Sharp On Fhir

A clean-room SHARP-on-MCP compliant FHIR R4 MCP server with interactive MCP-UI clinical dashboards.

Built for the Prompt Opinion "Build the Future of Healthcare AI" Hackathon — a vendor-neutral MCP server that any SMART-on-FHIR app, agent, or LLM host can plug into without server-side OAuth, API keys, or proprietary auth flows.

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Why SHARP?

The SHARP (Standardised Healthcare Agent Remote Protocol) spec describes a headers-based context model for MCP servers in healthcare:

Header	Purpose
X-FHIR-Server-URL	Base URL of the patient's FHIR R4 endpoint
X-FHIR-Access-Token	Bearer token already minted by the agent host
X-Patient-ID	Optional default Patient resource id

Per SHARP §3.2, the MCP server never runs an OAuth dance itself. The agent host (e.g. a SMART-on-FHIR launch container) obtains the token and forwards it on every call. This means a single deployment of this server works against Epic, Cerner, MEDITECH, athenahealth, eClinicalWorks, ConnectEHR, HAPI, or any other FHIR R4 endpoint — there's nothing vendor-specific.

The server advertises capabilities.experimental.fhir_context_required = true on every initialise response so SHARP-aware clients know to forward those headers automatically.

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What's included

🩺 Clinical FHIR tools

• fhir_get_capability_statement — discover the connected FHIR server
• fhir_get_patient, fhir_search, fhir_read, fhir_patient_everything — generic R4 access
• clinical_search_patients, clinical_get_patient_summary
• clinical_get_appointments, clinical_get_encounters
• clinical_get_problems, clinical_get_medications, clinical_get_allergies, clinical_get_immunizations
• clinical_get_health_record — one-shot consolidated record
• clinical_get_context — full visit context (demographics + allergies + meds + problems + labs + vitals + encounters + alerts) in parallel

🔬 Labs, vitals & imaging

• lab_get_results, lab_get_vital_signs, lab_get_diagnostic_reports
• imaging_get_documents — DocumentReference search

🧠 Optional persistent clinical memory (mem0)

Backed by mem0 (Apache-2.0). mem0 is embedded as a Python library — no separate service or database. Memory state persists in a Docker volume (mem0_data).

mem0 is text-only at the storage layer, but is well-suited to clinical narrative use (encounters, alerts, notes, transcripts). For non-text inputs (radiology films, audio dictation, video clips), the agent host should pre-process — caption images via a VLM, transcribe audio with Whisper, summarise video — and persist the resulting text via memory_store_note. This keeps memory cleanly searchable and lets each host pick the right model per modality.

Available when OPENAI_API_KEY (or OPENAI_API_BASE for an OpenAI-compat provider) is set, and MEM0_DISABLED is not 1:

• memory_store_encounter — visit summary with diagnoses, plan, complaint
• memory_store_alert — persistent clinical flag (allergy, drug interaction, …)
• memory_store_note — free-text note (use for VLM/Whisper outputs)
• memory_search_history — semantic search scoped to current patient
• memory_get_patient_history — list memories for the patient
• memory_delete — remove a single memory by id
• memory_reset_patient — wipe all memories for one patient (irreversible)

📊 MCP-UI visualisations

• visualize_lab_trend — Chart.js line chart of one lab over time
• visualize_vitals — multi-chart vitals dashboard
• visualize_patient_dashboard — full HTML clinical page (demographics, alerts, allergies, meds, problems, labs, encounters, immunisations + Chart.js trends)

All visual tools return MCP-UI ui:// resources that the host renders in its inspector pane.

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Quickstart

1. Install

git clone https://github.com/your-org/sharp-fhir-mcp.git
cd sharp-fhir-mcp
pip install -e .

2. Run the server

sharp-fhir-mcp                     # http (streamable) on 0.0.0.0:8000
sharp-fhir-mcp --port 9000         # custom port
SHARP_STRICT_CONTEXT=1 sharp-fhir-mcp   # reject calls missing FHIR headers

The MCP endpoint is http://localhost:8000/mcp.

For the full stack (FHIR MCP server + embedded mem0 memory) use the one-shot bring-up script — it handles the broken-docker-symlink case (common after migrating off OrbStack), seeds .env if missing, optionally prunes build cache, and starts the stack detached:

./scripts/start.sh                   # build + start, detached
./scripts/start.sh --no-memory       # disable mem0 (memory_* tools omitted)
./scripts/start.sh --logs            # follow logs after start
./scripts/start.sh --prune --build   # free disk + rebuild from scratch
./scripts/start.sh --down            # tear down + remove memory volume

Or run compose directly:

cp .env.example .env                 # set OPENAI_API_KEY (or OPENAI_API_BASE)
docker compose up --build -d

Note: localhost here refers to localhost of the machine where you are running the server. To access it remotely, deploy the server (see below) or port-forward to your local instance.

3. Connect from any SHARP-aware MCP client

Send these headers on every JSON-RPC request:

X-FHIR-Server-URL: https://hapi.fhir.org/baseR4
X-FHIR-Access-Token: <bearer token from your SMART launch>
X-Patient-ID: 12345          # optional

4. Try a public sandbox without writing a SMART app

The HAPI public FHIR R4 sandbox is read-only and does not require auth — useful for kicking the tires:

curl -X POST http://localhost:8000/mcp \
  -H 'Content-Type: application/json' \
  -H 'Accept: application/json, text/event-stream' \
  -H 'X-FHIR-Server-URL: https://hapi.fhir.org/baseR4' \
  -H 'X-FHIR-Access-Token: anonymous' \
  -d '{"jsonrpc":"2.0","id":1,"method":"tools/list"}'

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Deployment

Vercel (Python serverless)

This server runs as a stateless Streamable-HTTP endpoint, which works on Vercel out of the box. You can re-use an existing Next.js MCP scaffold by either:

1. Adding the Python ASGI handler — drop the app Starlette instance into api/index.py:

   # api/index.py
   from sharp_fhir_mcp.server import app  # noqa: F401
   

   plus a minimal vercel.json:

   {
     "builds": [{"src": "api/index.py", "use": "@vercel/python"}],
     "routes": [{"src": "/(.*)", "dest": "api/index.py"}]
   }
   

2. Or running it as a sidecar behind your existing Vercel front-end and reverse-proxying /mcp to a longer-lived host (Fly.io, Railway, Render).

The server respects the Vercel-injected PORT environment variable.

Local development

cp .env.example .env             # set FHIR_SERVER_URL etc. for fallbacks
sharp-fhir-mcp                   # http://localhost:8000/mcp

Docker / docker-compose

A single-service stack: the FHIR MCP server runs in one container and embeds mem0 as a library.

cp .env.example .env
# Set OPENAI_API_KEY (or OPENAI_API_BASE for an OpenAI-compat provider:
# OpenRouter, Ollama OpenAI-mode, vLLM, LM Studio, Together).
docker compose up --build

• MCP endpoint: http://localhost:8000/mcp
• Persistent memory volume: mem0_data (mounted at /data in container)

Local LLM + embeddings (no OpenAI calls)

Point both the LLM and embedder at a local Ollama:

OPENAI_API_BASE=http://host.docker.internal:11434/v1
MEM0_LLM_PROVIDER=ollama
MEM0_LLM_MODEL=llama3.1
MEM0_EMBED_PROVIDER=ollama
MEM0_EMBED_MODEL=nomic-embed-text

Disabling memory

Pass MEM0_DISABLED=1 (or ./scripts/start.sh --no-memory) to skip mem0 entirely. The FHIR/clinical/lab/visualisation tools still work; only the memory_* tools are omitted.

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Architecture

┌─────────────────────────────────────────────────────────────┐
│  MCP Client / Agent / LLM host (Claude, Cursor, custom)     │
│  • Knows the patient's FHIR endpoint + access token         │
│  • Sends X-FHIR-Server-URL, X-FHIR-Access-Token headers     │
└────────────────────────┬────────────────────────────────────┘
                         │ Streamable HTTP (SHARP-on-MCP)
            POST /mcp + JSON-RPC + SHARP headers
                         ▼
┌─────────────────────────────────────────────────────────────┐
│  sharp-fhir-mcp                                             │
│                                                             │
│  ┌────────────────────────────────────────────────────────┐ │
│  │ SharpContextMiddleware                                 │ │
│  │ • Parses X-FHIR-Server-URL / X-FHIR-Access-Token       │ │
│  │ • Stores in ContextVar for the request scope           │ │
│  └─────────────────────────┬──────────────────────────────┘ │
│                            ▼                                │
│  ┌────────────────────────────────────────────────────────┐ │
│  │ FastMCP tool registry                                  │ │
│  │ ├─ fhir_*           (generic R4 search/read)           │ │
│  │ ├─ clinical_*       (patient/encounter/medication/…)   │ │
│  │ ├─ lab_* / imaging_*(observations, reports, docs)      │ │
│  │ ├─ memory_*         (optional, embedded mem0)         │ │
│  │ └─ visualize_*      (MCP-UI Chart.js dashboards)       │ │
│  └─────────────────────────┬──────────────────────────────┘ │
│                            ▼                                │
│  ┌────────────────────────────────────────────────────────┐ │
│  │ Vendor-neutral FHIR R4 client (httpx, async)           │ │
│  └─────────────────────────┬──────────────────────────────┘ │
└────────────────────────────┼────────────────────────────────┘
                             ▼
            FHIR R4 server (Epic / Cerner / HAPI / …)

See CLAUDE.md for detailed module-by-module notes and the SHARP compliance check-list.

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SHARP compliance check-list

Requirement	Status
Streamable-HTTP transport (stdio not in scope)	✅
Read FHIR endpoint from X-FHIR-Server-URL header	✅
Read bearer token from X-FHIR-Access-Token header	✅
Optional X-Patient-ID header for default patient context	✅
Advertise capabilities.experimental.fhir_context_required	✅
No server-side OAuth / token storage	✅
Vendor-neutral FHIR R4 client	✅
Structured fhir_context_required errors when headers absent	✅
Optional strict context enforcement (SHARP_STRICT_CONTEXT=1)	✅

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License

MIT — see LICENSE.