Architecting Rx-Gated E-commerce with EMR Integration: Best Path for Authorize-Only Payments and Clinical Approval Workflow

How would you architect an e-commerce build for a longevity clinic given the following requirements?

Some SKUs require a prescription (including injectables), others are OTC, plus memberships and subscription packages.

The critical requirement is medical review prior to final payment capture for Rx-required SKUs.

High-level flow:

• Customer places an order.
• If the cart contains any Rx-required SKU, we must authorize the payment but not capture it.
• A medical-risk assessment (rules-based binary decision model) runs using clinic-supplied thresholds and patient context.

Outcomes:

• Approved: capture payment and fulfill.
• More action required: hold authorization, trigger telehealth consult scheduling within 7 days, clinician manually approves or denies, then capture or void/refund.

Architecture pathways

1. Custom or headless commerce with a middleware orchestration service (order state machine, rules engine, integrations).
2. WooCommerce (self-hosted) with custom plugins for Rx gating, rules engine integration, and EMR sync.
3. Split model: non-Rx storefront plus Rx enrollment portal (eligibility first, then charge), to reduce commerce platform policy risk.
4. An alternative architecture pathway not yet considered?

Which architecture is most robust for authorize-only then capture after clinical approval, especially with telehealth escalation and manual overrides?