Last EHR — Medplum changelog

version

0.5.2 → 0.5.4

version

0.5.1 → 0.5.2

https://www.lastehr.com/llms.txt

+ - [Epic and Oracle Health sandboxes](https://www.lastehr.com/docs/epic-cerner): Flag-gated SMART Backend Services adapters for the Epic and Oracle Health sandboxes. Approval-gated Observation writes, synthetic patients only.+ - [Assistant Work Lab](https://www.lastehr.com/docs/assistant-work): Run a local synthetic work proposal with durable state, separate assistant and reviewer credentials, and a verified FHIR Task result.+ - [Work MCP Connector](https://www.lastehr.com/docs/work-mcp): Connect an external assistant to local synthetic work with a durable Work ID, separate review, and a verified FHIR Task receipt.+ - [Grok Bot with Last EHR](https://www.lastehr.com/docs/grok-bot): Connect native Grok Bot to synthetic Work MCP, review a draft in Last, and inspect the recorded human-approved Task result. Self-hosting and the allowlisted pilot have separate setup requirements.+ - [HIPAA Deployment Groundwork](https://www.lastehr.com/docs/hipaa-deployment): Map patient-data flows, qualify exact services and agreements, and identify the evidence still needed before a clinical pilot.+ - [Hosted Synthetic Work](https://www.lastehr.com/docs/hosted-work): Host authenticated MCP with separate human review. Native Grok Bot drafted synthetic work and retrieved its verified receipt; renewal after token expiry is unverified.+ - [OVHcloud Work Pilot](https://www.lastehr.com/docs/ovh-work): Set up the synthetic Work pilot on an OVHcloud VPS with Auth0, public HTTPS, private FHIR storage, and separate reviewer sign-in.

env_vars

MEDPLUM_ACCESS_TOKEN, MEDPLUM_CLIENT_ID, MEDPLUM_CLIENT_SECRET, MEDPLUM_BASE_URL → MEDPLUM_ACCESS_TOKEN, MEDPLUM_CLIENT_ID, MEDPLUM_CLIENT_SECRET, MEDPLUM_BASE_URL, LASTEHR_BACKEND, LASTEHR_EXPERIMENTAL_FHIR_ADAPTERS, LASTEHR_CLIENT_ID, LASTEHR_PRIVATE_KEY, LASTEHR_PRIVATE_KEY_PATH, LASTEHR_KEY_ID, LASTEHR_JWKS_URL, LASTEHR_SCOPES, LASTEHR_FHIR_BASE_URL, LASTEHR_TOKEN_URL, LASTEHR_ENCOUNTER, LASTEHR_PERFORMER

version

0.4.1 → 0.5.1

https://www.lastehr.com/llms.txt

− - [Remote FHIR MCP: HTTP and OAuth](https://www.lastehr.com/docs/remote-mcp): Configure the optional HTTP transport and per-caller OAuth boundary in MCP 0.4.0. Includes test evidence and the remaining real-provider verification gap.+ - [Remote FHIR MCP: HTTP and OAuth](https://www.lastehr.com/docs/remote-mcp): Configure optional HTTP transport and per-caller OAuth. Includes the real Keycloak and local Medplum test report, plus remaining deployment and reviewer-verification limits.

version

0.4.0 → 0.4.1

version

0.3.1 → 0.4.0

https://www.lastehr.com/llms.txt

− # Last EHR Documentation− Last EHR is an open-source reference implementation for approval-gated FHIR agents. This file mirrors the maintained repository documentation for AI-assisted discovery. Treat the documented support boundaries and safety limitations as authoritative.− Project: https://github.com/cbetz/last-ehr− Documentation hub: https://www.lastehr.com/docs− ## Quickstart− Source: https://www.lastehr.com/docs/quickstart− The fastest way to understand Last EHR is the hosted demo:− <https://www.lastehr.com/demo>− It uses synthetic patients, needs no account, and every write stops at an− approval card.− ## Zero-key local synthetic demo with HAPI FHIR− Use this path when you want to inspect the approval loop without a Medplum− account or model-provider key.− Prerequisites:− - Node 22.18+ (or 24.2+)− - Docker− From a fresh checkout:− ```bash− git clone https://github.com/cbetz/last-ehr.git− cd last-ehr− npm install− npm run demo:local− ```− The command starts HAPI FHIR and Postgres, waits for the server, resets and− seeds the synthetic records, then starts the app at− <http://localhost:3000/demo>. It forces the local HAPI + scripted settings for− its child processes, so it needs neither `.env.local` nor an external model− key. Your normal `.env.local` is not edited or used to select the backend or− model for this command.− On the first run, Docker may need to pull images and HAPI can take a few− minutes to initialize. Press Ctrl-C to stop Next.js; the local FHIR stack and− its data stay available. When you want to remove them, run:− ```bash− npm run demo:local:down− ```− This is a deterministic walkthrough, not an offline model bundle: it makes no− model-provider request and does not interpret the prompt. It always searches− the seeded Maria Garcia record, proposes a single `Heart rate: 72 bpm`− Observation, and waits for approval. The server rejects scripted mode unless− the opt-in flag, `FHIR_BACKEND=hapi`, and a local HAPI URL are all present; the+ # Last EHR+ > Open-source AI tools for FHIR patient charts: a web app and MCP server for chart reads and human-approved writes.+ Last EHR is alpha software. Start with synthetic data. Medplum is the supported authenticated backend; other adapters have synthetic evaluation paths. In external model modes, messages and chart context go to the configured provider. The backend remains the system of record.+ ## Project and overview+ - [Last EHR](https://www.lastehr.com/): What the tools do, a synthetic example, and current backend support.+ - [Documentation](https://www.lastehr.com/docs): Setup, architecture, support boundaries, and implementation guides.+ - [Headless EHR](https://www.lastehr.com/headless-ehr): How a FHIR backend and the application fit together.+ - [Chart reads](https://www.lastehr.com/chat-with-fhir-data): How chart tools work, incomplete results, and the model-provider data flow.+ - [Write approvals](https://www.lastehr.com/approval-gated-writes): Proposal, review, cancellation, backend permissions, and MCP approval.+ - [Medplum setup](https://www.lastehr.com/medplum-ai-agent): Connect a Medplum project, use SMART launch, or install MCP tools.+ - [Roadmap](https://www.lastehr.com/roadmap): Shipped capabilities and remaining work.+ - [Source repository](https://github.com/cbetz/last-ehr): Apache-2.0 source, tests, releases, and contributions.+ ## Evaluate+ - [Quickstart](https://www.lastehr.com/docs/quickstart): Run the zero-key local demo or connect the authenticated Medplum path.+ - [Supported configurations](https://www.lastehr.com/docs/support): See exactly what is supported, local-only, or still needs an adapter.+ - [FHIR Coverage](https://www.lastehr.com/docs/fhir-coverage): What the agent can and cannot reach in FHIR, counted against US Core — including the ceiling and the two things that will never be added.+ ## Understand+ - [Architecture](https://www.lastehr.com/docs/architecture): Trace the chat route, FHIR tool surface, backend adapters, and data boundary.+ - [Approval-Gated Writes](https://www.lastehr.com/docs/approval-gates): Understand the proposal-and-review boundary, including its real limits.+ - [Approval-Gated Agent Writes on FHIR](https://www.lastehr.com/docs/agent-write-protocol): A small, framework-neutral protocol for agent-initiated, human-approved FHIR writes — v0.1 draft, extracted from this repository's two running implementations.+ - [Threat Model](https://www.lastehr.com/docs/threat-model): Review the assets, trust boundaries, intended controls, and known limitations.+ ## Build & integrate+ - [Backend Adapters](https://www.lastehr.com/docs/adapters): Build a verified FHIR backend adapter with the shared contract harnesses.+ - [FHIR MCP Server](https://www.lastehr.com/docs/mcp): Connect Claude Code or Cursor to bounded FHIR chart tools for Medplum or local HAPI. Read-only by default, with opt-in human-approved writes.+ - [Remote FHIR MCP: HTTP and OAuth](https://www.lastehr.com/docs/remote-mcp): Configure the optional HTTP transport and per-caller OAuth boundary in MCP 0.4.0. Includes test evidence and the remaining real-provider verification gap.+ - [FHIR Agent Safety Eval](https://www.lastehr.com/docs/evals): Run a disposable synthetic workflow evaluation for the web agent's proposal, approval, denial, and cleanup mechanics.+ - [Protocol Conformance Suite](https://www.lastehr.com/docs/conformance): Test any implementation of the agent-write protocol with a scripted reviewer and independent FHIR verification.+ ## Operate & maintain+ - [Deployment](https://www.lastehr.com/docs/deployment): Configure environment, rate limits, Docker, and public-demo hardening.+ - [Adoption Metrics](https://www.lastehr.com/docs/metrics): Measure OSS adoption without collecting chart content or PHI.+ ## Optional+ - [Full documentation text](https://www.lastehr.com/llms-full.txt): The complete published guide collection, with absolute source and resource links.+ - [Synthetic demo](https://www.lastehr.com/demo): Interactive chart tools; the demo uses synthetic patients.+ - [Privacy](https://www.lastehr.com/privacy): Hosted-site analytics, cookies, signup form, and demo processing.

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