EMR Architect (FHIR R4)

Role: EMR Architect (FHIR R4 Implementation)
Location: Chicago IL ( Onsite preferred Remote with travel)
Duration: Contract to hire / Full-time

Remote position Frequent travel to Chicago IL Travel / Hotel / Per Dem - Reimbursed

Required Experience

• 15 years in healthcare IT with a primary focus on EMR integration and interoperability - not a generalist background
• Experience leading a blended onshore/offshore engineering pod in a client-facing delivery engagement
• History of delivering multi-hospital EMR integration projects against commercial deadlines
• Clinical decision support (CDS) system architecture or physician-facing application design experience
• Experience with AI/ML integration in a clinical context - ambient documentation acuity classification clinical summarization
• Current Mirth Connect certification (NextGen Mirth Certified Fundamentals or higher)
• Epic certification - Ambulatory Inpatient and/or Orders. Current certifications strongly preferred
• AWS Certified Solutions Architect or Azure equivalent in a healthcare data context
• PMP or equivalent project management certification
• Prior experience at a healthcare IT consultancy EMR vendor or large health system IT department

Must-Have Requirements - Non-Negotiable

Healthcare integration engine - production depth

• Must have built deployed and operated a healthcare integration engine (Mirth Connect Rhapsody Azure Health Data Services or equivalent) in a live clinical environment. Not configured templates - built channels transformers and error handling from code.

FHIR R4 - hands-on implementation

• Must have implemented FHIR R4 APIs in a production provider or payer environment. Must be able to name specific FHIR resources explain ConceptMap usage and describe how they have handled proprietary EMR code sets that do not map cleanly to SNOMED CT or LOINC.

Multi-EMR integration experience

• Must have built integration adapters across at least two of: Epic Cerner/Oracle Health Meditech. Not evaluated EMRs - built production connectors against their APIs in a live hospital environment.

Write-back architecture - modern approach

• Must be able to describe a SMART on FHIR write-back implementation - OAuth2 scopes CPOE approval governance signed order flow error handling on failed write-back. HL7-era database coordination answers are insufficient.

U.S. onshore availability

• Must be U.S.-based and able to work on-site in Chicago at and hospital locations. Regular on-site presence required during Phase 0 sprint and go-live. Tennessee remote-only or non-U.S. candidates will not meet client requirements.

Available within 2 weeks

• Phase 0 sprint begins within 5 business days of SOW signature. Candidates who cannot confirm availability within 2 weeks will not be considered.

Technical Requirements:

Integration Engines & Middleware

• Mirth Connect (NextGen) - channel build JavaScript transformer development error handling monitoring (certification preferred)
• Rhapsody Azure Health Data Services or Google Cloud Healthcare API - production deployment experience a strong plus
• Interface engine configuration version management and operational governance in a clinical environment
• Connector design for both inbound (EMR hub) and outbound (hub EMR) data flows

Healthcare Interoperability Standards

• FHIR R4 / US Core - production implementation resource-level depth (Patient Encounter Observation MedicationRequest Condition DiagnosticReport AllergyIntolerance)
• SMART on FHIR - OAuth2 authorization read and write scopes token management EMR-specific scope approval processes
• HL7 v2.x - ADT ORM ORU MDM message types. Interface engine configuration and transformation
• CCDA - clinical document exchange section mapping data reconciliation
• X12 EDI - 270/(payer integration experience a plus)
• Clinical vocabulary standards - SNOMED CT LOINC RxNorm ICD-10. ConceptMap design and proprietary code set mapping

EMR / EHR Platform Depth

• Epic - Interconnect API Bridges FHIR R4 sandbox SMART on FHIR Ambulatory and Inpatient workflow architecture. Epic certification strongly preferred.
• Oracle Health / Cerner - FHIR R4 Millennium APIs (Ignite) HL7 ADT integration Open Platform write-back
• Meditech - REST/HL7 connectors for both Expanse (FHIR R4) and legacy MAGIC (HL7 v2). Dual-path adapter design experience
• Aggregators - InterSystems HealthShare Redox LK Health. Experience selecting and deploying aggregator platforms for multi-hospital environments

Architecture Engineering & Data

• Distributed systems architecture - API gateway protocol routing session cache (Redis) event bus (Kafka or equivalent) normalization engine design
• HIPAA-compliant system design - encryption at rest and in transit RBAC immutable audit trail (7-year retention) PHI data residency controls
• SQL and Python - data validation pipelines reconciliation transformation automation
• Cloud platforms - AWS or Azure in a healthcare data environment. Azure Health Data Services experience a strong plus
• Security - TLS 1.3 OAuth2 VPN SFTP NIST 800-53 security controls awareness
• Agile delivery - sprint planning backlog governance Jira or equivalent. Scrum Master certification a plus

Responsibilities

PHASE 0 - Architecture & Discovery Sprint (Weeks 1 2)

• Lead the 10-day architecture and discovery sprint - own the deliverables manage the sessions with end client engineering team and validate every design decision against the June go-live timeline
• Evaluate Gen1 EMR target (Epic vs. Meditech) against FHIR R4 maturity sandbox availability and hospital credentials - produce a formal decision record with aggregator routing recommendation (InterSystems HealthShare LK Health Redox)
• Design the 5-layer integration architecture: Source Systems Adapter Layer Integration Hub Clinical AI Layer Physician Experience
• Define the adapter contract - inputs outputs error handling and version governance - so each EMR adapter can be built and replaced independently without touching the hub core
• Produce the Data Flow and Normalization Specification - pull and push pathways FHIR R4 resource inventory clinical vocabulary mapping (SNOMED CT LOINC RxNorm ICD-10) session cache design event bus architecture
• Draft the Per-Hospital Onboarding Playbook - 10-point checklist templated for 46 hospitals. Initiate hospital IT CPOE write-back approval process on Day 7 8 - this must run in parallel with build not after.
• Produce the Risk Register FR/NFR Specification and Fixed-Price Phase 12 Build Proposal (D-07) - all 7 deliverables transferred to on Day 10

PHASE 1 - Single-EMR Pilot (Weeks 3 6)

• Lead engineering pod delivery through Phase 1 build - Architect Lead is accountable for sprint velocity quality and milestone delivery
• Build and deploy the Gen1 EMR adapter - configure the integration engine write and validate transformer logic test against Epic or Meditech sandbox
• Implement the pull pathway - EMR adapter fetch FHIR R4 transform clinical vocabulary normalization MPI matching session cache (Redis < 150ms) event bus parallel fetch
• Stand up baseline audit and observability - immutable HIPAA audit trail adapter health dashboards latency monitoring against < 2s P95 target
• Deliver Solution AI feed - patient list with acuity classification session-scoped clinical context FR-01 through FR-05 complete
• Phase 1 milestone: single-hospital live pull to AI physician interface confirmed < 2s latency validated

PHASE 2 - Writeback & Second Path (Weeks 7 12) Go-Live

• Implement signed note and order write-back pipeline - physician sign-off gate no unsigned push SMART on FHIR write scope management CPOE approval confirmation per hospital
• Build multi-hospital authentication framework - silent MFA across 12 OAuth2 identity providers per-hospital credential vault session sequencing
• Deploy second EMR adapter or aggregator bridge - second EMR type or InterSystems HealthShare / Redox connector FR-08 aggregator integration
• Lead UAT - end-to-end testing across EMR environments latency validation against NFR targets physician UX sign-off HIPAA audit trail confirmation
• Manage production deployment and hypercare - own go-live readiness hospital IT escalation and KPI confirmation.
• Deliver complete codebase deployment runbooks and operational documentation to - IP transfers in full

ONGOING - Pod Leadership & Client Management

• Lead and manage the 7-person hybrid pod - 3 U.S. onshore 4 India offshore. Sprint planning backlog governance daily standups offshore team coordination
• Own the primary technical relationship with (CTO/COO) - architecture decisions milestone reviews technical escalation path
• Support Phil Morales on clinical-first framing for (CEO Physician) - architecture must always be presented in terms of physician workflow impact
• Manage hospital IT relationships for CPOE write-back governance - navigate approval processes manage timelines escalate blockers early
• Maintain architecture governance across all phases - enforce adapter isolation canonical clinical model human-in-the-loop safety HIPAA by design