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smart-fhir

Ein Connector, der keinen Patienten erfindet.

MCP v1 transport stdio FHIR R4 4.0.1 SMART 2.2.0 writes off

tools 4 sandbox public synthetic empty search stays empty unknown id 404 PHI none

Installation · Tools · So funktioniert’s · Grenzen


Installation

Nur stdio. Nach dem TypeScript-Build einen lokalen Connector hinzufügen:

name: smart-fhir
command: node
args: dist/index.js
npm install
npm run build

Umgebung dafür (Standardwerte, keine Secrets):

FHIR_ISS = https://launch.smarthealthit.org/v/r4/fhir
FHIR_VERSION = R4
FHIR_AUTH_MODE = open
FHIR_WRITE = off
FHIR_AUDIT_PATH = ./audit/audit.jsonl

Lege keine Secret-Werte ins Repository ab. Kein öffentlicher HTTP-Port. Kein TCP-Bind.

Morgen-Shortcut (gleiche Umgebung)

npx -y tsx src/index.ts

Siehe Skripte in package.json: install, build, test, prove.

Related MCP server: Healthpoint MCP Server

Tools

Vier Tools. Kein create / update / delete.

Tool

Funktion

smart_discover

GET {iss}/.well-known/smart-configuration. Liefert geparstes JSON oder einen eindeutigen Fehler. Erfindet keine Endpunkte.

fhir_auth_status

{ mode, iss, fhir_version: "R4", write: "off", token_present, discovery_ok, last_error? }. Gibt niemals Token oder PEM aus.

fhir_search

GET {iss}/{resourceType}?... _Standard 10, max 50. Eine Seite. Leeres Bundle wird unverändert zurück.

fhir_read

GET {iss}/{resourceType}/{id}. 404 ist nicht gefunden und keine erfundene Ressource.

resourceType-Allowlist: Patient | Observation | Condition | MedicationRequest | Encounter. Alles andere → { ok: false, error: "resourceType not in v1 allowlist" }.

So funktioniert’s

FHIR_VERSION muss R4 sein. Alles andere verweigert den Start.

Thema

URL

Wie einzuordnen

FHIR-Index (veröffentlichte Seite ist R5 5.0.0)

http://hl7.org/fhir/

Nur offizieller Index. Nicht implementiert.

FHIR R4 (v1)

https://hl7.org/fhir/r4/

FHIR Release 4, 4.0.1. Ressourcenmodell.

SMART App Launch 2.2.0 (STU 2.2)

https://hl7.org/fhir/smart-app-launch/

Aktuell veröfentlichter SMART IG. Basierend auf FHIR R4.

App Launch + Autorisierung

https://hl7.org/fhir/smart-app-launch/app-launch.html

Discovery, Standalone-/EHR-Launch, PKCE, Token. App Launch (code+PKCE) ist in v1 nicht enthalten.

Backend Services

https://hl7.org/fhir/smart-app-launch/backend-services.html

client_credentials + Private-Key-JWT. Implementiert; nur verwendet, wenn die Umgebung entsprechend gesetzt ist.

ISS-Zulassung (abschließender Schrägstrich wird entfernt, alles andere wird abgelehnt):

  • https://sandbox.smarthealthit.org/v/r4/fhir (Standard)

  • https://r4.smarthealthit.org

  • https://hapi.fhir.org/baseR4

Setze FHIR_ISS auf eine andere zugelassene Basis, um auf eine andere ISS zu zeigen. Eine neue ISS muss zuerst geprüft werden. Weisen Sie dieses nicht auf eine Live-EHR ohne diese Prüfung und eine echte client_id.

FHIR_AUTH_MODE

Verhalten

open (Standard)

Discovery, dann FHIR GET ohne Authorization. Eine Discovery-404 ist im open-Modus nicht fatal (wird geloggt; weiter geht’s). 401/403 von FHIR → { ok: false, http_status, ... }.

bearer

Gleiche Discovery. FHIR GET mit Authorization-Bearer-Token.

backend_jwt

Nur wenn sowohl FHIR_CLIENT_ID (oder SMART_CLIENT_ID) als auch FHIR_PRIVATE_KEY_PEM existieren. SMART Backend Services JWT. Fehlende Umgebungsvariable → Verweigerung des Starts. Erfindet keine Zugangsdaten.

App Launch (code+PKCE) ist nicht enthalten. FHIR_REDIRECT_URI ist reserviert und ungenutzt.

Fehlerfall Authentifizierung: { ok: false, http_status, issue?, error? }. Niemals eine synthetische Patientenseite.

FHIR_WRITE ist standardmäßig off. v1 hat keine Schreib-Tools, selbst wenn jemand on setzt. Schreibvorgänge senden kein AuditEvent per POST an FHIR.

Name

Standardwert

Hinweise

FHIR_ISS

Standard-Launcher R4

Muss in der Zulassungsliste bleiben

FHIR_VERSION

R4

Alles andere ablehnen

FHIR_AUTH_MODE

open

open / bearer / backend_jwt

FHIR_WRITE

off

Schreibzugriffe bleiben in v1 aus

FHIR_AUDIT_PATH

/workspace/smart-fhir-mcp/audit/audit.jsonl

Nur Append Datei JSONL; lokal ./audit/audit.json1 setzen

FHIR_ACCESS_TOKEN

nicht gesetzt

Nur für Bearer

FHIR_CLIENT_ID

nicht gesetzt

Backend Services

SMART_CLIENT_ID

nicht gesetzt

Alias für FHIR_CLIENT_ID

FHIR_PRIVATE_KEY_PEM

nicht gesetzt

Backend Services JWT

FHIR_JWKS_URL

nicht gesetzt

Reserviert, falls eine EHR JWKS verwenden will

FHIR_SCOPE

fünf system/*.rs-Typen

Überschreibung im JWT-Modus

FHIR_REDIRECT_URI

nicht gesetzt

Reserviert für später. App Launch

Auditzeilen: ts, tool, iss, mode, resourceType, id?, http_status, entry_count?. Kein Ressourcenrumpf, kein Token, kein PEM, keine Name/MRN-Abfragewerte.

Grenzen

  • R5 / R4B als Standard. Zusätzliche Resourcentypen. CRUD. Bulk. App-Launch (Browser/PKCE).

  • Echte EHR / echte PHI. Produktionsbereitstellung. Öffentliches Binding oder Streamable HTTP.

  • momentum / fhirhydrant / Atrium / Pinecone / Medplum.

  • Kein Medizinprodukt. Stellt keine Diagnosen, behandelt nichts und speichert keine PHI.


Keine PHI. Keine Live-EHR.

Available Tools

4 tools
fhir_auth_statusFHIR auth statusA

Report mode, ISS, R4 lock, write=off, token_present, discovery_ok. Never prints token or PEM.

ParametersJSON Schema
NameRequiredDescriptionDefault

No parameters

TDQS

A3.5/5.0
Behavior3/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

The description adds the behavioral note 'Never prints token or PEM', which is a valuable safety disclosure not available in annotations (since none are provided). It also lists exactly what will be reported. However, it does not state whether the operation is read-only, whether it can fail (e.g., if discovery hasn't been run), or what the response format will be. Given zero annotations, the description carries the burden but provides only partial behavioral transparency.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness5/5

Is the description appropriately sized, front-loaded, and free of redundancy?

The description is a single, tightly written sentence that front-loads the verb 'Report' and then enumerates the status fields. It ends with a concise safety disclaimer. There is no fluff or repetition; every word earns its place. This is an exemplary model of conciseness.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness4/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

For a zero-parameter tool with no output schema, the description lists all the status values it reports and adds a safety constraint. It lacks details on the exact output structure (e.g., JSON keys vs. plain text) and does not specify whether the tool requires prior setup (like discovery), but these are minor given the tool's simplicity. Overall, it provides enough context for an agent to call and interpret the results reasonably.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters4/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

The tool has zero parameters (schema is an empty object), so the baseline for parameter semantics is 4 according to the rubric. The description correctly mentions the fields that will be reported, which are effectively the tool's 'output' rather than input parameters. Since there are no parameters to document, the description adds what little meaning is needed.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose4/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description uses the verb 'Report' and lists specific status fields (mode, ISS, R4 lock, etc.), making the tool's purpose clear: to report FHIR authentication status. It is distinguishable from siblings like fhir_search and fhir_read by focusing on auth state rather than data operations, and from smart_discover by being a status check. However, it does not explicitly differentiate itself from siblings in the text.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines2/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The description provides no guidance on when to use this tool versus the sibling tools. It doesn't mention scenarios like 'before calling fhir_search' or 'when you need to verify authentication state'. The purpose is implicit from the name and list of status fields, but no explicit usage context is given, and no exclusions or alternatives are referenced.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

fhir_readFHIR readB

GET {iss}/{resourceType}/{id} as FHIR R4. 404 is not found, not a made-up resource. Same resourceType allowlist as search.

ParametersJSON Schema
NameRequiredDescriptionDefault
idYes
issNo
resourceTypeYes

TDQS

B3.3/5.0
Behavior3/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

With no annotations provided, the description carries the full burden. It does disclose that a 404 means genuinely not found, which is valuable error semantics. It also indicates the response is FHIR R4 format. However, it does not mention authentication requirements, rate limits, or what happens on other errors (e.g., 401, 500). For a read-only GET operation, this is above minimum but not rich.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness5/5

Is the description appropriately sized, front-loaded, and free of redundancy?

The description is two sentences with no wasted words. The URL template is front-loaded, followed by a critical error-handling note and a cross-reference to search. Every sentence earns its place, making it highly efficient.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness3/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

For a simple single-resource read, the description covers the URL construction, 404 semantics, and resource type allowlist. It does not explicitly state the tool's overall purpose (fetching one resource) or mention authentication, which might be assumed from a prior auth step. Given no output schema, it could also clarify the response shape, though 'FHIR R4' implies a FHIR resource. Slight gaps remain in purpose clarity and auth context.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters3/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema description coverage is 0%, so the description must compensate. The URL template '{iss}/{resourceType}/{id}' gives meaning and ordering to the three parameters, and the allowlist note constrains resourceType. However, it does not explain what iss represents (likely the server base URL) or any format expectations for id or resourceType beyond being strings. This is partial compensation for the lack of schema documentation.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose4/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description states 'GET {iss}/{resourceType}/{id} as FHIR R4', which clearly indicates a read operation targeting a specific FHIR resource. It also clarifies the 404 semantics, which helps distinguish it from a search that might return empty results. However, it does not explicitly say 'retrieve a single resource by ID', relying on the URL pattern to imply it, and it does not contrast with fhir_search directly beyond the allowlist note.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines2/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

The description provides no explicit guidance on when to use this tool versus fhir_search or other siblings. It only mentions 'Same resourceType allowlist as search', which hints at shared constraints but does not explain the core difference (single resource lookup vs query). A clear statement like 'Use this to fetch one resource by ID; use fhir_search for queries' is missing.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

smart_discoverSMART discoverA

GET {iss}/.well-known/smart-configuration (SMART App Launch 2.2.0). Optional iss must be v1-allowlisted. Does not invent endpoints.

ParametersJSON Schema
NameRequiredDescriptionDefault
issNo

TDQS

A3.8/5.0
Behavior3/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

With no annotations, the description carries the full burden of behavioral disclosure. It includes one genuinely useful behavioral note ('Does not invent endpoints'), signaling the tool only returns what the server actually advertises. However, it omits other relevant behavior such as error handling when iss is not allowlisted, whether authentication is needed, or any required scopes, leaving the behavioral profile only partially disclosed.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness5/5

Is the description appropriately sized, front-loaded, and free of redundancy?

Three terse, information-dense sentences with no filler. The endpoint is front-loaded, followed by the spec version, the parameter constraint, and the single most important behavioral caveat. Every sentence earns its place.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness4/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

For a simple one-optional-parameter discovery tool with no output schema, the description covers the endpoint, the constraint, and the key behavior. Return format is not described, but SMART discovery responses are standardized by the cited spec, reducing the need. Only edge-case behavior (unallowlisted iss handling) is left unspecified, which is minor for this tool's simplicity.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters3/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema coverage is 0%, so the description must compensate. It does add meaning by substituting iss into the URL path and by stating the v1-allowlist constraint. However, it never explicitly defines iss as the FHIR server base URL or describes the valid format/value domain beyond the allowlist, leaving some semantic burden on inference from the '{iss}' placeholder.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose5/5

Does the description clearly state what the tool does and how it differs from similar tools?

States a specific verb (GET) plus a concrete resource (.well-known/smart-configuration) with a spec version (SMART App Launch 2.2.0). The '{iss}' prefix clarifies it targets a specific FHIR server's discovery document, and it is clearly distinct from the sibling tools (fhir_auth_status, fhir_search, fhir_read) which handle auth status and searches/reads rather than capability discovery.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines3/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

Provides a useful precondition (iss must be v1-allowlisted) and clarifies the call is optional-parameter. However, it gives no explicit guidance on when to prefer smart_discover versus sibling tools like fhir_auth_status, nor any exclusion criteria. The 'when to use vs alternatives' context is implied by its distinct purpose but never stated.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

Tool Schema Changelog

Recent tool additions, removals, and schema changes observed during successful MCP inspections.

  1. 4 tool updatesv1.0.0
    • First observedfhir_auth_status
    • First observedfhir_read
    • First observedfhir_search
    • First observedsmart_discover

TDQS

A3.6/5.0

Scored across 4 tools

Disambiguation5/5

Each tool targets a distinct function: smart_discover retrieves server metadata, fhir_auth_status reports client-side authentication state, fhir_search performs list queries, and fhir_read fetches individual resources. There is no overlap or ambiguity between the four operations.

Naming Consistency4/5

Tools use a consistent prefix pattern (smart_ for auth/discovery, fhir_ for data operations) and each suffix clearly indicates the action (discover, auth_status, search, read). While the prefixes differ by domain, the overall structure is predictable and not chaotic.

Tool Count4/5

Four tools is on the lower end but appropriate for a narrowly scoped read-only FHIR access server focused on discovery and basic querying. It avoids bloat while covering the primary use cases.

Completeness3/5

The server covers read and search for a limited set of resources, but lacks pagination (only one page), search parameters beyond resource type, and a capability statement. Given the explicit read-only nature, core operations are present but notable gaps exist in search depth and server metadata.

Maintenance

ActivityMaintained
ResponsivenessNo issues

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