Metriport Medical API

# Fix list: Metriport Medical API

From Anchor Terminal's listing at https://www.anchorterminal.com/tools/metriport, the October 2026 research run, assessed 14 October 2026. Grade D, 50.1 out of 100.

This is everything the published grade says the listing lacks, the biggest possible gain to the total first. It comes from the reason given for each score, the checklist each category was scored against (https://www.anchorterminal.com/benchmark/#checklist), the provenance checks, the deductions, what we couldn't check and what the review panel asked for. A fix counts at the next check, once it's public.

For a coding agent working on Metriport Medical API: work through the items below in the product, its docs and its public pages. Each category gives the reason for its score, with the points each checklist item earned, and the checklist itself, so the gap is the items that earned less than their points. Change the product, not the wording, and keep a note of what you changed and where it's published.

## 1. Payments & pricing, 5 out of 100, up to 11.9 more on the total

Why it scored 5: Read with the hosted rubric. No x402, MPP or L402 (0). No published prices (0). A sandbox with example patients opens after Metriport approves the account, with no price or card requirement stated (5 of 20). A person signs up in the dashboard and waits for approval, and production starts with an intro call (0). The AGPLv3 source can be self-hosted, but it needs the operator's own network memberships, so the hosted API is what we graded.

The checklist (https://www.anchorterminal.com/benchmark/#checklist-payments):

The published rubric, also on the [x402 page](https://www.anchorterminal.com/x402/).

- 40, a machine payment protocol (x402, MPP or L402) on the tool's own endpoints. 10 to 30 when it covers only some endpoints or only goes through a third party, and the note says which.
- 20, per-call or per-unit pricing published without a login. 10 for public plan-only pricing, 0 for "contact sales" or prices behind a login.
- 20, a free tier or trial that doesn't need a card.
- 20, autonomous onboarding, meaning an agent can get access without a person signing up in a browser (keyless use, x402, a programmatic key API).

Payment platforms and agent wallets rarely charge for their own API over a machine protocol, so the first line has steps for them, and the highest one that applies counts. 40 when x402, MPP or L402 runs on all their own endpoints, 30 when it runs on part of their own API, 25 when their merchants can accept one, 20 for running a facilitator, 15 for paying as a buyer, and 0 when the only protocol is their own. Merchant acceptance sits above a facilitator because the platform's own customers can charge agents through it, while a facilitator settles for sellers who wire up the protocol themselves. The counter-argument (a facilitator does more for the protocol as a whole) has a point. Each note says which step applied.

Open-source software you run yourself is scored on its hosted or paid option if it has one. A free, self-hosted package with nothing to buy gets 20, 20 and 20 for the last three lines, and 0 to 40 for the first only if it ships a payment protocol.

## 2. Reliability, 45 out of 100, up to 11 more on the total

Why it scored 45: Read with the hosted lines. status.metriport.com is a Checkly dashboard that renders only with JavaScript, so we confirmed the page exists but could not read components or history (10 of 20, history unreadable 5). Rate limits are published per operation, such as 15 patient creates and 20 network queries a minute (15). No 429, Retry-After or backoff guidance was found. ETag with `If-Match` and a 412 on stale updates gives safe concurrent writes (5 of 15). No SLA was found, and the terms say the site cannot be guaranteed available (0). The Medical API is generally available, with legacy document query endpoints marked as such (10).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-reliability):

Hosted APIs, MCP servers, models and platforms.

- 20, a public status page with component history (Statuspage, Instatus, BetterStack or the vendor's own).
- 0 to 30, the incident record for the last 90 days on that page. 30 for a clean record or trivial incidents only, 20 for minor incidents only, 10 for one major outage (an hour or more of a core API down, or errors across the board), 0 for several. 5 when there's no history we could read, and the note says so.
- 15, rate limits documented with numbers.
- 15, documented 429 or overload handling (Retry-After, backoff guidance), and idempotency keys or safe-retry guidance where writes are involved.
- 10, an SLA published for any paid tier.
- 10, the surface agents use is generally available, not beta or preview.

Local packages, SDKs, frameworks and stdio MCP servers.

- 20, installs from an official package with supported runtimes stated.
- 25, a public CI and test suite, passing on the default branch.
- 0 to 25, open crash or regression issues relative to activity (25 for few and handled, 0 for many, old and unanswered).
- 15, semver discipline and breaking changes called out in a changelog.
- 15, version 1.0 or later, or declared stable.

Protocols are read from their reference implementations, the public facilitators or servers, spec stability and test vectors.

## 3. Security & auth, 41 out of 100, up to 10.3 more on the total

Why it scored 41: One kind of key, sent in the `x-api-key` header, with full access including destructive operations. Two keys can be active for rotation and each is revocable at once (15 of 30). No read-only key or scopes for the API. Dashboard roles separate clinical, billing and developer access, and patients can be opted out of HIE exchange (5 of 20). The API returns external C-CDA, PDF and image documents with no prompt-injection guidance (3 of 15). Webhook requests can be listed, and no API audit log was found (4 of 15). HITRUST r2 and SOC 2 Type 2 are claimed in the README, SECURITY.md routes reports through GitHub or email, with no security.txt or bug bounty (14 of 20).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-security):

- 0 to 30, the credential model. 30 for OAuth 2.1 with scopes, or scoped and revocable keys with rotation. 20 for plain revocable API keys. 10 for one all-powerful key. 10 off when a secret can travel in a URL query string as a documented option.
- 0 to 20, read-only or least-privilege modes, and confirmation or approval for destructive actions.
- 0 to 15, prompt-injection posture where the tool returns untrusted content (documented mitigations or guidance). A tool that returns no untrusted content gets 10.
- 0 to 15, audit logs or per-call visibility for the operator.
- 0 to 20, a security programme. security.txt or a disclosure policy, a bug bounty, SOC 2 or ISO 27001, advisories handled in public.

Models are read for retention, whether API data trains models (and whether that's off by default), zero-retention options and certifications. Frameworks for telemetry defaults, approval hooks, guardrails and sandboxing.

## 4. Schema & documentation, 65 out of 100, up to 5.7 more on the total

Why it scored 65: The public repository holds a Fern API definition that the docs call the OpenAPI specification. It covers patients, facilities, FHIR, documents and webhooks, but not network query, cohorts, messages or settings, and the repository was last synced on 27 August 2026 (12 of 25). llms.txt and a Markdown copy of every page (10). Descriptions state when to use an endpoint and its traps, such as the consolidated query returning cached data and network query returning 2XX with partial failures (16 of 20). Parameters are typed with defaults in hand-written reference pages, without a schema file for most of them (10 of 15). SDK examples on each page and an RFC 7807 error format (12 of 15). Paths are versioned under /medical/v1, but no public changelog was found (5 of 15).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-schema):

APIs and MCP servers.

- 25, a machine-readable contract (a public OpenAPI file or similar; for MCP, typed JSON Schema inputs on every tool).
- 10, llms.txt or Markdown docs served for agents.
- 0 to 20, descriptions that say what a tool is for, when to use it and when not to, read from the tool definitions in the source or the API reference.
- 0 to 15, typed inputs with enums, constraints and required fields, and no free-form JSON blobs.
- 0 to 15, examples and documented error responses.
- 15, versioning and a public changelog.

Models are read from the API reference, the OpenAPI file, llms.txt, the structured-output and tool-use docs and the model cards. Frameworks from docs a model can follow, typed interfaces, examples and the API reference.

## 5. Agent ergonomics, 70 out of 100, up to 4.9 more on the total

Why it scored 70: Lists take `count` up to 500, consolidated queries filter by resource type and date, a count endpoint sizes a patient's record before fetching, and summaries cut the volume (18 of 25). Cursor-style pagination with `nextPage` URLs and filters (18 of 20). Errors carry a stable `title` and an occurrence `detail` (16 of 20). No idempotency keys. ETag guards updates, and failed webhooks can be listed and retried (10 of 20). Few required fields, but the only official SDK is TypeScript (8 of 15).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-ergonomics):

- 0 to 25, context cost. For MCP, the number and size of the tool definitions (25 for ten or fewer compact tools, 15 for 11 to 30, 5 for more than 30, plus up to 10 back for toolsets, dynamic loading or read-only subsets). For APIs, whether responses can be sized (field selection, limits, summaries).
- 20, pagination, filtering and output-size controls.
- 20, actionable, documented error responses, codes and messages an agent can recover from.
- 20, idempotency or safe retries, and for MCP the `readOnlyHint` and `destructiveHint` annotations.
- 15, sensible defaults, few required parameters, and official SDKs in at least two languages.

Models are read for tool use, structured output, prompt caching, context length, batch and SDKs. Frameworks for how much code and how many defaults a tool-calling agent with MCP needs.

## 6. Transparency & trust, 56 out of 100, up to 3.9 more on the total

Made of editorial 43, provenance 69.

Why it scored 56: The source is AGPLv3, with an enterprise directory under a separate licence, while the hosted service runs under terms of use from January 2024. The public mirror lags the private repository (25 of 30). The privacy policy (February 2023) covers the website and contacts only, and no DPA, BAA or retention period for API data was found in public (8 of 30). Legacy endpoints are labelled, with no dated deprecation policy (5 of 20). Data stays in the US per the privacy policy, with no sub-processor list (5 of 20).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-transparency):

- 0 to 30, source availability and licence clarity. 30 for open source under an OSI licence, 15 for closed with clear terms, 0 for unclear terms.
- 0 to 30, data handling and retention statements that agree with each other (privacy policy, DPA, retention periods, subprocessors).
- 0 to 20, a deprecation policy or notices with dates.
- 0 to 20, telemetry disclosed with an opt-out (local software), or subprocessors and data locations disclosed (hosted).

The other half of Transparency and trust is the provenance score, computed from checked facts (below). The category score is the mean of the two.

Provenance checks not met in full (half of this category, computed from checked facts):

- Domain age: metriport.com, registered 2021-02-09 (5 years) (11 of 15)
- Terms of service: read, states 6 of the 7 things a reader expects, and has 3 clauses that cost points (3.1 of 10)
- Changelog: not found (0 of 10)
- security.txt: not found (0 of 10)

## 7. Maintenance & community, 74 out of 100, up to 2.3 more on the total

Why it scored 74: @metriport/api-sdk 18.22.0 was published on 28 September 2026 (30). Seven SDK releases since 16 July 2026 (20). No public changelog. Support is by email, and the public repository has 74 open issues that we could not read because GitHub's API rate-limited us (7 of 25). One current official SDK, in TypeScript (10 of 15). The repository has CI workflows for build, deploy and end-to-end tests (7 of 10).

The checklist (https://www.anchorterminal.com/benchmark/#checklist-maintenance):

- 0 to 30, time since the last release, or the last published model or API change for a closed service. 30 within 30 days, 20 within 90, 10 within 180, 0 older.
- 20, at least three releases or dated changelog entries in the last 90 days.
- 0 to 25, responsiveness. Issues and pull requests answered on GitHub (the open issues and how recent the replies are). For closed services, a public changelog and a support or community channel that answers, 0 to 15.
- 15, presence in the official MCP registry under a verified namespace (MCP servers), or current official SDKs (APIs and models).
- 10, package health, current dependencies and CI.

Models are read for deprecation notice periods and model churn rather than release counts.

## What we couldn't check

What we couldn't read counted as absent. Publishing it on a page a plain HTTP fetch can read (not only in a browser) lets the next check count it.

- unchecked: status page history, because status.metriport.com renders only with JavaScript
- unchecked: the trust centre at security.metriport.com, which renders only with JavaScript
- unchecked: GitHub issue response times, because the GitHub API rate-limited us
- Whether the sandbox is free, and how long approval takes, is not stated

## Weaknesses

- Every API key has full access, including destructive operations, with no scopes
- No public prices, and the sandbox needs Metriport's approval first
- The Fern definition covers only part of the API and no public changelog was found
- The status page renders only with JavaScript, so its history could not be read

## What costs an agent a turn today

The notes we give agents before they call it. Each one is a workaround an agent shouldn't need.

- Check the `errors` array after Start Network Query. It returns 2XX even when some sources fail
- Wait for `network-query.*` webhooks or poll Get Network Query Status before reading consolidated data, which is cached from the last query
- Send the resource's `eTag` in `If-Match` on updates to avoid overwriting newer data
- Keep patient creates under 15 a minute and network queries under 20 a minute per source
- In sandbox, create patients whose first name matches a pre-defined persona to get example records

## When it's done

Send what changed and where it's published as a dispute (https://www.anchorterminal.com/builders/#disputes, or `POST https://www.anchorterminal.com/api/v1/contact` with `"kind": "dispute"`). Disputes are answered in public, and the listing is checked again by the same checklist. Paying for an audit or a listing claim changes nothing here.