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>

frontend/components/lab/lab-integration-card.tsx

@@ -0,0 +1,176 @@
+"use client";
+
+import { Cable, RefreshCw, Search } from "lucide-react";
+import { useEffect, useMemo, useState } from "react";
+import { useTranslation } from "react-i18next";
+
+import { Avatar, AvatarFallback } from "@/components/ui/avatar";
+import { Badge } from "@/components/ui/badge";
+import { Button } from "@/components/ui/button";
+import { Input } from "@/components/ui/input";
+import { ApiError } from "@/lib/api-client";
+import {
+  getIntegration,
+  type IntegrationConfig,
+  syncFhirLabs,
+} from "@/lib/integrations";
+import type { Patient } from "@/lib/patients";
+import { notify } from "@/lib/toast";
+import { cn } from "@/lib/utils";
+
+// The Lab page's HL7/FHIR connection panel: shows the connection status and, when
+// enabled, lets staff pull a patient's results from the configured lab system.
+export function LabIntegrationCard({
+  patients,
+  onSynced,
+}: {
+  patients: Patient[];
+  onSynced: () => void;
+}) {
+  const { t } = useTranslation();
+  const [config, setConfig] = useState<IntegrationConfig | null>(null);
+  const [query, setQuery] = useState("");
+  const [selected, setSelected] = useState<Patient | null>(null);
+  const [syncing, setSyncing] = useState(false);
+
+  useEffect(() => {
+    let active = true;
+    getIntegration("fhir").then((c) => active && setConfig(c));
+    return () => {
+      active = false;
+    };
+  }, []);
+
+  const search = query.trim().toLowerCase();
+  const matches = useMemo(() => {
+    if (!search) return [];
+    return patients
+      .filter(
+        (p) =>
+          p.name.toLowerCase().includes(search) ||
+          p.fileNumber.includes(search),
+      )
+      .slice(0, 5);
+  }, [patients, search]);
+
+  // Hide entirely until we know the config (avoids a flash); render a muted
+  // "configure me" card when present but disabled.
+  if (!config) return null;
+
+  const sync = async () => {
+    if (!selected) return;
+    setSyncing(true);
+    try {
+      const { imported } = await syncFhirLabs(selected.fileNumber);
+      notify.success(
+        t("integrations.fhir.syncedTitle"),
+        t("integrations.fhir.syncedBody", {
+          count: imported,
+          name: selected.name,
+        }),
+      );
+      setSelected(null);
+      setQuery("");
+      onSynced();
+    } catch (err) {
+      notify.error(
+        t("integrations.fhir.failedTitle"),
+        err instanceof ApiError
+          ? err.message
+          : t("integrations.fhir.failedBody"),
+      );
+    } finally {
+      setSyncing(false);
+    }
+  };
+
+  return (
+    <section className="flex flex-col gap-3 rounded-2xl border bg-card/30 p-4">
+      <div className="flex items-center gap-2">
+        <Cable className="size-4 text-muted-foreground" />
+        <h2 className="font-medium text-foreground text-sm">
+          {t("integrations.fhir.cardTitle")}
+        </h2>
+        <Badge
+          className="ml-auto"
+          variant={
+            config.status === "connected"
+              ? "secondary"
+              : config.status === "error"
+                ? "destructive"
+                : "outline"
+          }
+        >
+          {t(`settings.integrations.status.${config.status}`)}
+        </Badge>
+      </div>
+
+      {!config.enabled ? (
+        <p className="text-muted-foreground text-sm">
+          {t("integrations.fhir.disabledHint")}
+        </p>
+      ) : selected ? (
+        <div className="flex items-center gap-3 rounded-xl border bg-background/40 px-3 py-2">
+          <Avatar className="size-8">
+            <AvatarFallback>{selected.initials}</AvatarFallback>
+          </Avatar>
+          <div className="flex min-w-0 flex-1 flex-col">
+            <span className="truncate font-medium text-foreground text-sm">
+              {selected.name}
+            </span>
+            <span className="text-muted-foreground text-xs">
+              #{selected.fileNumber}
+            </span>
+          </div>
+          <Button
+            disabled={syncing}
+            onClick={() => setSelected(null)}
+            size="sm"
+            type="button"
+            variant="ghost"
+          >
+            {t("integrations.fhir.change")}
+          </Button>
+          <Button disabled={syncing} onClick={sync} size="sm" type="button">
+            <RefreshCw className={cn("size-4", syncing && "animate-spin")} />
+            {syncing
+              ? t("integrations.fhir.syncing")
+              : t("integrations.fhir.sync")}
+          </Button>
+        </div>
+      ) : (
+        <div className="flex flex-col gap-1.5">
+          <div className="relative">
+            <Search className="-translate-y-1/2 absolute top-1/2 left-3 size-4 text-muted-foreground" />
+            <Input
+              className="pl-9"
+              onChange={(e) => setQuery(e.target.value)}
+              placeholder={t("integrations.fhir.searchPlaceholder")}
+              value={query}
+            />
+          </div>
+          {matches.length > 0 && (
+            <div className="flex flex-col gap-1">
+              {matches.map((p) => (
+                <button
+                  className="flex items-center gap-3 rounded-lg px-2 py-2 text-left transition-colors hover:bg-accent"
+                  key={p.fileNumber}
+                  onClick={() => setSelected(p)}
+                  type="button"
+                >
+                  <Avatar className="size-7">
+                    <AvatarFallback>{p.initials}</AvatarFallback>
+                  </Avatar>
+                  <span className="min-w-0 truncate text-sm">{p.name}</span>
+                  <span className="ms-auto text-muted-foreground text-xs">
+                    #{p.fileNumber}
+                  </span>
+                </button>
+              ))}
+            </div>
+          )}
+        </div>
+      )}
+    </section>
+  );
+}

frontend/components/lab/lab-view.tsx

@@ -39,6 +39,7 @@ import {
 } from "@/components/ui/dialog";
 import { Input } from "@/components/ui/input";
 import { Switch } from "@/components/ui/switch";
+import { LabIntegrationCard } from "@/components/lab/lab-integration-card";
 import { StagedFilesField } from "@/components/patients/patient-files";
 import { uploadAttachment } from "@/lib/attachments";
 import { LAB_ANALYSES, LAB_ANALYSIS_UNITS } from "@/lib/lab-analyses";
@@ -609,6 +610,18 @@ export function LabView() {
         </Button>
       </div>
 
+      <LabIntegrationCard
+        onSynced={() =>
+          listPatients()
+            .then((data) => {
+              setPatients(data);
+              setRecent(buildRecent(data));
+            })
+            .catch(() => {})
+        }
+        patients={patients}
+      />
+
       <section className="flex flex-col gap-3">
         <div>
           <h2 className="font-semibold text-lg tracking-tight">