git:20260329.86f6e68 to git:20260414.cf87ffd

1 added, 3 removed. Audit B to B.

---

name: fasten-connect

description: "Use this skill whenever connecting a patient's real health records from EHR systems (Epic, Cerner, Athena) or the TEFCA national network into HealthClaw Guardrails. Covers: Fasten Stitch widget embed, org_connection_id registration, EHI export job tracking, NDJSON ingestion status, TEFCA IAS identity-verified multi-provider retrieval, and post-import Curatr quality scan workflow."

- homepage: https://docs.connect.fastenhealth.com

- disable-model-invocation: true

- metadata: {"openclaw":{"requires":{"env":["FASTEN_PUBLIC_KEY","FASTEN_PRIVATE_KEY"]},"primaryEnv":"FASTEN_PUBLIC_KEY"}}

+ metadata: {"homepage":"https://docs.connect.fastenhealth.com","openclaw":{"requires":{"env":["FASTEN_PUBLIC_KEY","FASTEN_PRIVATE_KEY"]},"primaryEnv":"FASTEN_PUBLIC_KEY"}}

---

# Fasten Connect — Patient Health Record Ingestion

Connects patient-authorized real EHR data into HealthClaw Guardrails via

[Fasten Connect](https://docs.connect.fastenhealth.com). Once ingested, all

records flow through the full guardrail stack: PHI redaction, audit trail,

step-up authorization, and tenant isolation.

**Two modes:**

- **Standard** — patient authenticates with their EHR portal (Epic, Cerner, Athena, etc.)

- **TEFCA IAS** — single identity verification (CLEAR / ID.me) retrieves records from all

QHINs the patient has records at, without per-provider logins

---

## Environment Variables

| Variable | Required | Description |

|---|---|---|

| `FASTEN_PUBLIC_KEY` | Yes | Fasten API public key (`public_test_*` or `public_live_*`) |

| `FASTEN_PRIVATE_KEY` | Yes | Fasten API private key — never expose client-side |

| `FASTEN_WEBHOOK_SECRET` | Recommended | Standard-Webhooks HMAC secret from Fasten portal |

| `FASTEN_CURATR_SCAN` | No | Set `true` to run Curatr quality scan after each import |

---

## Integration Flow

### 1. Embed the Fasten Stitch Widget

```html

<fasten-stitch-element public-id="your_public_test_key"></fasten-stitch-element>

<fasten-stitch-element public-id="your_public_test_key" tefca-mode="true"></fasten-stitch-element>

```

### 2. Handle the Widget Callback

```javascript

document.querySelector('fasten-stitch-element')

.addEventListener('widget.complete', async (event) => {

const { org_connection_id, endpoint_id, tefca_directory_id,

platform_type, connection_status } = event.detail;

// Register connection with HealthClaw Guardrails

await fetch('/fasten/connections', {

method: 'POST',

headers: {

'Content-Type': 'application/json',

'X-Tenant-Id': YOUR_TENANT_ID,

body: JSON.stringify({

org_connection_id,

endpoint_id,

tefca_directory_id, // use this as stable ID in TEFCA mode

platform_type,

connection_status,

}),

});

```

### 3. Configure Your Webhook

In the [Fasten Developer Portal](https://app.connect.fastenhealth.com), set your webhook URL:

```

https://your-domain.com/fasten/webhook

```

The webhook fires `patient.ehi_export_success` when the export is ready.

HealthClaw automatically downloads and ingests the FHIR NDJSON files.

### 4. Trigger an EHI Export (optional — Fasten may auto-trigger)

```bash

curl -X POST https://api.connect.fastenhealth.com/v1/bridge/fhir/ehi-export \

-u "public_test_XXX:private_test_XXX" \

-H "Content-Type: application/json" \

-d '{"org_connection_id": "your-org-connection-id"}'

```

### 5. Monitor Ingestion

```bash

# List jobs for your tenant

curl /fasten/jobs -H "X-Tenant-Id: tenant-001"

# Poll a specific job

curl /fasten/jobs/<task_id> -H "X-Tenant-Id: tenant-001"

```

Job status lifecycle: `pending` → `downloading` → `ingesting` → `complete` | `failed`

---

## HealthClaw API Endpoints

|---|---|---|---|

---

## Guardrails Applied to Ingested Data

Fasten imports pass through the full HealthClaw guardrail stack. Once

a resource is ingested, all existing guardrails apply automatically:

| Guardrail | Behavior |

|---|---|

| PHI redaction | Applied on every read — names to initials, identifiers masked, addresses stripped |

| Audit trail | Every resource write creates an immutable AuditEvent |

| Tenant isolation | `org_connection_id` is bound to one `tenant_id` at registration |

| Curatr scan | Optional: runs quality evaluation post-import (`FASTEN_CURATR_SCAN=true`) |

---

## TEFCA IAS Specifics

- Enable with `tefca-mode="true"` on the Stitch widget

- Use `tefca_directory_id` (not `endpoint_id`) as the stable identifier

- Scope is always `patient/*.read` — no narrower scope negotiation

- Identity verification via CLEAR (phone + email) or ID.me (username/password)

- May return `tefca_no_documents_found` when health systems have no records

- **Additional live-mode fees apply** — test with synthetic patients first

### TEFCA Test Patients

```

# CLEAR verification (test mode)

Phone: (from Fasten test patient credentials page)

Email: (from Fasten test patient credentials page)

# ID.me verification (test mode)

Username: (test patient email)

Password: IDme2026!!

# CCDA fixture override (API-mode testing)

POST /v1/bridge/fhir/ehi-export

{"org_connection_id": "...", "fixtures": {"tefca_ccda": "myra-jones.xml"}}

```

---

## Post-Import Curatr Workflow

After ingestion completes, run Curatr evaluation on clinical resources:

```

1. GET /fasten/jobs/<task_id> → wait for status: "complete"

2. fhir.search(patient, Condition) → list ingested Conditions

3. curatr.evaluate(Condition, id) → check each for coding issues

4. Present issues to patient in plain language

5. Patient approves fixes

6. curatr.apply_fix(resource, fixes) → apply with Provenance trail

```

Curatr checks ingested resources for:

- Deprecated code systems (ICD-9-CM flagged as critical)

- Invalid RxNorm, LOINC, SNOMED, CVX codes

- Missing US Core required fields (clinicalStatus, verificationStatus, etc.)

---

## Webhook Events

| Event | Trigger | Action |

|---|---|---|

| `patient.ehi_export_success` | Export ready | Auto-download + ingest |

| `patient.ehi_export_failed` | Export failed | Record failure reason |

| `patient.authorization_revoked` | Consent expired | Mark connection revoked |

| `patient.connection_success` | Widget complete | Optional auto-register |

| `webhook.test` | Config test | Accepted silently |

**Note:** Never log raw webhook payloads — `patient.request_support` events

explicitly may contain PHI per Fasten documentation.

---

## File Size Handling

Fasten exports range from ~30MB to 3GB+. HealthClaw uses HTTP streaming

(httpx `stream()`) to handle large files without loading them into memory.

Progress is committed to the database every 50 resources.

**Vercel limitation:** Serverless functions timeout before large downloads complete.

Railway or any persistent server deployment is required for production use with

Fasten Connect. See `railway.toml` for Railway deployment config.

---

## Setup

```bash

# Local development

export FASTEN_PUBLIC_KEY=public_test_XXX

export FASTEN_PRIVATE_KEY=private_test_XXX

export FASTEN_WEBHOOK_SECRET=whsec_XXX # from Fasten Developer Portal

export FASTEN_CURATR_SCAN=true

docker-compose up -d --build

# Test webhook locally (use Fasten webhook simulator or ngrok)

# Fasten Webhook Simulator: https://docs.connect.fastenhealth.com/guides/webhook-debugging-simulator.md

```

## Known Limitations

- Background download uses a daemon thread — if the process restarts mid-download,

the job remains in `downloading` status (re-trigger by calling the Fasten API again)

- Download links expire after 24 hours — webhook triggers immediate download

- TEFCA live mode has additional per-use fees (test mode is free with synthetic patients)

- Upstream tenant isolation is local only — Fasten does not enforce tenant boundaries