A comprehensive MCP (Model Context Protocol) server for FHIR R4 with AI-powered clinical insights, intelligent validation explanations, enhanced narrative generation, and complete resource management capabilities.

Configuration

The server is configured entirely through command line flags. All configuration must be provided via named parameters - no environment variables or config files are used.

Required Configuration

# Basic usage - FHIR URL is required
node dist/index.js -f http://localhost:3000/fhir
node dist/index.js --fhir-url https://your-fhir-server.com/fhir

Optional Configuration

# Custom timeout
node dist/index.js -f http://localhost:3000/fhir --timeout 60000

# Legacy API key support
node dist/index.js -f http://localhost:3000/fhir --api-key your-api-key

Getting Help

# View all available options
node dist/index.js --help

# Check version
node dist/index.js --version

Authentication

The FHIR MCP Server includes a comprehensive authentication system supporting multiple authentication modes for secure FHIR server connections. All authentication is configured via CLI flags.

🔐 Authentication Modes

1. None (Default)

No authentication required - suitable for development and open FHIR servers:

node dist/index.js -f http://localhost:3000/fhir
# --auth-type defaults to 'none'

2. Bearer Token Authentication

Static bearer token for API access:

node dist/index.js -f http://localhost:3000/fhir \
  --auth-type bearer \
  --auth-token your-bearer-token

3. OAuth 2.0 Client Credentials

Dynamic OAuth token management with automatic refresh:

node dist/index.js -f http://localhost:3000/fhir \
  --auth-type client_credentials \
  --oauth-client-id your-client-id \
  --oauth-client-secret your-client-secret \
  --oauth-token-url https://auth.server.com/oauth/token \
  --oauth-scope "user/*.read" \
  --oauth-auto-discover

🛠️ Complete CLI Options

All Available Flags

# Required
-f, --fhir-url <url>              FHIR server base URL

# Optional Configuration
-t, --timeout <ms>                Request timeout in milliseconds (default: 30000)
--auth-type <type>                Authentication type: none, bearer, client_credentials (default: none)

# Bearer Token Authentication
--auth-token <token>              Bearer token for authentication

# OAuth 2.0 Client Credentials
--oauth-token-url <url>           OAuth token endpoint URL
--oauth-client-id <id>            OAuth client ID
--oauth-client-secret <secret>    OAuth client secret
--oauth-scope <scope>             OAuth scope
--oauth-auto-discover             Auto-discover OAuth endpoints from FHIR server

# Legacy Support
--api-key <key>                   Legacy API key (deprecated)

# Utility
-V, --version                     Output the version number
-h, --help                        Display help for command

Claude Desktop Configuration Examples

Basic Configuration (No Auth):

{
  "mcpServers": {
    "fhir": {
      "command": "node",
      "args": [
        "C:\\projects\\fhir-mcp\\dist\\index.js",
        "-f",
        "http://localhost:3000/fhir"
      ]
    }
  }
}

With Bearer Token:

{
  "mcpServers": {
    "fhir": {
      "command": "node",
      "args": [
        "C:\\projects\\fhir-mcp\\dist\\index.js",
        "-f",
        "https://your-fhir-server.com/fhir",
        "--auth-type",
        "bearer",
        "--auth-token",
        "your-bearer-token"
      ]
    }
  }
}

With OAuth 2.0 Client Credentials:

{
  "mcpServers": {
    "fhir": {
      "command": "node",
      "args": [
        "C:\\projects\\fhir-mcp\\dist\\index.js",
        "-f",
        "https://your-fhir-server.com/fhir",
        "--auth-type",
        "client_credentials",
        "--oauth-client-id",
        "your-client-id",
        "--oauth-client-secret",
        "your-client-secret",
        "--oauth-token-url",
        "https://auth.server.com/oauth/token",
        "--oauth-scope",
        "user/*.read"
      ]
    }
  }
}

🚀 OAuth Management Tools

The server provides built-in tools for OAuth configuration and management:

`fhir_auth_configure`

Configure authentication settings dynamically:

{
  "tool": "fhir_auth_configure",
  "args": {
    "authType": "client_credentials",
    "tokenUrl": "https://auth.server.com/oauth/token",
    "clientId": "your-client-id",
    "clientSecret": "your-client-secret",
    "scope": "user/*.read"
  }
}

`fhir_auth_test`

Test current authentication configuration:

{
  "tool": "fhir_auth_test"
}

`fhir_token_status`

Check OAuth token status and expiry:

{
  "tool": "fhir_token_status"
}

`fhir_token_refresh`

Force refresh OAuth tokens:

{
  "tool": "fhir_token_refresh"
}

`fhir_oauth_discover`

Auto-discover OAuth endpoints from FHIR server:

{
  "tool": "fhir_oauth_discover",
  "args": {
    "fhirUrl": "https://your-fhir-server.com/fhir"
  }
}

🔧 Advanced OAuth Features

Automatic Token Management

Token Caching: Access tokens cached for performance
Automatic Refresh: Tokens refreshed before expiry (5-minute safety margin)
Error Handling: Robust error recovery and retry logic

SMART on FHIR Auto-Discovery

Automatically discover OAuth endpoints from FHIR server .well-known configuration:

FHIR_OAUTH_AUTO_DISCOVER=true

Searches these endpoints automatically:

{fhirUrl}/.well-known/smart_configuration
{fhirUrl}/.well-known/smart-configuration
{baseUrl}/.well-known/smart_configuration

Security Features

Secure Token Storage: Tokens stored only in memory, never persisted
Connection Security: HTTPS enforcement for OAuth endpoints
Timeout Handling: Configurable timeouts for token requests
Error Recovery: Graceful degradation on authentication failures

✅ Authentication Benefits

✅ Multiple Auth Modes: Support for none, bearer token, and OAuth 2.0 client credentials ✅ Automatic Token Management: Background token refresh with caching ✅ SMART on FHIR Compatible: Auto-discovery of OAuth endpoints ✅ Dynamic Configuration: Runtime authentication configuration changes ✅ Comprehensive Testing: Built-in tools for testing authentication ✅ Secure Implementation: Industry-standard OAuth 2.0 compliance ✅ Explicit Configuration: All settings visible in command line arguments ✅ Production Ready: Robust error handling and token management

🔍 Troubleshooting Authentication

Common Issues

Invalid Client Credentials:

{
  "error": "OAuth token request failed: invalid_client"
}

Verify FHIR_OAUTH_CLIENT_ID and FHIR_OAUTH_CLIENT_SECRET
Check client credentials with OAuth provider

Token Endpoint Not Found:

{
  "error": "Could not discover OAuth endpoints for FHIR server"
}

Set FHIR_OAUTH_TOKEN_URL manually
Verify FHIR server supports SMART on FHIR

Expired Bearer Token:

{
  "error": "Request failed: 401 Unauthorized"
}

Update FHIR_AUTH_TOKEN with valid token
Consider switching to OAuth 2.0 for automatic refresh

Testing Authentication

Test your authentication setup:

# Test with bearer token
node dist/index.js -f http://localhost:3000/fhir \
  --auth-type bearer \
  --auth-token your-token

# Test with OAuth
node dist/index.js -f http://localhost:3000/fhir \
  --auth-type client_credentials \
  --oauth-client-id your-id \
  --oauth-client-secret your-secret \
  --oauth-token-url https://auth.server.com/oauth/token

The OAuth authentication system ensures secure, standards-compliant access to FHIR servers while providing flexibility for different deployment scenarios.

Installation

npm install
npm run build

Usage

Development

# Development mode with CLI flags
npm run build
node dist/index.js -f http://localhost:3000/fhir

Production

npm run build
node dist/index.js -f https://your-fhir-server.com/fhir

Available Tools

Core FHIR Operations

fhir_search: Search FHIR resources by type and parameters
fhir_read: Read a specific FHIR resource by ID
fhir_create: Create new FHIR resources with validation
fhir_update: Update existing FHIR resources
fhir_delete: Delete FHIR resources by ID
fhir_capability: Get FHIR server capabilities and supported resources

Interactive FHIR Operations

fhir_create_interactive: Create FHIR resources with guided input collection for missing fields
fhir_search_guided: Search with interactive parameter collection and guidance
patient_identify: Interactive patient identification with disambiguation for multiple matches
elicit_input: Request specific user input with healthcare context and validation

Validation & Quality

fhir_validate: Validate FHIR resources against R4 specification with AI-powered error explanations
fhir_generate_narrative: Generate AI-enhanced human-readable narratives for resources

AI-Powered Clinical Tools (MCP Sampling)

fhir_clinical_insights: Generate AI-powered clinical insights and analysis from patient data
- Clinical summaries and overviews
- Care gap identification
- Risk assessments and prioritization
- Next-step recommendations

AI-Powered Prompts

fhir_list_prompts: List available contextual prompts by tag or resource type
fhir_get_prompt: Get specific prompts with parameter substitution
fhir_context_prompt: Get contextual prompts for clinical workflows

OAuth Authentication Management

fhir_auth_configure: Configure authentication settings dynamically
fhir_auth_test: Test current authentication configuration
fhir_token_status: Check OAuth token status and expiry
fhir_token_refresh: Force refresh OAuth tokens
fhir_oauth_discover: Auto-discover OAuth endpoints from FHIR server

Configuration & Utilities

get_config: Get current server configuration
send_feedback: Send feedback about server performance
ping: Test server connectivity

FHIR Auto-Completion System

The server provides intelligent auto-completion functionality to enhance the user experience when working with FHIR resources. This system offers contextual suggestions for resource types, search parameters, and other FHIR-related inputs.

🎯 Completion Capabilities

1. Resource Type Completions

Parameter: resourceType
Input: "Pat" → Suggestions: ["Patient"]
Input: "Med" → Suggestions: ["Media", "Medication", "MedicationRequest", ...]

Coverage: All 130+ FHIR R4 resource types
Features: Case-insensitive prefix matching
Usage: Tool parameters requiring FHIR resource type selection

2. Search Parameter Completions

Parameter: parameters
Input: "_" → Suggestions: ["_id", "_lastUpdated", "_tag", "_profile", ...]
Input: "birth" → Suggestions: ["birthdate"]
Input: "family" → Suggestions: ["family"]

Universal Parameters: _id, _lastUpdated, _include, _sort, _count, etc.
Common Parameters: identifier, active, name, subject, patient, etc.
Clinical Parameters: date, code, value, status, category, performer

3. Status Value Completions

Parameter: status
Input: "act" → Suggestions: ["active"]
Input: "comp" → Suggestions: ["completed"]
Input: "prel" → Suggestions: ["preliminary"]

Status Values: active, inactive, completed, draft, final, preliminary
Workflow States: requested, accepted, in-progress, on-hold, stopped

4. Code System Completions

Parameter: code
Input: "loinc" → Suggestions: ["http://loinc.org"]
Input: "snomed" → Suggestions: ["http://snomed.info/sct"]
Input: "hl7" → Suggestions: ["http://hl7.org/fhir/administrative-gender", ...]

Popular Terminologies: LOINC, SNOMED CT, HL7 FHIR code systems
Comprehensive Coverage: Administrative, clinical, and terminology code systems

5. Resource-Specific Search Parameters

Patient: identifier, family, given, birthdate, gender, address, phone, email
Observation: subject, code, value-quantity, date, category, component-code
Condition: clinical-status, verification-status, severity, onset-date
MedicationRequest: medication, intent, priority, authored-on, requester
Encounter: class, type, participant, date, period, location

🚀 Completion Features

MCP Specification Compliance

Result Limits: Maximum 100 completion values per request
Pagination Support: hasMore flag indicates additional results
Total Count: Complete count of matching options
Structured Response: Standardized MCP completion format

Intelligent Filtering

Prefix Matching: Case-insensitive starts-with filtering
Context Awareness: Parameter-specific completion logic
Performance Optimized: Fast response times with efficient algorithms

Enhanced User Experience

Real-time Suggestions: Instant completion as users type
Contextual Help: Parameter-appropriate suggestions
Error Prevention: Reduces typos and invalid parameter usage

🔧 Implementation Architecture

The completion system is built with clean, modular architecture:

FHIRCompletionManager Class

// Core completion manager
class FHIRCompletionManager {
  handleCompletion(params): Promise<CompletionResult>
  getResourceTypeCompletions(value): CompletionResult
  getSearchParameterCompletions(value): CompletionResult
  getStatusCompletions(value): CompletionResult
  getCodeCompletions(value): CompletionResult
  getResourceSpecificSearchParameters(resourceType, value): CompletionResult
}

Completion Integration

Server Capability: completions: {} capability declared
Request Handler: CompleteRequestSchema handler registered
Comprehensive Testing: 28 dedicated test cases ensuring reliability

💡 Usage Examples

Resource Type Completion

// User types "Pat" in resourceType field
{
  "ref": { "name": "resourceType", "value": "Pat" },
  "completion": {
    "values": ["Patient"],
    "total": 1,
    "hasMore": false
  }
}

Search Parameter Completion

// User types "_" in parameters field
{
  "ref": { "name": "parameters", "value": "_" },
  "completion": {
    "values": ["_id", "_lastUpdated", "_tag", "_profile", ...],
    "total": 12,
    "hasMore": false
  }
}

Status Completion

// User types "act" in status field
{
  "ref": { "name": "status", "value": "act" },
  "completion": {
    "values": ["active"],
    "total": 1,
    "hasMore": false
  }
}

✅ Benefits for FHIR Development

✅ Improved Productivity: Faster parameter entry with intelligent suggestions ✅ Reduced Errors: Fewer typos and invalid parameter usage ✅ Enhanced Discovery: Learn FHIR parameters through contextual suggestions ✅ MCP Integration: Native completion support in MCP-compatible tools ✅ Extensible Design: Easy to add new completion types and logic ✅ Performance Optimized: Fast response times for real-time user experience

The auto-completion system transforms FHIR development from manual parameter lookup to an intelligent, guided experience that accelerates workflow and reduces cognitive load.

Available Resources

config://server: Server configuration information

FHIR R4 Documentation System

The server includes a comprehensive FHIR R4 documentation provider that gives Claude deep insight into the FHIR specification:

Built-in FHIR Documentation

Core Documentation Resources

fhir://r4/specification - Complete FHIR R4 specification overview and key concepts
fhir://r4/resources - All 145+ FHIR resource types with descriptions and HL7.org links
fhir://r4/datatypes - Primitive, complex, and special data types reference
fhir://r4/search - Search parameters, modifiers, chaining, and examples
fhir://r4/validation - Validation rules, invariants, and profile conformance
fhir://r4/terminology - Code systems, value sets, and terminology services

Resource Categories Covered

Foundation Resources: Base types, elements, extensions, narratives
Base Resources: Patient, Practitioner, Organization, Location, Device
Clinical Resources: Observation, Condition, Procedure, Medication*, Encounter, DiagnosticReport
Financial Resources: Claim, Coverage, ExplanationOfBenefit, Account
Workflow Resources: Appointment, Schedule, Task, Slot

Advanced FHIR Features

Search Capabilities: Chaining, reverse chaining, modifiers, result parameters
Validation Framework: Structural, cardinality, terminology, profile validation
Terminology Services: $lookup, $validate-code, $expand, $translate operations
Data Types: 18 primitive types, 15+ complex types, special healthcare types
Best Practices: Implementation guidance, performance tips, security considerations

Benefits for AI Integration

✅ Specification Compliance: Claude has direct access to official FHIR R4 specification ✅ Resource Expertise: Detailed knowledge of all FHIR resource types and their purposes ✅ Validation Guidance: Understanding of FHIR validation rules and requirements ✅ Search Mastery: Advanced search capabilities with proper parameter usage ✅ Terminology Awareness: Code systems, value sets, and binding requirements ✅ Implementation Support: Best practices for FHIR API development and integration

AI-Powered Clinical Intelligence (MCP Sampling)

The FHIR MCP Server integrates MCP Sampling to provide sophisticated AI-powered clinical intelligence while maintaining client control over model access and selection.

🧠 AI-Enhanced Features

1. Intelligent Validation Explanations

Transform technical FHIR validation errors into actionable guidance:

❌ Traditional: "Element 'Patient.name': minimum required = 1, but only found 0"
✅ AI-Enhanced: "The Patient resource requires at least one name. Add a name with at least a family name or given name. For example: {'family': 'Smith'} or {'given': ['John']}. This ensures the patient can be properly identified in clinical workflows."

Features:

Plain English explanations of validation errors
Specific fix suggestions with examples
Clinical context for why validation rules exist
Graceful fallback to standard errors when AI unavailable

2. Enhanced Narrative Generation

AI-powered clinical narratives with multiple styles:

🏥 Clinical Style: "Patient John Doe, DOB 1985-06-15, presents with elevated blood pressure readings (140/90 mmHg) recorded on 2024-01-15. Clinical assessment indicates hypertension requiring monitoring and potential intervention."

👥 Patient-Friendly: "This is John Doe, born June 15, 1985. His recent blood pressure reading was higher than normal at 140/90. This means his blood pressure needs to be watched and may need treatment."

🔧 Technical: "Patient resource (ID: patient-123) with HumanName elements and Observation references. Blood pressure Observation uses LOINC code 85354-9 with Quantity value and mmHg UCUM unit."

Features:

Three narrative styles: clinical, patient-friendly, technical
Clinical context and relationships highlighted
FHIR compliance maintained in generated narratives
Fallback to client-side generation when AI unavailable

3. Clinical Decision Support

AI-powered insights and analysis from patient data:

📊 Clinical Summary: "Jane Smith shows well-controlled diabetes with recent HbA1c of 6.8%. Blood pressure trending upward (current: 145/92). Medication adherence appears good based on prescription fills."

🔍 Care Gaps: "Missing: Annual diabetic eye exam (last: 2022), Foot examination (overdue by 4 months), Lipid panel (last: 8 months ago)."

⚠️ Risk Assessment: "Moderate cardiovascular risk due to diabetes + hypertension combination. Blood pressure elevation trend warrants attention."

📋 Next Steps: "1. Schedule ophthalmology referral for diabetic screening, 2. Consider ACE inhibitor adjustment for BP control, 3. Order lipid panel and HbA1c follow-up."

Analysis Types:

Clinical Summary: Comprehensive overview of patient status
Care Gaps: Identification of missing documentation or overdue care
Risk Assessment: Clinical risk stratification and priorities
Next Steps: Evidence-based recommendations for follow-up

🔒 Privacy & Security

✅ Client Control: LLM remains with client, server never has direct model access ✅ Permission Respect: Honors client model selection and usage policies ✅ Graceful Degradation: All features work with or without sampling support ✅ Clinical Boundaries: Appropriate disclaimers and scope limitations ✅ Data Privacy: No patient data sent to external AI services

🚀 Architecture Benefits

Zero Infrastructure: No AI model hosting or API keys required on server
Cost Efficiency: Uses client's existing LLM quota and permissions
Scalability: Server remains lightweight while gaining AI capabilities
Flexibility: Works with any MCP-compatible AI client and model
Reliability: Robust fallback handling ensures consistent functionality

📋 Usage Examples

# Validate with AI explanations
fhir_validate --resourceType Patient --resource {...}

# Generate AI-enhanced narratives
fhir_generate_narrative --resourceType Patient --resource {...} --style clinical

# Get clinical insights
fhir_clinical_insights --patientData {...} --analysisType summary

The documentation system is powered by the FHIRDocumentationProvider class, ensuring maintainable and up-to-date FHIR knowledge.

MCP Resource Templates

The server implements comprehensive MCP Resource Templates for parameterized, discoverable resource access patterns:

Template Categories

1. FHIR Documentation Templates

fhir://r4/{docType}

Parameters: docType ∈ [specification, resources, datatypes, search, validation, terminology]
Usage: fhir://r4/specification, fhir://r4/resources, etc.
Purpose: Dynamic access to any FHIR R4 documentation type

2. Contextual FHIR Prompts

prompt://fhir/{category}/{promptId}

Parameters:
- category ∈ [clinical, security, technical, workflow]
- promptId - Specific prompt identifier
Usage: prompt://fhir/clinical/patient-assessment
Purpose: Category-organized prompt access

3. Resource-Specific Prompts

prompt://fhir/resource/{resourceType}

Parameters: resourceType ∈ [Patient, Observation, Condition, MedicationRequest, ...]
Usage: prompt://fhir/resource/Patient
Purpose: Tailored prompts for specific FHIR resource types

4. Workflow Context Templates

context://fhir/{workflow}/{userType}

Parameters:
- workflow ∈ [admission, discharge, medication-review, care-planning, billing, scheduling]
- userType ∈ [clinical, administrative, technical, billing] (default: clinical)
Usage: context://fhir/admission/clinical
Purpose: Workflow-specific contextual guidance

5. Configuration Templates

config://{configType}

Parameters: configType ∈ [server, fhir, security, prompts, documentation]
Usage: config://fhir, config://prompts
Purpose: Access different configuration aspects

6. Validation Templates

validation://fhir/{resourceType}/{level}

Parameters:
- resourceType - Any FHIR resource type
- level ∈ [structure, cardinality, terminology, profile, invariants] (default: structure)
Usage: validation://fhir/Patient/terminology
Purpose: Resource-specific validation guidance

7. Search Examples Templates

examples://fhir/{resourceType}/search

Parameters: resourceType - Any FHIR resource type
Usage: examples://fhir/Observation/search
Purpose: Dynamic search pattern examples

Template Benefits

✅ Discoverable API: Templates make all resource patterns visible in MCP Inspector ✅ Parameter Validation: Built-in validation for enum values and required parameters ✅ Dynamic Construction: Claude can programmatically build resource URIs ✅ Interactive Testing: Easy parameter substitution in development tools ✅ Self-Documenting: Templates show available parameters and allowed values ✅ Type Safety: Full schema validation with clear error messages

Using Templates

Templates are automatically discovered by MCP clients and displayed in tools like MCP Inspector:

// List all available templates
const templates = await client.listResourceTemplates();

// Use resolved template URIs
const docContent = await client.readResource('fhir://r4/validation');
const promptContent = await client.readResource('prompt://fhir/clinical/patient-assessment');
const contextContent = await client.readResource('context://fhir/admission/clinical');

The template system is powered by the ResourceTemplateManager class, providing a structured approach to resource discovery and access.

MCP Roots

The server implements comprehensive MCP Roots functionality for file system access patterns:

Available Root Systems

The FHIR MCP server provides 5 specialized root systems for healthcare development:

1. FHIR Implementation Guides

file://fhir-ig

Purpose: Access to FHIR Implementation Guide files and profiles
Usage: Custom profiles, extensions, and regional FHIR specifications
Examples: US Core, UK Core, AU Base, custom hospital profiles

2. FHIR Test Data Resources

file://fhir-test-data

Purpose: Sample FHIR resources for testing and development
Usage: Test patient data, synthetic clinical records, edge cases
Examples: Patient bundles, observation sets, medication orders

3. FHIR Server Configuration

file://fhir-config

Purpose: Server configuration files and environment settings
Usage: Endpoint configs, authentication settings, feature flags
Examples: Server capabilities, security policies, validation rules

4. FHIR Terminology Resources

file://fhir-terminology

Purpose: Code systems, value sets, and terminology files
Usage: Custom terminologies, local code systems, translations
Examples: SNOMED CT subsets, LOINC mappings, ICD-10 codes

5. FHIR Custom Profiles

file://fhir-profiles

Purpose: Organization-specific FHIR resource profiles
Usage: Constrained resource definitions, validation profiles
Examples: Patient admission profiles, lab result constraints

Root Benefits for Development

✅ File System Integration: Direct access to FHIR development assets ✅ Development Workflow: Seamless integration with MCP-enabled tools ✅ Version Control: Easy management of FHIR artifacts in repositories ✅ Collaboration: Shared access to FHIR resources across teams ✅ Testing Support: Organized test data and validation resources ✅ Configuration Management: Centralized server and profile configuration

Using Roots

Roots are automatically discovered by MCP clients and provide file system access:

// List all available roots
const roots = await client.listRoots();

// Access FHIR Implementation Guides
// Files under file://fhir-ig/ become accessible

// Access test data resources
// Files under file://fhir-test-data/ become accessible

// Access configuration files
// Files under file://fhir-config/ become accessible

The root system enables Claude and other AI assistants to directly access, read, modify, and manage FHIR development files, making it easier to:

Review and update FHIR profiles
Access test data for validation
Modify server configurations
Work with custom terminologies
Collaborate on Implementation Guides

FHIR Intelligent Prompts System

The server includes a comprehensive prompt management system providing contextual AI assistance for FHIR operations:

Prompt Categories

Clinical Prompts

Patient Care: Prompts for patient assessment, treatment planning, and care coordination
Clinical Documentation: Templates for clinical notes, discharge summaries, and care plans
Diagnostic Support: Guidance for interpreting observations, lab results, and diagnostic reports
Medication Management: Prompts for prescribing, medication reconciliation, and adverse event monitoring

Security Prompts

Data Privacy: HIPAA compliance and PHI handling guidelines
Access Control: Role-based access patterns and authorization checks
Audit & Compliance: Security logging, audit trail generation, and regulatory compliance
Risk Assessment: Security vulnerability identification and mitigation strategies

Technical Prompts

Resource Validation: FHIR R4 compliance checking and structure validation
Integration Patterns: Best practices for FHIR API integration and interoperability
Performance Optimization: Query optimization, caching strategies, and scalability patterns
Error Handling: Robust error management and recovery procedures

Workflow Prompts

Care Workflows: Clinical pathways, treatment protocols, and care coordination
Administrative Workflows: Scheduling, billing, insurance processing, and claims management
Quality Workflows: Quality measures, outcome tracking, and performance metrics
Research Workflows: Clinical research protocols, data collection, and analysis patterns

Using Prompts

# List all available prompts
fhir_list_prompts

# Get prompts for specific resource type
fhir_list_prompts --resourceType=Patient

# Get prompts by category/tag
fhir_list_prompts --tag=clinical

# Get a specific prompt with parameters
fhir_get_prompt --id=patient-assessment --args='{"patientAge":"65","condition":"diabetes"}'

# Get contextual prompt for workflow
fhir_context_prompt --resourceType=Patient --workflow=admission --userType=clinical

Prompt Features

Dynamic Parameter Substitution: Prompts adapt based on provided parameters
Context-Aware Selection: Automatic prompt selection based on resource type and workflow
Multi-User Support: Tailored prompts for clinicians, administrators, and technical users
Localization Ready: Framework supports multiple languages and regional variations
Caching & Performance: Intelligent caching for fast prompt retrieval

Using FHIR Documentation Resources

Claude can access comprehensive FHIR R4 documentation through MCP resources:

// Access FHIR specification overview
await client.readResource('fhir://r4/specification')

// Get complete resource type definitions
await client.readResource('fhir://r4/resources')

// Learn about FHIR data types
await client.readResource('fhir://r4/datatypes')

// Master FHIR search capabilities
await client.readResource('fhir://r4/search')

// Understand validation requirements
await client.readResource('fhir://r4/validation')

// Access terminology guidance
await client.readResource('fhir://r4/terminology')

These resources provide Claude with deep knowledge of FHIR R4 specifications, enabling more accurate and compliant healthcare integrations.

Interactive Elicitation System

The server includes a sophisticated elicitation system that provides interactive user input collection for complex healthcare workflows. This system transforms static FHIR operations into guided, conversational experiences.

Key Features

🎯 Context-Aware Prompts

Generates healthcare-appropriate guidance based on FHIR resource type and clinical workflow
Adapts messaging for different user types (clinical, administrative, technical)
Provides relevant examples and validation patterns for medical data entry

🔍 Smart Validation

Healthcare-Specific Patterns: Birth dates (YYYY-MM-DD), FHIR IDs, gender codes
Data Type Validation: String, number, boolean, object, and array inputs
Range Validation: Minimum/maximum values for numeric inputs
Enumeration Validation: Controlled vocabularies and code systems
Pattern Matching: Regular expressions for structured data formats

🏥 Clinical Workflow Integration

Admission Workflows: Prompts for admission type, priority, department selection
Discharge Workflows: Destination, follow-up requirements, medication changes
Patient Identification: Disambiguation when multiple patients match search criteria
Resource Creation: Guided collection of required FHIR fields

Interactive Tools

`fhir_create_interactive`

Creates FHIR resources with step-by-step guidance for missing information:

// Example: Create a patient with guided input
{
  "tool": "fhir_create_interactive",
  "args": {
    "resourceType": "Patient",
    "resource": {
      "resourceType": "Patient"
      // Missing required fields will trigger prompts
    }
  }
}

// Response: Elicitation request for missing data
{
  "requiresInput": true,
  "elicitation": {
    "prompt": "Please provide the status for Patient during creation...",
    "context": "fhir_create - status elicitation",
    "required": true,
    "validation": { "type": "string", "enum": ["active", "inactive"] },
    "examples": ["active", "inactive"]
  }
}

`fhir_search_guided`

Provides interactive search parameter collection:

// Example: Search patients with guidance
{
  "tool": "fhir_search_guided",
  "args": {
    "resourceType": "Patient"
    // No parameters triggers guidance
  }
}

// Response: Search parameter elicitation
{
  "requiresInput": true,
  "elicitation": {
    "prompt": "To continue with this healthcare workflow, please provide...",
    "examples": [
      "family=Smith&given=John",
      "birthdate=1990-01-15",
      "identifier=MRN12345"
    ]
  }
}

`patient_identify`

Handles patient identification with disambiguation:

// Example: Multiple patients found
{
  "tool": "patient_identify",
  "args": {
    "searchParams": { "family": "Smith" }
  }
}

// Response: Disambiguation request
{
  "requiresInput": true,
  "multipleMatches": 3,
  "elicitation": {
    "prompt": "Multiple patient options were found:\n\n1. Smith, John (DOB: 1990-01-01, ID: patient-001)\n2. Smith, Jane (DOB: 1985-05-15, ID: patient-002)\n3. Smith, Robert (DOB: 1978-11-30, ID: patient-003)\n\nPlease respond with the number of your choice (1-3).",
    "validation": { "type": "number", "minimum": 1, "maximum": 3 }
  }
}

`elicit_input`

Direct input requests with healthcare context:

// Example: Custom input with validation
{
  "tool": "elicit_input",
  "args": {
    "prompt": "Please enter the patient's medical record number",
    "validation": {
      "type": "string",
      "pattern": "^MRN\\d+$"
    },
    "examples": ["MRN12345", "MRN67890"]
  }
}

Validation Capabilities

The elicitation system provides comprehensive validation for healthcare data:

Pattern Validation

// FHIR ID validation
{ "type": "string", "pattern": "^[A-Za-z0-9\\-\\.]{1,64}$" }

// Birth date validation
{ "type": "string", "pattern": "^\\d{4}-\\d{2}-\\d{2}$" }

// Medical record number validation
{ "type": "string", "pattern": "^MRN\\d+$" }

Enumeration Validation

// Gender codes
{ "type": "string", "enum": ["male", "female", "other", "unknown"] }

// Observation status
{ "type": "string", "enum": ["final", "preliminary", "amended", "cancelled"] }

Range Validation

// Age validation
{ "type": "number", "minimum": 0, "maximum": 150 }

// Priority selection
{ "type": "number", "minimum": 1, "maximum": 5 }

Resource Disambiguation

The system intelligently formats healthcare resources for disambiguation:

Patient Formatting

1. Smith, John (DOB: 1990-01-01, ID: patient-001)
2. Johnson, Mary (DOB: 1985-05-15, ID: patient-002)

Practitioner Formatting

1. Dr. Jane Smith (Cardiology)
2. Dr. Robert Johnson (Emergency Medicine)

Error Handling & User Experience

Validation Errors

Clear, actionable error messages
Specific format requirements
Examples of correct input

Required Field Handling

"This field is required and cannot be empty."
"Value must be a valid number."
"Value does not match the required format."

Healthcare Context

Clinical terminology in prompts
Workflow-appropriate guidance
User-type specific messaging

Benefits for Healthcare Workflows

✅ Reduced Errors: Comprehensive validation prevents invalid healthcare data entry ✅ Improved UX: Guided workflows make complex FHIR operations accessible ✅ Clinical Context: Healthcare-appropriate prompts and validation patterns ✅ Workflow Integration: Seamless integration with admission, discharge, and care workflows ✅ Multi-User Support: Tailored experiences for clinicians, administrators, and technical users ✅ Comprehensive Testing: 415+ test cases ensure robust validation and error handling

The elicitation system transforms static FHIR operations into intelligent, conversational experiences that guide users through complex healthcare data collection with clinical accuracy and regulatory compliance.

Example Usage with Claude Desktop

Add to your Claude Desktop configuration:

{
  "mcpServers": {
    "fhir": {
      "command": "node",
      "args": [
        "C:\\projects\\fhir-mcp\\dist\\index.js",
        "-f",
        "http://localhost:3000/fhir",
        "--api-key",
        "your-api-key"
      ]
    }
  }
}

Real-Time Server Notifications

The FHIR MCP Server includes a comprehensive notification system powered by the dedicated FHIRNotificationManager class that provides real-time updates about server operations, connection status, and progress tracking. These notifications appear in the Server Notifications section of MCP Inspector and other MCP-compatible tools.

🏗️ Notification Architecture

The notification system is built with a clean, modular architecture:

FHIRNotificationManager Class

class FHIRNotificationManager {
  // Core notification methods
  notifyConnectionStatus(status, details?)
  notifyProgress(operation, progress, details?)
  notifyError(error, context?)
  notifyResourceOperation(operation, resourceType, details?)
  notifyValidation(type, message, resourceType?, details?)

  // Enhanced notification methods
  notifyServerStartup(capabilities, transport?)
  notifyOperationStart(operation, resourceType?, details?)
  notifyOperationComplete(operation, resourceType?, details?)
  notifyBatchOperation(operation, resourceTypes, count, details?)
  notifyValidationSummary(resourceType, errorCount, warningCount, details?)
  notifyConnectionTest(success, responseTime?, details?)
  notifyOperationTimeout(operation, timeout, details?)
}

Type-Safe Notification Interfaces

ConnectionStatusData: Connection monitoring with status tracking
OperationProgressData: Progress updates with automatic value clamping (0-100)
ResourceOperationData: FHIR operation tracking with resource context
ErrorData: Error reporting with detailed context information
ValidationData: Validation results with error/warning categorization

🔔 Notification Types

1. Connection Status Notifications

Real-time FHIR server connection monitoring:

{
  "type": "connection_status",
  "status": "connected",
  "fhirUrl": "http://localhost:3000",
  "message": "Successfully connected to FHIR server",
  "timeout": 30000,
  "timestamp": "2025-09-14T15:30:00.000Z"
}

Status Types:

connecting: Attempting to connect to FHIR server
connected: Successful connection established
error: Connection failed (ECONNREFUSED, ENOTFOUND, ETIMEDOUT)
disconnected: Connection lost or terminated

2. Operation Progress Notifications

Real-time progress tracking for long-running operations:

{
  "type": "operation_progress",
  "operation": "search",
  "progress": 75,
  "resourceType": "Patient",
  "message": "Search completed: found 42 Patient resources",
  "resultCount": 42,
  "timestamp": "2025-09-14T15:30:15.000Z"
}

Progress Stages:

0%: Operation started
50%: Request submitted/executing
100%: Operation completed with results

3. Resource Operation Notifications

Detailed tracking of all FHIR operations:

{
  "type": "resource_operation",
  "operation": "create",
  "resourceType": "Patient",
  "resourceId": "patient-123",
  "message": "Creating Patient resource",
  "parameters": { "validate": true },
  "timestamp": "2025-09-14T15:30:30.000Z"
}

Operation Types:

create: Resource creation operations
read: Resource retrieval by ID
update: Resource modification
delete: Resource removal
search: Resource queries and filtering

4. Error Notifications

Comprehensive error reporting with actionable context:

{
  "type": "error",
  "message": "Failed to create Patient resource",
  "context": {
    "resourceType": "Patient",
    "error": "Validation failed: missing required field 'status'",
    "statusCode": 400,
    "errorCode": "VALIDATION_ERROR"
  },
  "timestamp": "2025-09-14T15:30:45.000Z"
}

Error Categories:

Connection Errors: Network, timeout, authentication issues
Validation Errors: FHIR compliance and data validation failures
Operation Errors: Failed CRUD operations with detailed context
Server Errors: FHIR server-side errors with HTTP status codes

5. Validation Notifications

FHIR resource validation results with detailed feedback:

{
  "type": "validation",
  "validationType": "warning",
  "message": "Validation passed with 2 warning(s)",
  "resourceType": "Patient",
  "errorCount": 0,
  "warningCount": 2,
  "timestamp": "2025-09-14T15:31:00.000Z"
}

Validation Types:

error: Critical validation failures preventing resource creation
warning: Non-critical issues that allow resource creation but need attention

6. Server Startup Notifications

Comprehensive server initialization status:

{
  "type": "server_startup",
  "message": "FHIR MCP Server started successfully",
  "transport": "StdioServerTransport",
  "fhirUrl": "http://localhost:3000",
  "capabilities": {
    "tools": true,
    "resources": true,
    "notifications": true
  },
  "timestamp": "2025-09-14T15:25:00.000Z"
}

📊 MCP Inspector Integration

All notifications automatically appear in MCP Inspector's Server Notifications section:

Real-time Updates: See operations as they execute
Structured Data: JSON format with complete context
Timestamp Tracking: Precise timing for performance analysis
Error Debugging: Detailed error context for troubleshooting
Progress Monitoring: Visual progress bars for long operations
Connection Health: Live connection status monitoring

🎯 Benefits for Development

✅ Real-time Monitoring: Track FHIR operations as they execute ✅ Debugging Support: Detailed error context and validation feedback ✅ Performance Analysis: Operation timing and progress tracking ✅ Connection Health: Live FHIR server connectivity status ✅ Validation Feedback: Immediate FHIR compliance reporting ✅ Operational Insights: Complete audit trail of server activities

🚀 Using Notifications

Notifications work automatically with any MCP-compatible tool:

MCP Inspector: View in Server Notifications panel
Claude Desktop: Notifications inform Claude about operation status
Custom MCP Clients: Receive notifications via logging/message events
Development Tools: Real-time feedback during FHIR development

The notification system provides unprecedented visibility into FHIR operations, making development, debugging, and monitoring significantly more efficient.

Development

Project Status

Current Version: 1.10.1 FHIR Version: R4 Node.js: 16+ required TypeScript: 5.0+

Features & Capabilities

✅ Core FHIR Operations - Full CRUD operations with validation ✅ OAuth Authentication System - Comprehensive authentication with support for none, bearer token, and OAuth 2.0 client credentials with automatic token management ✅ FHIR Auto-Completion System - Intelligent completion for resource types, search parameters, status values, and code systems with MCP specification compliance ✅ Interactive Elicitation System - Guided user input collection with healthcare context and validation ✅ AI-Powered Clinical Insights - MCP sampling integration for intelligent clinical analysis, care gap identification, and decision support ✅ Real-Time Notifications - Modular notification system with dedicated FHIRNotificationManager class providing 12 notification methods for comprehensive monitoring ✅ Intelligent Validation - Complete R4 specification compliance checking with AI-powered error explanations ✅ Enhanced Narrative Generation - AI-enhanced human-readable resource descriptions with multiple style options ✅ Comprehensive FHIR Documentation - Built-in R4 specification, resource types, data types, search, validation, and terminology guidance ✅ MCP Resource Templates - 7 parameterized template categories for discoverable, dynamic resource access ✅ MCP Roots - 5 specialized file system roots for FHIR development assets (Implementation Guides, test data, configuration, terminology, profiles) ✅ Intelligent Prompts - 50+ contextual AI prompts for healthcare workflows ✅ Patient Disambiguation - Smart handling of multiple patient matches with clinical context ✅ Healthcare Validation - FHIR-specific patterns for IDs, dates, codes, and clinical data ✅ Security Framework - HIPAA-compliant data handling and audit logging ✅ Multi-Server Support - Works with any FHIR R4 compatible server ✅ MCP Integration - Full Model Context Protocol compatibility with Inspector support ✅ TypeScript - Complete type safety and IntelliSense support ✅ Comprehensive Testing - 500+ test cases with full validation coverage ✅ Modular Architecture - Clean separation with dedicated providers for prompts, documentation, templates, elicitation, and completions

Development Scripts

npm run dev              # Development mode with hot reload
npm run build           # Build TypeScript to JavaScript
npm run start           # Start production server
npm run lint            # ESLint code quality check
npm run debug           # Debug mode with inspector
npm run inspect         # MCP Inspector for testing
npm run release         # Semantic release (automated)

Code Quality & Review

This project uses automated code review powered by Claude AI:

Automatic Reviews: Every pull request gets analyzed for code quality, FHIR compliance, and security
Interactive Reviews: Mention @claude in PR comments for specific feedback
Security Focus: Specialized healthcare security analysis including PHI handling and HIPAA considerations
ESLint Integration: Comprehensive TypeScript linting with healthcare-specific rules

See Claude Setup Guide for configuration details.

Testing & Quality Assurance

npm test               # Run comprehensive Jest test suite (500+ tests)
npm run lint           # Code style and quality checks
npm run build          # TypeScript compilation validation
npm run inspect        # Interactive MCP testing with inspector

The project includes:

Comprehensive Test Suite: 500+ passing tests with Jest framework
Unit Test Coverage: All core functionality including elicitation system
Healthcare Validation Testing: FHIR-specific patterns and edge cases
Integration Testing: MCP tool handlers and workflow validation
ESLint Configuration: Comprehensive TypeScript rules
Semantic Versioning: Automated releases with conventional commits
Pre-commit Hooks: Code quality validation before commits
CI/CD Pipeline: Automated testing and deployment

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Package last updated on 18 Sep 2025

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