Road-Map Check
# supportk
Kai
07/23/2025, 5:42 PMHi Medplum team,
First off, thank you for making such a powerful open‑source platform available. At (sapientiahealth.org) we’ve been running a local Linux deployment and now have promising early results.
Our next milestone is to capture and later analyze clinicians’ diagnostic reasoning. For us that means adding:
additional (possibly custom) FHIR resources
stricter version‑control semantics
a clinician‑facing SMART‑on‑FHIR UI
We’ve studied the Analytics Guide https://www.medplum.com/docs/analytics which looks like an excellent foundation, but doesn’t yet cover those pieces.
hosting question:
We’re self‑hosting Medplum today. Could you confirm whether any of the functionality above would eventually require a paid Medplum Cloud plan https://www.medplum.com/pricing or can we achieve it entirely on the open‑source, self‑hosted version?
We’re now deciding between two paths:
1. Extend Medplum via new resources, Bots, and UI components and contributing upstream when possible @ https://github.com/rkirkendall/medplum-mcp @ https://github.com/Fuegomar/CUSP or
2. Fork to pursue a more opinionated approach while cherry picking our way through Medplum upgrades.
Could you share any guidance on:
recommended patterns for introducing new resource types and versioning logic,
whether contributions in this area would be welcome upstream , and
any hosting implications we should bear in mind if we stay self‑hosted?
Thanks again for your work and for any insights you can provide.
Kai on behalf of the CUSP team
Kai
07/28/2025, 3:13 PMTL;DR version: Self‑hosting Medplum; need to add custom FHIR resources, version‑control semantics, and a clinician‑facing SMART‑on‑FHIR UI to capture diagnostic reasoning. Can we build all of this on the open‑source stack, or would anything require a paid Medplum Cloud plan? Any guidance before we extend upstream vs. fork would be greatly appreciated!
r
rahul1
07/28/2025, 4:45 PM@Kai , thaks for the thoughtful questions
rahul1
07/28/2025, 4:46 PMIf you'll permit, I'll break your question down into a couple pieces to tackle individually
rahul1
07/28/2025, 4:53 PMCloud vs. Self Hosted: The consideration here isnot about capabilities, it's about operational considerations. As a system of record platform, Medplum requires Dev Ops experience to deploy and maintain. Operational considerations include: 1) DB maintenance and tuning 2) Security Patching + Upgrade management 3) Compliance & Security review
While it can be quick to get started, we found that these considerations required our customers to deploy more FTE resources against those problems as they scaled. We offer our Cloud hosted version to take care of those dev ops tasks on behalf of my customers
rahul1
07/28/2025, 4:59 PMPaid vs. Community Edition: If you're self-hosting with the platform, you would have access to all the core platform features. However, you can purchase an enterprise self-hosted plan to gain access to:
* Our paid first-party integrations (Labs, eRx, RCM)
* Enterprise support
On the cloud platform, the different pricing tiers include the entitlements above, as increased limits on platform usage (rate limits, web sockets etc.). When self hosting, there are no such limits but you have to manage your own infrastructure
rahul1
07/28/2025, 5:04 PMFeatures: Now to answer you questions about those specific features:
- *Clinician‑facing SMART‑on‑FHIR UI*: Smart-on-FHIR authentication is possible with the current base platform - no extra purchase required
- *Custom FHIR resources*: This isn't on our near term roadmap to support. However, we've actually found that in many cases when we get this requets, there are existing FHIR resources that map to the workflow. So feel free to share about your use case in a separate thread and we can advise.
- version‑control semantics: I'm not quite clear on what this requirement is
rahul1
07/28/2025, 5:04 PMIf you're seriously considering a fork, I'd advise you to read this blog post from our CTO (https://www.medplum.com/blog/so-youre-thinking-about-forking)
rahul1
07/28/2025, 5:04 PMIt goes over a lot of the considerations related to forking
k
Kai
07/28/2025, 6:29 PM@rahul1 thanks for your thoughts and perspectives. I've also already considered the excellent doc from your CTO too. Needing version control like git: every change to a diagnostic reasoning note tracked with history, diffs, and rollback (by clinician's only). FHIR already stores versionId and meta.lastUpdated; can Medplum surface this for CUSP?
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