DisEASE: Epic on FHIR Integration

Public documentation for the DisEASE SMART on FHIR application.

Version 1.0 · Last updated: August 2026.

Overview

DisEASE is a clinical decision support (CDS) platform for chronic disease management, built by DisEASE LLC. The Epic integration is a provider-facing SMART on FHIR application. A clinician launches DisEASE from within the patient chart. The application reads a defined, minimal set of chart data to pre-populate a structured clinical workup, and a deterministic rules engine returns guideline-based medication guidance for the clinician to review.

• Audience: Clinicians and administrative users. DisEASE is not a patient-facing application.
• Direction: Read-only. DisEASE retrieves chart data during a launched session and does not write to the EHR.
• Decision model: All medication recommendations are produced by a deterministic rules engine curated and maintained under clinical pharmacy oversight. Identical inputs produce identical, auditable recommendations. See our live Clinical Proof Review for complete worked examples with engine output, fired rules, and citations.
• AI narration: The integration operates in one of two modes. In rules-only mode, no generative AI runs in the session, and the clinician sees the deterministic engine output alone. In rules plus narration mode, a single AI component, the evidence agent, composes the narrative text. It pairs each fired rule with an excerpt from the clinical source that backs it, and it retrieves only from the sources the rules already cite. In both modes the narration layer is independent of the rules engine. It cannot create, remove, or modify a recommendation, and all narrative text is presented to the clinician for review.
• Clinical authority: DisEASE provides recommendations with supporting rationale. The treating clinician retains full authority over all care decisions.

Clinical Workflow

1. 1 Launch

   A clinician opens a patient chart in Epic and launches DisEASE (Provider EHR launch).

2. 2 Retrieve

   DisEASE receives the launch context and retrieves only the data listed below under the granted scopes.

3. 3 Workup

   Retrieved data pre-populates the structured workup. The clinician reviews it and completes any fields not available from the chart.

4. 4 Recommend

   The rules engine evaluates the completed workup and presents guidance with rationale for clinician review.

5. 5 Session ends

   No chart data is retained (see Data Handling & Retention).

Data Accessed

DisEASE requests the following Epic APIs, and no others. All are FHIR R4, all are read-only (HTTP GET), and all are classified by Epic as USCDI industry-standard Level 1 APIs.

DisEASE integrates exclusively on FHIR R4 because it is the federally required version. The ONC certification criterion for standardized APIs (45 CFR § 170.315(g)(10)) requires certified EHRs to serve USCDI patient data using HL7 FHIR Release 4.0.1, the standard adopted at 45 CFR § 170.215. R4 is therefore the version every certified Epic installation deploys and maintains. It is also the first FHIR release with normative content. Its core resources and REST mechanics are locked backward-compatible, so an integration built on it remains stable across future releases of the standard.

The application registers no Outgoing APIs. Epic never initiates calls to DisEASE infrastructure, and DisEASE exposes no inbound endpoint to the EHR beyond the OAuth redirect.

The integration also deliberately excludes chart data it does not need. DisEASE requests no clinical notes or documents, no insurance or coverage information, and no social history. Workup inputs that reflect clinical judgment (for example, NYHA class, volume status, and the A1c goal) are entered by the clinician during the workup rather than read from the chart.

Chart data is the starting point, not the limit. The workup also accepts clinical detail the chart may not hold, such as home blood pressure trends or glucose monitoring patterns, entered by the care team during the visit. The engine scores with the inputs provided, and richer inputs produce a more precise recommendation.

Authentication & Authorization

• SMART on FHIR Provider EHR launch using the OAuth 2.0 authorization code flow.
• Launch requests are accepted only from known Epic organizations. The launching FHIR server address is validated against Epic's published endpoint directory before authorization begins.
• The authorization flow uses PKCE and a signed, single-use state value. Replayed or forged callbacks are rejected.
• Registered as a confidential client. The authorization code is exchanged for tokens server-side, and the Epic-issued client credential is held in AWS Secrets Manager. Tokens and secrets are never exposed to the browser.
• Access tokens are scoped to the launched patient context and the APIs listed above, and are used only for the duration of the session.
• All communication with Epic endpoints occurs over TLS 1.2 or higher.
• Dynamic client registration is not used.

Data Handling & Retention

• Chart data retrieved during a session is processed in memory to populate the workup and evaluate rules.
• Chart data that pre-populates the workup is held in the clinician's browser for the duration of the session and is cleared when the session ends.
• Each recommendation writes a minimal audit record: clinician identifier, timestamp, disease module, and source EHR. The audit record contains no patient data.
• DisEASE does not persist EHR-derived protected health information (PHI) after the session ends.
• PHI is excluded from application logs and analytics.
• Patient data is never sold, shared with third parties, or used to train machine-learning models.
• Infrastructure is hosted on Amazon Web Services using HIPAA-eligible services.

Security

• Encryption in transit (TLS) and at rest across all infrastructure components.
• Least-privilege by design. Every requested scope maps directly to a workup field or rule input, with no speculative data access.
• The requested scopes are fixed in code and match the APIs listed above exactly. Changing them requires a code release and a matching update to this page.
• Administrative access to production infrastructure is restricted and logged.
• To report a security concern: security@diseaseease.com

Frequently Asked Questions

Does DisEASE store data from the chart?

No. Chart data is used within the launched session to populate the workup and evaluate rules, and is not retained afterward. The only record kept is a minimal audit entry (clinician, timestamp, disease module, and source EHR) that contains no chart data.

Does DisEASE write anything back to Epic?

No. The integration is read-only. Clinicians act on DisEASE guidance within their normal Epic workflows.

Are recommendations generated by AI?

No. Medication recommendations come from a deterministic, clinically curated rules engine. The same patient inputs always produce the same recommendations, and every recommendation carries its rationale. The integration runs in one of two modes: rules-only, with no generative AI in the session, or rules plus a single AI narration, in which the evidence agent pairs each fired rule with an excerpt from the clinical source that backs it. In either mode, AI cannot add, remove, or change a recommendation.

Contact

• Support: support@diseaseease.com
• Security: security@diseaseease.com
• Company: DisEASE LLC, 4180 Lincoln Road, Standish, MI 48658, United States
• Privacy Policy: https://www.diseaseease.com/privacy
• Terms of Use: https://www.diseaseease.com/terms

Revision History