{ "meta": { "attribution": "Anchor Terminal (https://www.anchorterminal.com)", "docs": "https://www.anchorterminal.com/docs/", "generatedAt": "2026-10-14", "license": "CC-BY-4.0", "method": "https://www.anchorterminal.com/benchmark/", "methodology": "0.4", "openapi": "https://www.anchorterminal.com/openapi.json", "preview": false, "run": "2026-10-01", "runLabel": "October 2026 research run" }, "tool": { "slug": "zus-health", "name": "Zus Health", "vendor": "Zus Health, Inc.", "vendorUrl": "https://www.zushealth.com", "kind": "http-api", "category": "health-data", "summary": "Zus Health assembles a patient's history from CommonWell, Carequality, Surescripts, Quest and ADT networks into the Zus Aggregated Profile, and exposes it through FHIR R4 REST, GraphQL and webhook APIs for care organisations it onboards.", "url": "https://www.anchorterminal.com/tools/zus-health", "markdownUrl": "https://www.anchorterminal.com/tools/zus-health.md", "slimMarkdownUrl": "https://www.anchorterminal.com/tools/zus-health.min.md", "jsonUrl": "https://www.anchorterminal.com/api/v1/tools/zus-health.json", "license": "Proprietary service under the Zus Builder Terms of Service (last updated 11 March 2025), the Developer Sandbox Terms and the Zus Business Associate Addendum", "transports": [ "http" ], "packages": [], "auth": "oauth", "authNotes": "OAuth 2.0 bearer tokens valid for one hour. Backend systems use machine-to-machine App Clients created in the Zus app or through the Auth Service API, limited to 200 token requests an hour per client. Apps can exchange an OIDC ID token from their own identity provider for a Zus token, and integration App Clients with the Builder Data Integration role can fetch tokens for users through the proxy-token endpoint. Accounts are provisioned by Zus, with an initial admin per customer.", "pricing": "paid", "pricingNotes": "No public prices. The Builder Terms set fees in an executed Order Form or pricing list, invoiced monthly. A developer sandbox is requested through a Google Form on the docs site, and its cost is not stated (checked 2026-10-14).", "priceSummary": "Paid", "where": "local", "x402": { "level": "no", "evidence": "No x402, MPP or L402 in the documentation, llms.txt or the Builder Terms (checked 2026-10-14).", "endpoints": [] }, "toolCount": null, "popularity": { "githubStars": null, "npmWeekly": null, "pypiWeekly": null, "asOf": "2026-10-14" }, "docsUrl": "https://docs.zushealth.com", "llmsTxt": "https://docs.zushealth.com/llms.txt", "capabilities": [ "health.records", "health.fhir", "health.ehr", "health.consent" ], "tags": [ "hosted", "health-records", "fhir", "graphql", "oauth", "llms-txt", "webhooks", "status-page", "sla", "sales-led" ], "lastRelease": "2026-10-14", "graded": true, "anchor": { "graded": true, "score": 56.6, "grade": "C", "agentReady": false, "rank": 669, "ranked": true, "rankOf": 1076, "categoryRank": 7, "methodology": "0.4", "run": "2026-10-01", "scores": { "ergonomics": 67, "maintenance": 64, "payments": 5, "reliability": 66, "schema": 77, "security": 49, "transparency": 59 }, "pending": [ "performance", "tasks" ], "breakdown": [ { "key": "reliability", "name": "Reliability", "weight": 16, "effectiveWeight": 20, "score": 66, "points": 13.2, "reason": "Read with the hosted lines. status.zusapi.com on StatusPal with components and history (20). Between 16 July and 14 October 2026 it lists major incidents on the athenahealth embedded app (27 July), ZusHooks delays of up to two hours (4 August), risk gap calculations (5 August) and the embedded app across EHRs (13 August), with FHIR API errors on 24 August marked minor. Several majors, none on the FHIR API itself (5 of 30). Rate limits with numbers for FHIR, tokens and Patient History (15). 429 is documented with no Retry-After or backoff guidance, while conditional writes by identifier and `Zus-If-Match` make retries safe (8 of 15). A published SLA of 99.5 per cent with credits (10). FHIR REST is generally available and GraphQL is beta (8 of 10)." }, { "key": "performance", "name": "Performance", "weight": 10, "effectiveWeight": 0, "pending": true, "points": 0, "reason": "Pending. Latency is measured per call by our probes, which haven't run yet, so this run doesn't score it. Its weight is shared across the assessed categories until the first probe window closes." }, { "key": "schema", "name": "Schema \u0026 documentation", "weight": 13, "effectiveWeight": 16.25, "score": 77, "points": 12.51, "reason": "Each reference page carries an OpenAPI 3.0.3 fragment with enums and required fields, with no single specification file found (18 of 25). llms.txt and Markdown pages (10). Guides explain the ZAP, Patient History jobs and when to subscribe or query once (13 of 20). Typed inputs with enums on Auth Service and Patient History operations, FHIR search parameters listed (12 of 15). A Postman collection and Loom walkthroughs, with little on error bodies (9 of 15). A dated changelog with about ten entries since 29 July 2026 (15)." }, { "key": "ergonomics", "name": "Agent ergonomics", "weight": 13, "effectiveWeight": 16.25, "score": 67, "points": 10.89, "reason": "`_count` up to 500, and GraphQL selects only the fields requested, though GraphQL is beta (20 of 25). FHIR search parameters across resources and lastUpdated ordering (18 of 20). Error responses are not described beyond 429 (10 of 20). Conditional create by identifier and `Zus-If-Match` version checks, no idempotency keys (14 of 20). No official SDK, a Postman collection only (5 of 15)." }, { "key": "security", "name": "Security \u0026 auth", "weight": 14, "effectiveWeight": 17.5, "score": 49, "points": 8.57, "reason": "OAuth 2.0 with one-hour tokens, machine-to-machine App Clients managed in the app, token exchange from the customer's identity provider and a proxy-token endpoint now limited to a dedicated role (22 of 30). Managed roles such as Builder Admin and Builder Data Integration, with no read-only API role confirmed (12 of 20). The ZAP returns documents and data from outside organisations with no prompt-injection guidance (3 of 15). AuditEvent is a supported resource and the Builder Security Policy asks builders to keep audit logs, with no operator-facing API log documented (7 of 15). No named certification, an annual third-party audit summary on request, no security.txt or bug bounty (5 of 20)." }, { "key": "payments", "name": "Payments \u0026 pricing", "weight": 10, "effectiveWeight": 12.5, "score": 5, "points": 0.63, "reason": "Read with the hosted rubric. No x402, MPP or L402 (0). No published prices (0). A developer sandbox is requested by Google Form, limited to test data, with no price stated (5 of 20). Zus provisions accounts and users (0)." }, { "key": "tasks", "name": "Task success", "weight": 10, "effectiveWeight": 0, "pending": true, "points": 0, "reason": "Pending. Task success needs the category task suites run through each tool, which haven't run yet, so this run doesn't score it. Its weight is shared across the assessed categories until then. A data provider's data-quality score is published on its listing now and becomes half of this category when it's scored." }, { "key": "maintenance", "name": "Maintenance \u0026 community", "weight": 7, "effectiveWeight": 8.75, "score": 64, "points": 5.6, "reason": "The Builder Data Integration role change took effect on 14 October 2026 and the last dated entry is 21 September 2026 (30). About ten dated changelog entries since 29 July 2026 (20). A public changelog, a weekly product email and a Zendesk support form. We did not test support (11 of 15). No official SDK was found (0 of 15). A maintained Postman workspace (3 of 10)." }, { "key": "transparency", "name": "Transparency \u0026 trust", "weight": 7, "effectiveWeight": 8.75, "score": 59, "points": 5.16, "note": "editorial 46, provenance 71", "reason": "Closed service with published Builder Terms, Developer Sandbox Terms, BAA and SLA (15 of 30). The terms forbid de-identifying Patient Data for sale but let Zus use and sell System Data. The privacy policy covers the website only, with no retention periods (15 of 30). The terms promise reasonable efforts at 60 days' notice for changes that aren't backwards-compatible, and the changelog announces dated changes in advance (14 of 20). No sub-processor list or data location found (2 of 20)." } ], "assessment": { "date": "2026-10-14", "basis": "public evidence", "confidence": "medium", "notes": { "ergonomics": "`_count` up to 500, and GraphQL selects only the fields requested, though GraphQL is beta (20 of 25). FHIR search parameters across resources and lastUpdated ordering (18 of 20). Error responses are not described beyond 429 (10 of 20). Conditional create by identifier and `Zus-If-Match` version checks, no idempotency keys (14 of 20). No official SDK, a Postman collection only (5 of 15).", "maintenance": "The Builder Data Integration role change took effect on 14 October 2026 and the last dated entry is 21 September 2026 (30). About ten dated changelog entries since 29 July 2026 (20). A public changelog, a weekly product email and a Zendesk support form. We did not test support (11 of 15). No official SDK was found (0 of 15). A maintained Postman workspace (3 of 10).", "payments": "Read with the hosted rubric. No x402, MPP or L402 (0). No published prices (0). A developer sandbox is requested by Google Form, limited to test data, with no price stated (5 of 20). Zus provisions accounts and users (0).", "reliability": "Read with the hosted lines. status.zusapi.com on StatusPal with components and history (20). Between 16 July and 14 October 2026 it lists major incidents on the athenahealth embedded app (27 July), ZusHooks delays of up to two hours (4 August), risk gap calculations (5 August) and the embedded app across EHRs (13 August), with FHIR API errors on 24 August marked minor. Several majors, none on the FHIR API itself (5 of 30). Rate limits with numbers for FHIR, tokens and Patient History (15). 429 is documented with no Retry-After or backoff guidance, while conditional writes by identifier and `Zus-If-Match` make retries safe (8 of 15). A published SLA of 99.5 per cent with credits (10). FHIR REST is generally available and GraphQL is beta (8 of 10).", "schema": "Each reference page carries an OpenAPI 3.0.3 fragment with enums and required fields, with no single specification file found (18 of 25). llms.txt and Markdown pages (10). Guides explain the ZAP, Patient History jobs and when to subscribe or query once (13 of 20). Typed inputs with enums on Auth Service and Patient History operations, FHIR search parameters listed (12 of 15). A Postman collection and Loom walkthroughs, with little on error bodies (9 of 15). A dated changelog with about ten entries since 29 July 2026 (15).", "security": "OAuth 2.0 with one-hour tokens, machine-to-machine App Clients managed in the app, token exchange from the customer's identity provider and a proxy-token endpoint now limited to a dedicated role (22 of 30). Managed roles such as Builder Admin and Builder Data Integration, with no read-only API role confirmed (12 of 20). The ZAP returns documents and data from outside organisations with no prompt-injection guidance (3 of 15). AuditEvent is a supported resource and the Builder Security Policy asks builders to keep audit logs, with no operator-facing API log documented (7 of 15). No named certification, an annual third-party audit summary on request, no security.txt or bug bounty (5 of 20).", "transparency": "Closed service with published Builder Terms, Developer Sandbox Terms, BAA and SLA (15 of 30). The terms forbid de-identifying Patient Data for sale but let Zus use and sell System Data. The privacy policy covers the website only, with no retention periods (15 of 30). The terms promise reasonable efforts at 60 days' notice for changes that aren't backwards-compatible, and the changelog announces dated changes in advance (14 of 20). No sub-processor list or data location found (2 of 20)." }, "sources": [ { "what": "documentation index", "url": "https://docs.zushealth.com/llms.txt", "seen": "2026-10-14" }, { "what": "rate limits", "url": "https://docs.zushealth.com/docs/api-rate-limits.md", "seen": "2026-10-14" }, { "what": "user authentication", "url": "https://docs.zushealth.com/docs/user-authentication.md", "seen": "2026-10-14" }, { "what": "FHIR REST capabilities", "url": "https://docs.zushealth.com/docs/fhir-rest-api-capabilities.md", "seen": "2026-10-14" }, { "what": "sandbox sign-up", "url": "https://docs.zushealth.com/page/sign-up.md", "seen": "2026-10-14" }, { "what": "changelog entry", "url": "https://docs.zushealth.com/changelog/new-role-builder-data-integration.md", "seen": "2026-10-14" }, { "what": "status history", "url": "https://status.zusapi.com/history.rss", "seen": "2026-10-14" }, { "what": "SLA", "url": "https://www.zushealth.com/zus-service-level-agreement", "seen": "2026-10-14" }, { "what": "Builder Terms", "url": "https://www.zushealth.com/builder-terms-of-service", "seen": "2026-10-14" }, { "what": "Developer Sandbox Terms", "url": "https://www.zushealth.com/developer-sandbox-terms-of-service", "seen": "2026-10-14" }, { "what": "Builder Security Policy", "url": "https://www.zushealth.com/builder-security-policy", "seen": "2026-10-14" }, { "what": "privacy policy", "url": "https://www.zushealth.com/privacy-policy", "seen": "2026-10-14" } ], "openQuestions": [ "Whether the developer sandbox is free and how quickly a form request is answered is not stated", "unchecked: whether Zus holds SOC 2 or HITRUST, since no certification was named on the pages read", "No error response format was found in the documentation read" ] }, "negative": 0, "verdict": "FHIR R4 over an aggregated patient profile drawn from CommonWell, Carequality, Surescripts, Quest and ADT networks, with published rate limits, a 99.5 per cent SLA and a dated changelog. Accounts and sandboxes are provisioned by Zus on request, with no public prices, no named security certification and no SDK.", "bestFor": "US care organisations and digital health builders that want a shared, continuously refreshed patient profile in FHIR with EHR embedding.", "strengths": [ "One profile per patient from EHR, pharmacy, ADT and lab networks, shared across Zus customers treating the same patient", "Rate limits with numbers and a published 99.5 per cent SLA with credits", "Conditional writes by identifier and `Zus-If-Match` version checks for safe retries", "Dated changelog that announces changes ahead, such as the proxy-token role change on 14 October 2026" ], "weaknesses": [ "No public prices, and the sandbox is requested through a Google Form", "Four major incidents on the status page between 27 July and 13 August 2026", "No named security certification, security.txt or bug bounty", "The GraphQL API is beta and no official SDK exists" ], "agentNotes": [ "Cache the access token for its hour. More than 200 token requests an hour per App Client returns 429", "Request Patient History at most once per patient per 24 hours, and poll the job status endpoint", "Use conditional create by identifier so a retried write doesn't duplicate a resource", "Send `Zus-If-Match` with the resource's ETag on PUT and PATCH", "Set `_count` up to 500 on searches, since the default page is 10" ], "metrics": { "kind": "remote", "measured": false }, "reviewCount": 0, "avgRating": 0, "history": [ { "basis": "public evidence", "confidence": "medium", "grade": "C", "methodology": "0.4", "pending": [ "performance", "tasks" ], "run": "2026-10-01", "runLabel": "October 2026 research run", "score": 56.6 } ], "editorialScores": { "ergonomics": 67, "maintenance": 64, "payments": 5, "reliability": 66, "schema": 77, "security": 49, "transparency": 46 }, "provenanceScore": 71 }, "connect": { "http": "GET https://api.sandbox.zusapi.com/fhir/Patient?_count=50\nAuthorization: Bearer \u003caccess-token\u003e" }, "letme": { "capability": "https://letme.dev/health.records", "tool": "https://letme.dev/zus-health" }, "notable": [ "FHIR endpoints at api.zusapi.com and fqs.zusapi.com allow 2,000 requests a minute per customer, and Patient History allows one request per patient per 24 hours (https://docs.zushealth.com/docs/api-rate-limits.md)", "The SLA commits to 99.5 per cent monthly uptime for Builder Services, with credits of 2 to 10 per cent, excluding third-party network services (https://www.zushealth.com/zus-service-level-agreement)", "The Builder Terms promise reasonable efforts to give 60 days' notice of changes that aren't backwards-compatible, and forbid de-identifying Patient Data for sale (https://www.zushealth.com/builder-terms-of-service)", "From 14 October 2026 only App Clients with the new Builder Data Integration role can call the proxy-token endpoint (https://docs.zushealth.com/changelog/new-role-builder-data-integration.md)", "The GraphQL API at fqs.zusapi.com is labelled beta (https://docs.zushealth.com/docs/graphql-api.md)", "status.zusapi.com on StatusPal lists four major incidents between 27 July and 13 August 2026 on the embedded app, ZusHooks and risk gaps (https://status.zusapi.com/history.rss)" ], "area": "domain-data", "details": [ { "label": "Endpoints", "value": "FHIR R4 at https://api.zusapi.com/fhir (sandbox https://api.sandbox.zusapi.com/fhir), GraphQL at https://fqs.zusapi.com/query, Auth Service, Patient History and ZAP Data Subscriptions APIs" }, { "label": "Data sources", "value": "EHR data through CommonWell and Carequality, pharmacy fills through Surescripts, ADT through PointClickCare and Bamboo Health, labs through Quest" }, { "label": "FHIR", "value": "Most FHIR R4 resource types, POST, PUT, JSON Patch and DELETE, transaction Bundles, conditional create, update and delete by identifier, `Zus-If-Match` version checks" }, { "label": "Pagination", "value": "Ordered by lastUpdated, 10 per page by default and up to 500" }, { "label": "Rate limits", "value": "2,000 FHIR requests a minute per customer, 200 token requests an hour per App Client, one Patient History request per patient per 24 hours and 10 priority jobs a minute per customer" }, { "label": "Webhooks", "value": "ZusHooks push events such as ADTs, and Data Marts export to customer warehouses" }, { "label": "EHR integrations", "value": "Epic, athenahealth, Elation, eClinicalWorks, Salesforce Health Cloud, Healthie, Canvas and Medplum" }, { "label": "SLA", "value": "99.5 per cent monthly uptime for Builder Services, credits 2, 5 or 10 per cent of the month's invoice" }, { "label": "Status", "value": "status.zusapi.com on StatusPal with components for the app, EHR integrations, FHIR and Patient History APIs, each network, ZusHooks and the Auth Service" } ], "provenance": { "legalEntity": "Zus Health, Inc.", "domain": "zushealth.com", "domainRegistered": "2012-02-25", "endpointOnVendorDomain": false, "terms": "https://www.zushealth.com/builder-terms-of-service", "privacy": "https://www.zushealth.com/privacy-policy", "statusPage": "https://status.zusapi.com", "changelog": "https://docs.zushealth.com/changelog", "securityTxt": "none", "checked": "2026-10-14", "notes": [ "The APIs answer on zusapi.com, a separate domain from zushealth.com.", "The Builder Terms (last updated 11 March 2025) put term changes into effect 30 days after posting and BAA changes after 90 days. The Developer Sandbox Terms (22 January 2024) limit the sandbox to test data. The website lists 1 Lincoln Street, Suite 2900, Boston, MA 02111.", "The privacy policy (last updated 24 June 2026) covers the website only and names Google Analytics.", "The Builder Security Policy (11 March 2025) names no certification and makes a summary of an annual third-party audit available on request.", "www.zushealth.com/.well-known/security.txt returns 404.", "RDAP gives zushealth.com a registration date of 2012-02-25." ], "score": 71, "checks": [ { "check": "Legal entity named", "value": "Zus Health, Inc.", "points": 20, "max": 20, "state": "ok" }, { "check": "Domain age", "value": "zushealth.com, registered 2012-02-25 (14 years)", "points": 15, "max": 15, "state": "ok" }, { "check": "Endpoint on the vendor's domain", "value": " is not on zushealth.com", "points": 0, "max": 15, "state": "no" }, { "check": "Terms of service", "value": "read, states 7 of the 7 things a reader expects", "points": 10, "max": 10, "state": "ok" }, { "check": "Privacy policy", "value": "read, states 3 of the 8 things a reader expects", "points": 6.3, "max": 10, "state": "part" }, { "check": "Status page", "value": "status.zusapi.com", "points": 10, "max": 10, "state": "ok" }, { "check": "Changelog", "value": "published", "points": 10, "max": 10, "state": "ok" }, { "check": "security.txt", "value": "not found", "points": 0, "max": 10, "state": "no" } ], "policies": [ { "kind": "terms", "url": "https://www.zushealth.com/builder-terms-of-service", "state": "read", "readAt": "2026-10-14", "statedDate": "2025-03-11", "words": 8311, "points": 10, "max": 10, "expected": [ { "key": "terms.date", "label": "Gives the date it was last updated", "found": true, "quote": "Last Updated 2025-03-11", "says": "Last updated 2025-03-11" }, { "key": "terms.law", "label": "Names the governing law or courts", "found": true, "quote": "These Builder Terms are governed by and construed in accordance with the laws of the Commonwealth of Massachusetts, without regard to its conflict of law rules.", "says": "The law of the Commonwealth of Massachusetts" }, { "key": "terms.liability", "label": "States a limit on its liability", "found": true, "quote": "…in which the sole responsibility for such breach rests with Zus, Zus’s liability for such breach shall not exceed an amount equal to 5 times the total amount of Fees paid by you to Zus during the 12 month period immediately preceding the event that gave rise to the claim for damages.", "says": "Capped at the fees paid in the 12 months before the claim" }, { "key": "terms.termination", "label": "Says how the agreement or account can be ended", "found": true, "quote": "Notwithstanding the foregoing, if no Initial Term is designated on the Order Form either party may terminate your use of the Builder Services at any time with 30 days’ prior written notice to the other party." }, { "key": "terms.changes", "label": "Says how changes to the terms are announced", "found": true, "quote": "Unless we note otherwise, changes to these Builder Terms become effective 30 days after they are posted.", "says": "Gives 30 days of notice before a change" }, { "key": "terms.use", "label": "Lists what users may not do", "found": true, "quote": "You may not use or call any private, internal, or other APIs to which you may have access through the Builder Services." }, { "key": "terms.sla", "label": "Refers to a service level or uptime commitment", "found": true, "quote": "Any Service Credits set forth in the Builder Services SLA shall be your sole and exclusive remedy for any failure by us to achieve the uptime commitment." } ], "toKnow": [ { "key": "terms.cutoff", "label": "Says access can be ended without notice or for any reason", "found": true, "quote": "Notwithstanding the foregoing, if no Initial Term is designated on the Order Form either party may terminate your use of the Builder Services at any time with 30 days’ prior written notice to the other party." } ], "notes": [ { "date": "2026-10-14", "text": "Order Forms renew automatically for one-year periods unless either party gives notice at least 90 days before the term ends.", "quote": "The Order Form will thereafter automatically renew for additional one-year periods (collectively with the Initial Term, the “Term”) unless either party provides written notice of its intent to terminate no later than 90 days prior to the end of the then current Term." }, { "date": "2026-10-14", "text": "Zus may license, sell and receive payment for System Data.", "quote": "System Data. We may use, disclose, market, license, distribute, sell, receive remuneration for, create derivative works of System Data as permitted by Applicable Law." }, { "date": "2026-10-14", "text": "Zus may name the customer as a participant in the Zus Network and a contributor to the Common Patient Record.", "quote": "Zus may identify you as a Participant in the Zus Network and as a contributor to the Common Patient Record." } ] }, { "kind": "privacy", "url": "https://www.zushealth.com/privacy-policy", "state": "read", "readAt": "2026-10-14", "statedDate": "2026-06-24", "words": 724, "points": 6.3, "max": 10, "expected": [ { "key": "privacy.date", "label": "Gives the date it was last updated", "found": true, "quote": "Last Updated 2026-06-24", "says": "Last updated 2026-06-24" }, { "key": "privacy.collected", "label": "Says what personal data is collected", "found": true, "quote": "Other information that we may collect for customer surveys." }, { "key": "privacy.retention", "label": "Says how long data is kept", "found": false }, { "key": "privacy.processors", "label": "Says who else receives the data", "found": true, "quote": "We will not activate non-essential third-party tracking technologies until you have provided your consent." }, { "key": "privacy.sale", "label": "Says whether personal data is sold or shared for advertising", "found": false }, { "key": "privacy.rights", "label": "Says what rights people have over their data", "found": false }, { "key": "privacy.contact", "label": "Gives a privacy contact", "found": false }, { "key": "privacy.transfers", "label": "Says where data is transferred or stored", "found": false } ] } ] }, "pageJsonUrl": "https://www.anchorterminal.com/tools/zus-health.json", "live": { "slug": "zus-health", "vendorStatus": { "page": "https://status.zusapi.com", "indicator": "unknown", "summary": "no machine-readable status found", "checkedAt": "2026-10-14T08:54:10.020449939Z" }, "updatedAt": "2026-10-14T08:54:10.020449939Z" } } }