Quickstart

The fastest way to understand Last EHR is the hosted demo:

https://www.lastehr.com/demo

It uses synthetic patients, needs no account, and every write stops at an approval card.

Zero-key local synthetic demo with HAPI FHIR

Use this path when you want to inspect the approval loop without a Medplum account or model-provider key.

Prerequisites:

• Node 22.18+ (or 24.2+)
• Docker

From a fresh checkout:

git clone https://github.com/cbetz/last-ehr.git
cd last-ehr
npm install
npm run demo:local

The command starts HAPI FHIR and Postgres, waits for the server, resets and seeds the synthetic records, then starts the app at http://localhost:3000/demo. It forces the local HAPI + scripted settings for its child processes, so it needs neither .env.local nor an external model key. Your normal .env.local is not edited or used to select the backend or model for this command.

On the first run, Docker may need to pull images and HAPI can take a few minutes to initialize. Press Ctrl-C to stop Next.js; the local FHIR stack and its data stay available. When you want to remove them, run:

npm run demo:local:down

This is a deterministic walkthrough, not an offline model bundle: it makes no model-provider request and does not interpret the prompt. It always searches the seeded Maria Garcia record, proposes a single Heart rate: 72 bpm Observation, and waits for approval. The server rejects scripted mode unless the opt-in flag, FHIR_BACKEND=hapi, and a local HAPI URL are all present; the wrapped FHIR backend rejects reads or writes outside that synthetic record and fixed observation.

The local HAPI server itself has no auth. Use it for local, single-tenant synthetic evaluation only. Re-run npm run seed if the scripted demo says its seeded patient is missing.

Inspect the read-only MCP tools

The checkout also includes a separate MCP Local Lab for evaluating the two chart-reading tools without FHIR/Medplum credentials or a provider API key:

npm run mcp:demo -- --client claude-code

It prepares the same local HAPI stack and prints a client registration command. The MCP process is hard-wired to the local Docker endpoint and exposes only the four repository fixture patients through search_patients and show_patient_info. This is a synthetic evaluation path, not generic HAPI support or a substitute for the published @lastehr/mcp package. Claude Code or Cursor still uses its usual model account and may transmit those synthetic tool results to its provider. Port 8080 must be free; leave the local stack running while connected and use npm run demo:local:down when finished. See the MCP guide for Cursor/JSON configuration and the full boundary.

Use a real model instead

npm run demo:local is intentionally fixed to the safe walkthrough. To exercise the full agent instead, copy .env.example to .env.local, set FHIR_BACKEND=hapi, FHIR_BASE_URL=http://localhost:8080/fhir, NEXT_PUBLIC_QUICKSTART=true, and a supported provider configuration, for example:

AI_PROVIDER=openai
OPENAI_API_KEY=...

Leave LASTEHR_SCRIPTED_DEMO and NEXT_PUBLIC_SCRIPTED_DEMO unset, then run the HAPI stack:

docker compose up -d
npm run fhir:wait
npm run seed
npm run dev

Public NEXT_PUBLIC_* values are read at startup. The real agent can use its full tool surface (see FHIR coverage) and requires a tool-capable model credential.

To run the app itself in Docker too:

npm run docker:local

This uses docker-compose.yml plus docker-compose.app.yml and reads the build-time public values from .env.local.

Separately, if you only want the scripted zero-key lab without a local build: release tags and manual publish runs push a prebuilt image whose scripted configuration is baked in at build time, so it always runs the scripted walkthrough and cannot run the real-model setup described in this section; see Pull and run from GHCR, which also covers what to do if no public image has been published yet.

Medplum-backed demo

Use this path when you want real Medplum auth, AccessPolicy, and SMART launch behavior.

Prerequisites:

• Node 22.18+ (or 24.2+)
• A Medplum project
• A Medplum ClientApplication with client credentials
• One tool-capable model key

git clone https://github.com/cbetz/last-ehr.git
cd last-ehr
npm install
cp .env.example .env.local
npm run seed
npm run dev

At minimum set:

MEDPLUM_CLIENT_ID=...
MEDPLUM_CLIENT_SECRET=...
NEXT_PUBLIC_QUICKSTART=true
OPENAI_API_KEY=...

If you self-host Medplum, also set:

MEDPLUM_BASE_URL=https://your-medplum.example/
NEXT_PUBLIC_MEDPLUM_BASE_URL=https://your-medplum.example/

Model providers

AI_PROVIDER=scripted above is deliberately not a model provider. It is a fixed local synthetic walkthrough. For a real agent, supported providers are intentionally limited to BAA-capable paths:

The operator is responsible for signing the required BAA. A bare API key is not PHI-ready.

First prompts

In scripted mode, any submitted message starts the same fixed sequence. For a real model-backed agent, try these in order:

Find patients named Smith
Show me Maria Garcia's chart
Record a heart rate of 72 bpm for Maria Garcia
Add a note to Maria Garcia's chart that she reports feeling well with no complaints

The write prompts should stop at the approval card before anything is saved.

Other synthetic-evaluation backends

Beyond Medplum and the local HAPI stack, three more adapters are verified for synthetic evaluation: Firely Server (FHIR_BACKEND=firely, e.g. against the public sandbox at https://server.fire.ly), Aidbox (FHIR_BACKEND=aidbox, against a dev-licensed or hosted dev box), and Oystehr (FHIR_BACKEND=oystehr, against a developer-tier project). Setup, auth, and caveats for each are in the adapter guide; the boundaries are in the support matrix. None is an authenticated or PHI-ready path.