# Ways to connect an EMR
URL: https://docs.awellhealth.com/docs/connect-systems/getting-started-with-integrations

> For the complete documentation index, see [llms.txt](https://docs.awellhealth.com/llms.txt).



A hospital electronic medical record (EMR) system connects to Awell Care through a custom web service, a
Health Level Seven (HL7) A19 query, Scheduling Information Unsolicited (SIU) messages, or the Awell API.
All of them tie care flow creation and updates to existing clinical practice, so nobody has to key
patients in by hand.

A patient must exist in Awell before a care flow can start for them, so these mechanisms are mostly
about getting the patient **in**.

## Choosing a mechanism [#choosing-a-mechanism]

| Mechanism         | Direction | The hospital provides                            | Best when                                                          |
| ----------------- | --------- | ------------------------------------------------ | ------------------------------------------------------------------ |
| **Webservice**    | Pull      | A custom web service Awell queries by patient ID | The hospital can expose a service and wants Awell to ask on demand |
| **HL7 A19 query** | Pull      | An existing QRY A19 implementation               | The hospital already answers A19 queries                           |
| **SIU messages**  | Pull      | A location Awell collects SIU messages from      | Care flows should follow appointments                              |
| **Awell API**     | Push      | Buttons or links in the EMR that call Awell      | The hospital's system can call out, and a human triggers it        |

The pull options need a **virtual private network**, or VPN, between Awell and the hospital; the push
option doesn't.

## Webservice import [#webservice-import]

A clinician in Awell Care requests a patient by hospital patient ID or visit number. Awell calls the
hospital's web service over VPN and gets the demographics back. The clinician reviews them, picks a
physician, and saves the patient.

**The hospital must implement a custom web service** that Awell can query by patient ID and that
returns the patient's details.

## HL7 A19 query import [#hl7-a19-query-import]

The flow is the same, but the pull uses an HL7 **QRY A19** query rather than a custom service.

Awell needs an example of a QRY A19 already in use at the hospital, so the query matches what their
system expects.

## SIU message import [#siu-message-import]

The hospital collects the care flows to start into **SIU messages** in a local location. Once a day
Awell collects those messages and reads the basics, such as hospital patient ID and physician ID. It
then queries the hospital over VPN for the demographics, creates the patient, and starts the right care
flow for the right physician.

This is the most automated option, because no clinician has to do anything. See
[Patient creation with SIU messages](/docs/connect-systems/patient-creation-with-siu-messages) for the
detail.

## Awell API push [#awell-api-push]

When something happens in the hospital, such as a consultation or a discharge, their system calls Awell
to create or update a patient.

The hospital installs one or more buttons or links in the EMR for care team members to click. See
[Patients in the API reference](/api-reference/reference/patients).

## Clinical accounts can be provisioned through the API [#clinical-accounts-can-be-provisioned-through-the-api]

Alongside patient import, clinicians need accounts in Awell Care. They can be provisioned through
Awell's API rather than created by hand. See
[Administer & secure](/docs/administer-and-secure).

## Next steps [#next-steps]

**Next:** [EMR integration terminology](/docs/connect-systems/emr-integration-terminology) if any of
the acronyms above were new.