@fhir-dsl/mcp

Model Context Protocol bridge — exposes a FHIR endpoint as an MCP tool surface so an LLM agent can read, vread, search, history, and (opt-in) create / update / patch / delete against a real FHIR server with full audit + auth.

One server === one upstream FHIR endpoint, scoped to one IG (the IG pin lives at generate time; the runtime just receives the resource-types list).

Install

npm install @fhir-dsl/mcp
# Auth strategies that need it:
npm install @fhir-dsl/smart jose   # required only for backend-services / patient-launch auth

@fhir-dsl/smart and jose are optional peer dependencies — bearer-token-only deployments never load them.

Minimal example

import { createServer, stdioTransport } from "@fhir-dsl/mcp";

const server = createServer({
  name: "us-core-mcp",
  version: "1.0.0",
  baseUrl: "https://hapi.fhir.org/baseR4",
  resourceTypes: ["Patient", "Observation", "Encounter"],
  auth: { kind: "bearer", token: process.env.FHIR_TOKEN! },
});

await server.listen(stdioTransport());

Read-only by default; opt into writes with writes: ["create", "update"] plus optional writeResourceTypes / confirmWrites / dryRun guards.

Transports

• stdioTransport() — newline-delimited JSON over stdin/stdout. Default for CLI MCP clients (Claude Desktop, the claude CLI, …) which spawn the server as a child process.
• httpTransport({ port, cors?, authenticate?, maxRequestBytes?, server?, sseKeepaliveMs? }) — full Streamable HTTP implementation: POST /mcp accepts a single JSON-RPC body or a batched array; the response is application/json by default or text/event-stream when the client sends Accept: text/event-stream. GET /mcp opens a long-lived SSE stream for server-initiated notifications, kept alive at sseKeepaliveMs intervals (default 30 s). server mounts the transport onto a caller-owned http.Server instead of starting a new one.

Auth strategies

Three pinned variants behind one AuthStrategy interface — every strategy resolves an outbound HTTP header set per request, so token refresh, JWT resigning, and zero-config bearer all coexist:

auth: { kind: "bearer", token: process.env.FHIR_TOKEN! }

auth: {
  kind: "backend-services",
  issuer: "https://hapi.example.org/fhir",
  clientId: "my-bot",
  privateKey: process.env.JWT_PRIVATE_KEY!,
  scope: "system/*.read",
}

auth: {
  kind: "patient-launch",
  issuer: "https://hapi.example.org/fhir",
  clientId: "my-spa",
  refreshToken: session.refreshToken,
  scope: "patient/*.read",
}

@fhir-dsl/smart is loaded lazily, so bearer-only servers never pay the jose cost.

Verb surface

Ten generic verbs typed by resourceType discriminated union: read, vread, search, history, create, update, patch, delete, operation, capabilities. The MCP resources/read URI scheme is fhir://<ResourceType>/{id} (and _history/<versionId> for vread).

Token economy

Defaults that prevent an LLM from reading 50 MB of bundle and burning your context:

• defaultSearchCount (default 20) — default _count when the LLM omits one.
• defaultReadSummary — default _summary for read verbs (text, data, count, …).
• maxResponseBytes (default 64 * 1024) — hard cap on JSON response bytes; oversized bodies are swapped for a too-costly OperationOutcome (the audit retains the original).

Audit

Every verb call routes through an AuditSink regardless of outcome. Three implementations ship: JsonLogAuditSink (default — structured JSON to stderr), MemoryAuditSink (keep events in memory; useful for tests), NullAuditSink (drop events; performance benchmarks). A custom sink is just an object with record(event: AuditEvent): void | Promise<void> — drop-in for Splunk, Loki, OTLP, or a FhirAuditEventSink writing AuditEvent resources back to the upstream.

Generating a server alongside the typed client

fhir-gen generate --version r4 --ig [email protected] \
  --out ./src/fhir --mcp ./mcp-server

./mcp-server/ gets a server.ts shim, mcp.config.json seeded with the IG's resource types, and a README. Launch with FHIR_BASE_URL=… node mcp-server/server.ts.

Or run inline (no generated types):

fhir-gen mcp https://hapi.fhir.org/baseR4 \
  --resources Patient,Observation \
  --writes create --confirm-writes \
  --auth-bearer-env FHIR_TOKEN

Documentation

Full guide: MCP Server

License

MIT