
+  const url =
+    `${trimSlash(endpoint)}/Observation` +
+    `?patient.identifier=${encodeURIComponent(fileNumber)}` +
+    `&category=laboratory&_sort=-date&_count=50`;
+
+  try {
+    const res = await fetch(url, { headers: headers(token) });
+    if (!res.ok) {
+      await markStatus(orgId, "fhir", "error");
+      throw new HttpError(502, `FHIR server returned ${res.status}.`);
+    }
+    const bundle = (await res.json()) as FhirBundle;
+    const labs = (bundle.entry ?? [])
+      .map((e) => e.resource)
+      .filter((r): r is FhirObservation => r?.resourceType === "Observation")
+      .map(observationToLab)
+      .filter((l): l is Lab => l !== null);
+
+    if (labs.length > 0) {
+      await appendLabs(orgId, fileNumber, labs);
+    }
+    await markStatus(orgId, "fhir", "connected", true);
+    return { imported: labs.length };
+  } catch (err) {
+    if (err instanceof HttpError) throw err;
+    await markStatus(orgId, "fhir", "error");
+    throw new HttpError(502, `FHIR sync failed: ${(err as Error).message}`);
+  }
+}
+
+// Parse a raw HL7 v2 ORU^R01 result message into lab entries (one per OBX
+// segment). Fields per the HL7 v2 spec: OBX-3 (observation id), OBX-5 (value),
+// OBX-6 (units), OBX-8 (abnormal flags), OBX-14 (observation datetime).
+export function parseHl7Oru(message: string): Lab[] {
+  const labs: Lab[] = [];
+  const segments = message.split(/\r\n|\r|\n/).filter(Boolean);
+  for (const segment of segments) {
+    const fields = segment.split("|");
+    if (fields[0] !== "OBX") continue;
+    const obsId = (fields[3] ?? "").split("^");
+    const name = obsId[1] || obsId[0] || "";
+    const rawValue = fields[5] ?? "";
+    if (!name || !rawValue) continue;
+    const units = fields[6] ?? "";
+    const abnormal = (fields[8] ?? "").toUpperCase();
+    const flag: LabFlag =
+      abnormal === "H"
+        ? "high"
+        : abnormal === "L"
+          ? "low"
+          : abnormal === "HH" || abnormal === "LL" || abnormal === "AA"
+            ? "critical"
+            : "normal";
+    const dt = fields[14] ?? "";
+    // HL7 datetime is YYYYMMDD[HHMM]; format just the date portion.
+    const takenAt = /^\d{8}/.test(dt)
+      ? `${dt.slice(0, 4)}-${dt.slice(4, 6)}-${dt.slice(6, 8)}`
+      : new Date().toISOString().slice(0, 10);
+    labs.push({
+      name,
+      value: units ? `${rawValue} ${units}` : rawValue,
+      flag,
+      takenAt,
+    });
+  }
+  return labs;
+}
+
+// Ingest a raw HL7 v2 ORU message: parse it and append the results to the
+// patient's record. Used by the message-based intake endpoint.
+export async function ingestHl7(
+  orgId: string,
+  fileNumber: string,
+  message: string,
+): Promise<{ imported: number }> {
+  const labs = parseHl7Oru(message);
+  if (labs.length === 0) {
+    throw new HttpError(400, "No OBX result segments found in the message.");
+  }
+  const updated = await appendLabs(orgId, fileNumber, labs);
+  if (!updated) throw new HttpError(404, "Patient not found.");
+  await markStatus(orgId, "fhir", "connected", true);
+  return { imported: labs.length };
+}
+
+export { getEndpoint };