Abridge Reference Architecture

Overview

Reference architecture for Abridge clinical AI integration in a multi-site health system. Covers data flow, component design, EHR integration patterns, and HIPAA-compliant infrastructure.

System Architecture

                    Health System Network
┌──────────────────────────────────────────────────────┐
│                                                       │
│  ┌─────────┐    ┌──────────────┐    ┌──────────────┐ │
│  │ Provider │───▶│ Abridge App  │───▶│ Integration  │ │
│  │ Device   │    │ (Ambient AI) │    │ Service      │ │
│  │ (mobile/ │    │              │    │ (your code)  │ │
│  │ desktop) │    └──────┬───────┘    └──────┬───────┘ │
│  └─────────┘           │                    │         │
│                        │                    │         │
│              ┌─────────▼─────────┐          │         │
│              │ Abridge Cloud API │          │         │
│              │ (Partner API)     │          │         │
│              │ - Session mgmt    │          │         │
│              │ - Note generation │          │         │
│              │ - Patient summary │          │         │
│              └─────────┬─────────┘          │         │
│                        │                    │         │
│              ┌─────────▼─────────┐  ┌──────▼───────┐ │
│              │ Webhook Events    │  │ EHR System   │ │
│              │ - Note completed  │──│ (Epic/Athena)│ │
│              │ - Quality alerts  │  │ FHIR R4 API  │ │
│              └───────────────────┘  └──────────────┘ │
│                                                       │
└──────────────────────────────────────────────────────┘

Project Structure

abridge-integration/
├── src/
│   ├── config/
│   │   ├── abridge.ts           # Abridge API configuration
│   │   ├── ehr.ts               # EHR/FHIR endpoint config
│   │   └── index.ts             # Environment-based config loader
│   ├── abridge/
│   │   ├── client.ts            # API client singleton
│   │   ├── errors.ts            # HIPAA-safe error handling
│   │   ├── retry.ts             # Retry with backoff
│   │   └── session-manager.ts   # Encounter session lifecycle
│   ├── ehr/
│   │   ├── fhir-client.ts       # FHIR R4 API wrapper
│   │   ├── epic-adapter.ts      # Epic-specific mappings
│   │   ├── athena-adapter.ts    # Athena-specific mappings
│   │   └── note-pusher.ts       # DocumentReference creation
│   ├── webhooks/
│   │   ├── handler.ts           # Express webhook endpoint
│   │   ├── signature.ts         # HMAC signature verification
│   │   ├── event-router.ts      # Event type → handler mapping
│   │   └── idempotency.ts       # Duplicate event prevention
│   ├── security/
│   │   ├── audit-logger.ts      # HIPAA audit trail
│   │   ├── phi-redactor.ts      # PHI detection and redaction
│   │   ├── rbac.ts              # Role-based access control
│   │   └── tls-config.ts        # TLS 1.3 enforcement
│   ├── monitoring/
│   │   ├── health.ts            # Health check endpoint
│   │   ├── metrics.ts           # Performance metrics collector
│   │   └── alerts.ts            # Quality and latency alerts
│   └── server.ts                # Express server entry point
├── tests/
│   ├── unit/                    # Unit tests (no API calls)
│   ├── integration/             # Sandbox API tests
│   └── fhir-validation/         # FHIR resource schema tests
├── fixtures/
│   └── transcripts/             # Synthetic encounter transcripts
├── scripts/
│   ├── deploy-cloud-run.sh      # GCP Cloud Run deployment
│   ├── readiness-check.ts       # Production readiness validation
│   └── diagnostic.sh            # Debug data collection
├── Dockerfile                   # HIPAA-compliant container
├── .env.example                 # Environment template (no secrets)
└── package.json

Key Design Decisions

Decision	Choice	Rationale
Language	TypeScript	Type safety for healthcare data
EHR adapter	Strategy pattern	Swap EHR backends without changing core
Error handling	Custom error class	HIPAA-safe: never log PHI
Authentication	SMART on FHIR	Standard for healthcare OAuth
Deployment	Cloud Run	HIPAA BAA, auto-scaling, managed
Secrets	GCP Secret Manager	HIPAA-compliant, audited access
Monitoring	Custom health endpoint	Abridge + FHIR connectivity checks

Data Flow

1. Provider opens encounter on device
2. Abridge app captures ambient audio
3. Audio streams to Abridge Cloud via WebSocket
4. Real-time transcript fragments returned
5. Provider closes encounter
6. Abridge generates structured clinical note (10-30s)
7. Webhook fires: encounter.session.completed
8. Integration service fetches note via API
9. Note pushed to EHR via FHIR DocumentReference
10. Patient summary generated and pushed to portal
11. Provider reviews, edits, and signs note in EHR
12. Webhook fires: encounter.note.signed

Multi-Site Deployment

// src/config/multi-site.ts
interface SiteConfig {
  siteId: string;
  siteName: string;
  ehrType: 'epic' | 'athena' | 'cerner';
  fhirBaseUrl: string;
  abridgeOrgId: string;
  specialties: string[];
  providerCount: number;
  goLiveDate: Date;
}

const sites: SiteConfig[] = [
  {
    siteId: 'main-campus',
    siteName: 'Main Hospital',
    ehrType: 'epic',
    fhirBaseUrl: 'https://fhir.main-hospital.epic.com/interconnect-fhir-oauth',
    abridgeOrgId: 'org_main_campus',
    specialties: ['internal_medicine', 'cardiology', 'pulmonology'],
    providerCount: 200,
    goLiveDate: new Date('2026-06-01'),
  },
  {
    siteId: 'community-clinic',
    siteName: 'Community Clinic Network',
    ehrType: 'athena',
    fhirBaseUrl: 'https://api.athenahealth.com/fhir/r4',
    abridgeOrgId: 'org_community',
    specialties: ['family_medicine', 'pediatrics'],
    providerCount: 50,
    goLiveDate: new Date('2026-09-01'),
  },
];

Output

• Complete project structure for Abridge integration
• EHR adapter pattern supporting Epic, Athena, and Cerner
• Multi-site deployment configuration
• End-to-end data flow documentation

Resources

• Abridge Platform
• Abridge Clinician App
• FHIR R4 Specification
• Epic FHIR APIs
• GCP Healthcare API

Next Steps

Start implementation with abridge-install-auth, then follow the skill sequence through production deployment.