Aditi Singh

Abul Ehtesham, Aditi Singh, Saket Kumar

Enhancing clinical decision support (CDS), reducing documentation burdens, and improving patient health literacy remain persistent challenges in digital health. This paper presents an open-source, agent-based framework that integrates Large Language Models (LLMs) with HL7 FHIR data via the Model Context Protocol (MCP) for dynamic extraction and reasoning over electronic health records (EHRs). Built on the established MCP-FHIR implementation, the framework enables declarative access to diverse FHIR resources through JSON-based configurations, supporting real-time summarization, interpretation, and personalized communication across multiple user personas, including clinicians, caregivers, and patients. To ensure privacy and reproducibility, the framework is evaluated using synthetic EHR data from the SMART Health IT sandbox (https://r4.smarthealthit.org/), which conforms to the FHIR R4 standard. Unlike traditional approaches that rely on hardcoded retrieval and static workflows, the proposed method delivers scalable, explainable, and interoperable AI-powered EHR applications. The agentic architecture further supports multiple FHIR formats, laying a robust foundation for advancing personalized digital health solutions.

Aditi Singh, Abul Ehtesham, Mahesh Lambe et al.

Autonomous AI agents now operate across cloud, enterprise, and decentralized domains, creating demand for registry infrastructures that enable trustworthy discovery, capability negotiation, and identity assurance. We analyze five prominent approaches: (1) MCP Registry (centralized publication of mcp.json descriptors), (2) A2A Agent Cards (decentralized self-describing JSON capability manifests), (3) AGNTCY Agent Directory Service (IPFS Kademlia DHT content routing extended for semantic taxonomy-based content discovery, OCI artifact storage, and Sigstore-backed integrity), (4) Microsoft Entra Agent ID (enterprise SaaS directory with policy and zero-trust integration), and (5) NANDA Index AgentFacts (cryptographically verifiable, privacy-preserving fact model with credentialed assertions). Using four evaluation dimensions: security, authentication, scalability, and maintainability, we surface architectural trade-offs between centralized control, enterprise governance, and distributed resilience. We conclude with design recommendations for an emerging Internet of AI Agents requiring verifiable identity, adaptive discovery flows, and interoperable capability semantics.