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Your Opportunity As a Principal Engineer , you will help design, build, and operate the clinical decision support and API-driven data delivery platform that enables Vytalize Health to embed timely, actionable clinical insights directly into provider workflows. Working cross-functionally with Data Engineering, Product, Clinical Operations, and EMR partners, your solutions will transform how clinicians access dataâmoving from external tools and workarounds to seamless, in-workflow decision support via CDS Hooks and real-time APIs. You will own the technical foundation for Clinical Decision Support (CDS) Hooks, REST APIs, and the architectural patterns that ensure clinical data is accessible, trustworthy, and performant at the moment of care. This role sits at the intersection of healthcare interoperability standards, modern API design, and operational excellence. You will establish reliability metrics and SLAs that ensure CDS Hooks and APIs serve clinician workflows with consistent quality and performance. You will be part of a small, high-performing healthcare engineering team where engineers support each other's growth through mentorship and tight collaboration. Primary Responsibilities Lead design and implementation of the CDS Hooks platform, including card orchestration, hook context handling, EHR-side logic orchestration, and integration with downstream data services Own CDS Hook API contracts and evolution, ensuring compliance with SMART CDS Hooks specification while adding performance, reliability, and healthcare-specific optimizations Lead technical integration with EMR systems (Epic, NextGen, Athena, ECW) for CDS Hook discovery, execution, card rendering, and user action handling Design, build, and maintain public-facing REST and event-driven APIs exposing clinical data, quality metrics, care gaps, attribution data, and decision support content to partners and provider-facing applications Establish API contracts, versioning strategies, and deprecation policies that balance innovation with stability for external consumers Implement and maintain API security patterns including OAuth 2.0, scope-based authorization, rate limiting, and audit logging for compliant clinical data access Design and optimize real-time or near-real-time data pipelines feeding CDS Hooks and APIsâensuring low latency, high freshness, and graceful failure modes Design and implement comprehensive testing and QA frameworks for CDS Hooks and APIs â including hook context validation, card rendering verification, and clinical workflow testing across EMR systems Establish reliability metrics and SLAs (latency, availability, freshness) for CDS Hook delivery and API performance; measure and track against clinical requirements Define and measure clinical impact metrics â adoption of CDS Hooks, clinician interaction rates, workflow integration success, and patient outcome influence Exercise architectural judgment across tradeoffs in correctness, latency, scalability, maintainability, and operational risk in clinical data systems Design and implement reliability patterns for CDS and API services including monitoring, alerting, failure detection, graceful degradation, and incident recovery Partner with Data Reliability Engineer to define and operate SLAs for CDS Hook delivery, API response times, and data freshness aligned to clinical needs Establish and uphold engineering standards for API design, data schemas, integration patterns, and interoperability; maintain high-quality technical documentation and OpenAPI specifications Partner with Data Engineering to align upstream data models, gold-layer datasets, and platform capabilities with clinical decision support and API requirements Serve as the technical authority on clinical interoperability standards (SMART CDS Hooks, FHIR, HL7, CDS Hooks, EHR integration patterns) Collaborate with Product, Clinical Operations, and Business stakeholders to clarify requirements, translate clinical workflows into platf