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/lib/i18n/locales/en/translation.json

@@ -1103,6 +1103,36 @@
     "uploadFailedTitle": "Some files didn't upload",
     "uploadFailedBody": "The record was saved, but one or more files failed to upload. Try adding them again from the record."
   },
+  "integrations": {
+    "fhir": {
+      "cardTitle": "Lab system (HL7/FHIR)",
+      "disabledHint": "Not enabled. An owner or admin can connect a lab system in Settings → Integrations.",
+      "searchPlaceholder": "Search a patient to pull results…",
+      "change": "Change",
+      "sync": "Sync results",
+      "syncing": "Syncing…",
+      "syncedTitle": "Results synced",
+      "syncedBody": "Imported {{count}} result(s) for {{name}}.",
+      "failedTitle": "Sync failed",
+      "failedBody": "Couldn't reach the lab system. Please try again."
+    },
+    "eRx": {
+      "send": "Send to pharmacy",
+      "sending": "Sending…",
+      "sentTitle": "Prescription sent",
+      "sentBody": "Transmitted to the pharmacy as an NCPDP SCRIPT NewRx.",
+      "failedTitle": "Couldn't send",
+      "failedBody": "The pharmacy gateway rejected the message or is unreachable."
+    },
+    "claims": {
+      "submit": "Submit claim",
+      "submitting": "Submitting…",
+      "submittedTitle": "Claim submitted",
+      "submittedBody": "Clearinghouse status: {{status}}.",
+      "failedTitle": "Couldn't submit claim",
+      "failedBody": "The clearinghouse rejected the claim or is unreachable."
+    }
+  },
   "patientCard": {
     "notFound": "No patient found for file #{{number}}.",
     "overview": "Overview",
@@ -1277,8 +1307,55 @@
       "records": "Records",
       "signing": "Signing",
       "careTeam": "Care team",
+      "integrations": "Integrations",
       "developers": "Developers"
     },
+    "integrations": {
+      "loading": "Loading integrations…",
+      "intro": "Connect temetro to external healthcare systems. Point each integration at your vendor's sandbox or production endpoint and supply its credentials.",
+      "endpoint": "Endpoint URL",
+      "credentials": "Credentials",
+      "credentialsSet": "•••••••• (stored — type to replace)",
+      "enable": "Enable integration",
+      "enableHint": "When on, its actions appear on the relevant pages.",
+      "save": "Save",
+      "saving": "Saving…",
+      "test": "Test connection",
+      "testing": "Testing…",
+      "savedTitle": "Integration saved",
+      "saveFailedTitle": "Couldn't save",
+      "saveFailedBody": "Something went wrong, or you don't have permission. Please try again.",
+      "testOk": "Connection succeeded",
+      "testFailed": "Connection failed",
+      "testError": "Couldn't reach the endpoint.",
+      "lastSync": "Last activity {{when}}",
+      "status": {
+        "connected": "Connected",
+        "error": "Error",
+        "unconfigured": "Not configured"
+      },
+      "fhir": {
+        "title": "Lab system (HL7/FHIR)",
+        "description": "Read lab results from a FHIR R4 server or HL7 v2 feed (e.g. a HAPI FHIR / SMART Health IT sandbox, or your lab's gateway).",
+        "endpointPlaceholder": "https://hapi.fhir.org/baseR4",
+        "credentialsPlaceholder": "Bearer token (optional for open sandboxes)",
+        "credentialsHint": "Sent as a Bearer token, or JSON {\"token\":\"…\"}. Leave blank for public sandboxes."
+      },
+      "eprescribe": {
+        "title": "e-Prescribing (NCPDP SCRIPT)",
+        "description": "Transmit prescriptions to pharmacies as NCPDP SCRIPT NewRx messages. Production routing requires your Surescripts (or sandbox) account.",
+        "endpointPlaceholder": "https://your-pharmacy-gateway.example/script",
+        "credentialsPlaceholder": "JSON: {\"token\":\"…\",\"senderId\":\"…\"}",
+        "credentialsHint": "JSON with your gateway token and sender id."
+      },
+      "claims": {
+        "title": "Insurance claims (X12 837/835)",
+        "description": "Submit professional claims (837P) to a clearinghouse and read remittances (835). Production requires your clearinghouse account.",
+        "endpointPlaceholder": "https://your-clearinghouse.example/claims",
+        "credentialsPlaceholder": "JSON: {\"token\":\"…\",\"submitterId\":\"…\",\"receiverId\":\"…\"}",
+        "credentialsHint": "JSON with your clearinghouse token and submitter/receiver ids."
+      }
+    },
     "empty": "Nothing here yet.",
     "copy": "Copy",
     "copied": "Copied",

frontend/lib/integrations.ts

@@ -0,0 +1,78 @@
+// Client for the backend integrations API (HL7/FHIR labs, e-prescribing,
+// insurance claims). Config is owner/admin-only to write; status is readable by
+// any member so pages can gate their on-page actions.
+
+import { apiFetch } from "@/lib/api-client";
+
+export type IntegrationType = "fhir" | "eprescribe" | "claims";
+export type IntegrationStatus = "unconfigured" | "connected" | "error";
+
+export type IntegrationConfig = {
+  type: IntegrationType;
+  endpoint: string;
+  enabled: boolean;
+  status: IntegrationStatus;
+  hasCredentials: boolean;
+  lastSyncAt: string | null;
+};
+
+export function listIntegrations(): Promise<IntegrationConfig[]> {
+  return apiFetch<IntegrationConfig[]>("/api/integrations");
+}
+
+export function saveIntegration(
+  type: IntegrationType,
+  input: { endpoint?: string; enabled?: boolean; credentials?: string },
+): Promise<IntegrationConfig> {
+  return apiFetch<IntegrationConfig>(`/api/integrations/${type}`, {
+    method: "PUT",
+    body: JSON.stringify(input),
+  });
+}
+
+export function testIntegration(
+  type: IntegrationType,
+): Promise<{ ok: boolean; message: string }> {
+  return apiFetch(`/api/integrations/${type}/test`, { method: "POST" });
+}
+
+// Pull a patient's lab results from the FHIR server.
+export function syncFhirLabs(fileNumber: string): Promise<{ imported: number }> {
+  return apiFetch("/api/integrations/fhir/sync", {
+    method: "POST",
+    body: JSON.stringify({ fileNumber }),
+  });
+}
+
+// Transmit a prescription to a pharmacy (NCPDP SCRIPT NewRx).
+export function sendEprescription(
+  rxId: string,
+): Promise<{ messageId: string; status: string }> {
+  return apiFetch("/api/integrations/eprescribe/send", {
+    method: "POST",
+    body: JSON.stringify({ rxId }),
+  });
+}
+
+// Submit an insurance claim for an invoice (X12 837P) and read the remittance.
+export function submitInsuranceClaim(
+  invoiceId: string,
+): Promise<{ claimStatus: string; paidAmount: number; submitted: boolean }> {
+  return apiFetch("/api/integrations/claims/submit", {
+    method: "POST",
+    body: JSON.stringify({ invoiceId }),
+  });
+}
+
+// Convenience hook-style fetch reused by the on-page sections: returns the
+// config for one type (or null while loading/absent).
+export async function getIntegration(
+  type: IntegrationType,
+): Promise<IntegrationConfig | null> {
+  try {
+    const all = await listIntegrations();
+    return all.find((c) => c.type === type) ?? null;
+  } catch {
+    return null;
+  }
+}