Awell builds care orchestration infrastructure, and on top of it Panels, a work surface where care teams define a patient population, configure how they work it, and trigger what happens next. Panels is population and workflow agnostic by design: intake, surgery prep, prescription refill, chronic care management and post-discharge follow-up each need to see different data and follow different steps.

At a national post-acute provider running 180+ inpatient facilities, post-discharge follow-up runs on Panels at roughly 250,000 discharges a year, with about 500 weekly users. A voice AI agent handles routine outreach; case manager assistants handle everyone the eligibility rules exclude. Both work the same panel. Panels did not exist before this project. It went from its first two hospitals to all 180 in nine months, on self-hosted Medplum. Guideway Care assembled the solution, implemented it, and ran the rollout.

Most folks, before encountering Medplum, think of FHIR in one of two ways:

• As a read-mostly interface bolted onto a proprietary EHR. Epic, Oracle Health, and exchange profiles like Da Vinci Payer Exchange all use FHIR only at the boundary between systems. The real data lives in someone's proprietary tables; FHIR is the negotiated contract at the edge.

• As a FHIR repository you publish into. HAPI, Aidbox, HealthLake, and the Azure or Google FHIR stores are often stood up alongside the operational datastore that actually serves the application — a landing zone for exchange, analytics, or compliance, rather than the system of record your app reads and writes on the hot path.

In both models, FHIR sits off to the side, and a separate database is doing the real work of running the application.

So when developers come to Medplum, they usually ask something along these lines:

• "How is the data handled and stored in the DB itself? How does that relate to FHIR?"
• "If I point a SQL explorer at the Postgres database when running Medplum locally, will I be able to see what's happening?"
• "Can I get direct access to the rows in the database when using your hosted service?"

These are all very reasonable questions for developers doing due diligence on Medplum, and part of the beauty of open source is that you can inspect our implementation directly. We also think these questions come from a particular understanding of the relationship between FHIR and an EHR — and this post is about how that relationship is different in Medplum.

PlumCon 2026 is this Thursday, September 3, in San Francisco. The agenda is posted. General registration has closed, but waitlist spots are available.

On August 1 we hosted the YC x Medplum Hackathon at the Y Combinator office in San Francisco, where 160+ hackers built on Medplum in a day. Read the recap.

It was a heavy month of shipping: 198 commits from 22 contributors, with nine patch releases, v5.1.28 through v5.1.36.

DICOM moved to Beta, scheduling got its own React package and a mountable booking workspace — the fastest path yet from empty project to a working calendar. Terminology got its 2026 refresh with multi-language display support, and externally issued JWTs can now authenticate against a specific project rather than the whole server.

All of this continues to drive forward our 2026 roadmap priorities.

We've been hard at work making updates to our Terminology Services to update them for 2026, and are excited to share all the new features and data sets available! The latest UMLS 2026AA data set has been imported into Medplum's hosted environment, and is available for customers to use in their self-hosted clusters as well. In addition, we've made a number of improvements across the core terminology API endpoints to make everything faster and serve multilingual users.

Medical imaging has been the part of the patient record that lives somewhere else. A digital health company builds its charting, ordering, and results workflows on FHIR, and then imaging arrives and the answer is a separate PACS, a separate login, a separate access control model, and a link out to a viewer that knows nothing about the rest of the chart.

Today we are releasing DICOM and DICOMweb support in Beta. A modality on a hospital network can send a study to Medplum over the DICOM network protocol, the study is stored as ordinary Medplum resources under the project's existing access policies, and a DICOMweb viewer can read it back out — with no image server in the middle.

MediMind is a proactive, AI-native hospital system built from the ground up on FHIR R4, now under contract with a 25-hospital network in the Republic of Georgia. Here is why we rebuilt what a hospital runs on instead of adding features to what was already there, and why we built it on Medplum.

Profile Health is building genetic intelligence for longevity and functional medicine — the concierge, naturopathic, and longevity practices that treat chronic, whole-person conditions rather than single episodes of care. Their thesis is simple: the most valuable signal in medicine — a patient's whole genome, enriched with a lifetime of their clinical records — sits scattered, unread, and never makes it into the exam room. Profile fuses the two and hands the result to the physician, so care can get ahead of disease instead of reacting to it.

On Saturday, August 1, 2026, the Y Combinator office in San Francisco filled up with 160+ hackers for the Agentic Healthcare Hackathon, co-hosted by Medplum and Y Combinator.

This post is a celebration of that day, and to express our heartfelt appreciation to every single hacker who showed up and shipped. You are the reason events like this exist, thank you all!

The headline this month: Medplum earned the 2026 FHIRplace Participant emblem from Drummond Group for electronic prior authorization testing, ahead of the January 2027 enforcement date. July was another heavy shipping month — 206 commits from 28 contributors and five patch releases, v5.1.23 through v5.1.27.

On the revenue cycle side, real-time insurance eligibility checks arrived as a FHIR operation of their own, and Claim/$submit learned to route preauthorization requests to their own processor. Elsewhere, server-scoped subscriptions give project-per-tenant deployments one central data-processing flow, a concentrated round of authentication hardening tightened JWT validation, outbound fetch, and MFA, and the Decision Guides are now published natively in the docs. A first DICOMweb implementation also landed in Alpha for teams beginning to work with imaging.

All of this continues to drive forward our 2026 roadmap priorities.

Today is the day: Medplum is hosting the Agentic Healthcare Hackathon with Y Combinator at the YC office in San Francisco on Saturday, August 1, 2026.