FHIR Patient Snapshot Agent

FHIR Patient Snapshot Agent is an AI-powered clinical summarisation tool built for the InterSystems AI Agents and FHIR Programming Contest.

The application retrieves structured FHIR resources for a selected patient from an InterSystems IRIS for Health FHIR Server and generates a concise clinical summary.

Contest Idea

The project implements a Smart Patient Summary Generator: an AI agent called inside a FHIR interoperability solution.

Idea link: https://community.intersystems.com/post/intersystems-programming-contest-ai-agents-fhir

FHIR Resources Used

• Patient
• Condition
• MedicationRequest
• AllergyIntolerance
• Observation
• Encounter
• CarePlan

Core Workflow

1. A user selects or provides a patient_id.
2. The app queries FHIR R4 resources from InterSystems IRIS for Health FHIR Server.
3. A Python layer extracts and normalises relevant clinical context.
4. The app can render a deterministic Markdown summary, build an LLM-ready prompt, or call an OpenAI-compatible LLM provider.
5. The output includes the source FHIR resources used so generated content can be verified.

Architecture

flowchart LR
    user["User / CLI"] --> cli["snapshot_demo.py"]
    cli --> agent["PatientSnapshotAgent"]
    agent --> client["FHIR client"]
    client --> iris["InterSystems IRIS for Health\nFHIR R4 Server"]
    iris --> resources["Patient, Condition,\nMedicationRequest, AllergyIntolerance,\nObservation, Encounter, CarePlan"]
    resources --> normalizer["FHIR normalizer"]
    normalizer --> context["PatientSnapshotContext"]
    context --> deterministic["Deterministic Markdown renderer"]
    context --> prompt["LLM prompt builder"]
    prompt --> llm["Nebius Token Factory\nOpenAI-compatible chat completions"]
    deterministic --> output["Patient snapshot summary\nwith source resource IDs"]
    llm --> output

IRIS for Health is the FHIR interoperability layer in this project. The Python agent does not read local files or query a database directly; it retrieves standards-based FHIR R4 JSON from IRIS and uses those resources as the source of truth for summarisation.

Summary Output

• Patient overview
• Active problems
• Medications
• Allergies
• Recent observations and labs
• Care plans
• Role-specific summary framing
• Source-data checks
• Missing information
• Source FHIR resources used

Safety Note

This project is for demonstration purposes only. It does not provide diagnosis, treatment recommendations, or clinical decision-making. All generated summaries must be verified against the source FHIR data.

The LLM prompt explicitly prohibits creating new care plans, monitoring recommendations, medication changes, referrals, and treatment follow-up instructions. Existing FHIR CarePlan resources may be summarised as source data. Potential concerns are framed as neutral source-data checks only.

The Missing Information section is constrained to items identified by the deterministic normalizer, which reduces the risk of the model inventing extra clinical gaps.

The prompt also requests Markdown headings, bullet lists, blank lines between sections, and readable clinical language instead of raw source-context line copying. FHIR resource IDs are kept out of narrative sections and shown in the collapsible source-resource review. The web UI applies compact display cleanup for common LLM Markdown spacing issues across role-specific summaries, including unbulleted lists after subsection labels and empty bullet points.

Tech Stack

• InterSystems IRIS for Health / FHIR Server
• Python
• FHIR R4
• Nebius Token Factory / OpenAI-compatible chat completions
• Docker

Current Features

• FHIR R4 client with Basic Auth support
• Local .env loading without external dependencies
• Patient snapshot resource fetch across Patient, Condition, MedicationRequest, AllergyIntolerance, Observation, Encounter, and CarePlan
• FHIR Bundle extraction and clinical context normalisation
• Observation grouping for recent vitals, labs, survey/social history, and other observations
• Deterministic Markdown summary mode
• LLM-ready prompt mode
• Nebius/OpenAI-compatible LLM summary mode
• Role-specific prompt sections for clinicians, ED doctors, care managers, patients, and family caregivers
• Prompt rules for readable Markdown output and source-data checks limited to data-quality/source-grounding facts
• UI cleanup that keeps FHIR resource IDs out of the narrative summary while preserving them in source review
• Streamlit web UI for patient ID entry, summary display, and collapsible source-resource review
• Unit tests for normalisation and LLM response parsing
• Sample LLM output for Patient 1

Contest Bonus Features

This project is designed to align closely with the InterSystems AI Agents and FHIR Programming Contest goals:

• Suggested task fit: implements the Smart Patient Summary Generator / FHIR Patient Snapshot Agent idea from the contest prompt.
• InterSystems usage: uses InterSystems IRIS for Health as the local FHIR R4 server and source system for patient resources.
• AI usage: calls an LLM through Nebius Token Factory using an OpenAI-compatible chat completions API.
• Model used: meta-llama/Llama-3.3-70B-Instruct.
• Docker usage: Docker is used to run the local InterSystems IRIS for Health FHIR Server through the external InterSystems community FHIR template. The Python/Streamlit application itself is not containerised in this repository.
• Demo readiness: includes screenshots, sample output, a demo script, and a YouTube video walkthrough of the working app.
• First-time contribution: structured as a clear, beginner-friendly open-source contest submission with setup steps, safety framing, tests, and reproducible local commands.

Demo Preview

The current demo uses Patient 1 from the local InterSystems IRIS for Health FHIR Server.

YouTube video demo: https://youtu.be/Hsu10Nnujng

Online demo deployment is supported through render.yaml. For public hosting, set ONLINE_DEMO_MODE=1. In this mode the Streamlit app uses a bundled Patient 1 demo context captured from the local IRIS for Health FHIR Server setup, so the public app does not need access to a local localhost FHIR endpoint or a private LLM API key. The full live FHIR workflow still runs locally against InterSystems IRIS for Health as described below.

Verified resource counts:

• Patient: 1
• Condition: 5
• MedicationRequest: 2
• AllergyIntolerance: 0
• Observation: 88
• Encounter: 14
• CarePlan: 2

Sample generated summary: docs/sample_patient_1_llm_summary.md

Streamlit Web UI Screenshots

The Streamlit UI allows a user to enter a FHIR patient ID, choose the summary audience, generate a deterministic or LLM-backed patient snapshot, and review the source FHIR resources used by the agent.

Repository Structure

.
+-- app/
|   +-- fhir_client.py
|   +-- llm_provider.py
|   +-- normalizer.py
|   +-- prompt_builder.py
|   +-- summary_renderer.py
|   +-- snapshot_demo.py
|   +-- web_ui.py
+-- tests/
|   +-- test_normalizer.py
+-- docs/
|   +-- day1_fhir_setup.md
|   +-- demo_script.md
|   +-- sample_patient_1_llm_summary.md
|   +-- screenshots/
|       +-- streamlit_ed_summary_top.png
|       +-- streamlit_ed_summary_middle.png
|       +-- streamlit_ed_summary_bottom.png
+-- .env.example
+-- .gitignore
+-- README.md
+-- render.yaml
+-- requirements.txt

Local FHIR Server Setup

The local FHIR server setup uses the InterSystems community FHIR template as the reference starting point:

https://github.com/intersystems-community/iris-fhir-template

Clone and run that template separately:

git clone https://github.com/intersystems-community/iris-fhir-template.git iris-challenge-ai-agent
cd iris-challenge-ai-agent
docker compose up --build

The project currently expects this FHIR base URL:

http://localhost:32783/fhir/r4

The local InterSystems template exposes the FHIR port through Docker. Check docker ps and use the host port mapped to container port 52773. In our first local run this was 32783.

The local template also requires Basic Auth:

FHIR_USERNAME=_SYSTEM
FHIR_PASSWORD=SYS

Verify the local FHIR API:

curl -i -u _SYSTEM:SYS http://localhost:32783/fhir/r4/metadata
curl -s -u _SYSTEM:SYS http://localhost:32783/fhir/r4/Patient | python3 -m json.tool
curl -s -u _SYSTEM:SYS http://localhost:32783/fhir/r4/Condition | python3 -m json.tool
curl -s -u _SYSTEM:SYS http://localhost:32783/fhir/r4/Observation | python3 -m json.tool

Configuration

Create a local .env file:

FHIR_BASE_URL=http://localhost:32783/fhir/r4
FHIR_USERNAME=_SYSTEM
FHIR_PASSWORD=SYS
LLM_BASE_URL=https://api.tokenfactory.nebius.com/v1
LLM_MODEL=meta-llama/Llama-3.3-70B-Instruct
LLM_API_KEY=your-nebius-token

Local .env files are loaded automatically and are ignored by Git.

Python Setup

python -m venv .venv
source .venv/bin/activate
pip install -r requirements.txt

On Windows PowerShell:

py -m venv .venv
.\.venv\Scripts\Activate.ps1
py -m pip install -r requirements.txt

Run

Run a deterministic patient snapshot:

python -m app.snapshot_demo 1

Generate an LLM-ready prompt:

python -m app.snapshot_demo 1 --format prompt

Generate a role-specific prompt:

python -m app.snapshot_demo 1 --format prompt --audience patient

Generate a summary with Nebius Token Factory or another OpenAI-compatible provider:

python -m app.snapshot_demo 1 --format llm

Supported audiences: clinician, ed_doctor, care_manager, patient, and family_caregiver. Each audience uses a different required section template.

Return only resource counts:

python -m app.snapshot_demo 1 --format counts

Run the Streamlit web UI:

py -m streamlit run app/web_ui.py

Run the Streamlit web UI in public online demo mode:

$env:ONLINE_DEMO_MODE="1"
py -m streamlit run app/web_ui.py

Sample output: docs/sample_patient_1_llm_summary.md

Demo walkthrough: docs/demo_script.md

Tests

Run tests:

python -m unittest discover -s tests

Status

Working prototype:

• Local InterSystems IRIS for Health FHIR Server verified
• Patient 1 verified with 5 conditions, 2 medication requests, 0 allergy records, 88 observations, 14 encounters, and 2 care plans
• Recent observations are grouped into vitals, labs, survey/social history, and other observations
• Deterministic summary mode works
• LLM prompt mode works
• Nebius Token Factory LLM summary mode works
• Role-specific summary framing works in CLI and Streamlit UI
• Streamlit web UI is available
• Tests pass

Roadmap

1. Add more tests with saved FHIR fixture bundles.
2. Decide whether to embed Docker/FHIR setup in this repo or keep the InterSystems template as an external setup step.