Medplum MCP
Securely access and manage FHIR healthcare data stored in Medplum.
Read a Tierward project's governance state (doctor, team-settings, arch-audit, skills) over MCP.
Pick the AI app you use, then copy the settings.
Passed 3/3 checks · Runs on your computer · ✓ Commands checked Nov 13, 2026
First: which AI do you use?
Pick your app and the steps appear below.
Works with Claude, with some setup first
Install Node.js on your computer first (one time) · Only the Claude desktop app (Windows or Mac), not the web or phone
One time only; it works for every server that needs Node.js
SettingsDeveloperEdit Config
{
"mcpServers": {
"tierward": {
"command": "npx",
"args": [
"-y",
"tierward"
]
}
}
}Use Tierward and tell me what you can do for me, then show me one thing✓ If Claude says it is using Tierward or shows a Tierward tool in the answer, you are connected
Menu names checked against Anthropic’s help page on Nov 11, 2026 · your screen may differ slightly by app version
ChatGPT cannot connect Tierward yet
Tierward runs on your computer, but ChatGPT can only connect servers that run on the web
A · Use an app that can connect Tierward
B · Others in Clinics & health that work with ChatGPT
Picked from the most used in the same category, only ones that connect by address with no key
Works with Claude Code, with some setup first
Install Node.js on your computer first (one time)
One time only; it works for every server that needs Node.js
Mac: press Command+Space and type Terminal · Windows: open PowerShell
claude mcp add --scope user tierward -- npx -y tierwardYou should see Tierward listed as connected
Use Tierward and tell me what you can do for me, then show me one thing✓ If Claude Code says it is using Tierward or shows a Tierward tool in the answer, you are connected
Menu names checked against Anthropic’s help page on Nov 11, 2026 · your screen may differ slightly by app version
Works with Cursor, with some setup first
Install Node.js on your computer first (one time)
One time only; it works for every server that needs Node.js
Use Tierward and tell me what you can do for me, then show me one thing✓ If Cursor says it is using Tierward or shows a Tierward tool in the answer, you are connected
Menu names checked against Cursor’s help page on Nov 11, 2026 · your screen may differ slightly by app version
Works with VS Code, with some setup first
Install Node.js on your computer first (one time)
One time only; it works for every server that needs Node.js
Use Tierward and tell me what you can do for me, then show me one thing✓ If VS Code says it is using Tierward or shows a Tierward tool in the answer, you are connected
Menu names checked against VS Code’s help page on Nov 11, 2026 · your screen may differ slightly by app version
Other apps that use MCP, such as Windsurf, Zed or Gemini CLI, each add servers differently. See how in the app list.
JSON settings are under “For developers” below
Claude Code
claude mcp add --scope user tierward -- npx -y tierwardClaude Desktop (claude_desktop_config.json)
{
"mcpServers": {
"tierward": {
"command": "npx",
"args": [
"-y",
"tierward"
]
}
}
}Cursor (~/.cursor/mcp.json)
{
"mcpServers": {
"tierward": {
"command": "npx",
"args": [
"-y",
"tierward"
]
}
}
}VS Code (mcp.json)
{
"servers": {
"tierward": {
"type": "stdio",
"command": "npx",
"args": [
"-y",
"tierward"
]
}
}
}These settings are generated from the maker’s registry entry. If the README says otherwise, follow the README.
Based on how this server connects and on each app’s own docs, checked Nov 10, 2026.
Run on your computer in
ClaudeGooseLM StudioMsty StudioCherry StudioCursorVS Code + GitHub CopilotVisual StudioWindsurf (Devin Desktop)ZedKiroClineContinueJetBrains AI AssistantClaude CodeCodex CLIGemini CLIOpenCodenodecodeWarpLibreChatRaycast
Runs on your computer; the tool list appears in your AI app after you install it.
We check information anyone can see; we have not read the code. Checks that do not apply are left out of the count. · Checked Nov 13, 2026
The registry name was verified with the GitHub account marcoguillermaz, which owns the repo
Code last changed 4 days ago
Uses MIT
This one runs on your computer; there is no internet endpoint
Runs on your computer and uses local settings instead
Runs on your computer; we can only read tool lists from internet endpoints
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Compared with every active server in this category in the registry. Stars count only when the publisher owns the repo.
It passed 3 of 3 applicable basic checks. We have not read the code. Before adding a key or token, see what access the server asks for and use a key with only the permissions you need.
The registry does not list a required key, though some servers ask you to sign in on first use.
It runs on your computer. Your AI app starts it when needed, and data does not pass through the maker’s servers (unless it calls an online service itself).
The GitHub repo last changed 4 days ago, and the latest version (2.3.4) reached the registry 30 days ago.
Apps that support MCP, such as Claude Desktop, Claude Code, Cursor and VS Code. You also need Node.js on your computer.
In the same category: Medplum MCP, Mirobody, Apple Health
Servers in the same category from other makers, sorted by stars.
Reading a card:↓ Downloads per weeki★ GitHub starsiThree pillars: reviews · checks · usageiUpdated = latest version published to the registryi
Securely access and manage FHIR healthcare data stored in Medplum.
Local-first Apple Health MCP server for questions about your sleep, workouts and heart data.
Copied from the maker’s repo as written. PopNx MCP has not reviewed or endorsed it. HTML, images and scripts are removed. Links lead off this site.
Claude generates. You or your team decides.
A development framework that gives Claude Code a governed, phased process, so you build real software consistently and reviewably, from day one.
MCP-native: read Tierward governance state from Claude Desktop, ChatGPT, Cursor, VS Code.
Claude Code is fast. The problem it creates isn't in the code: it's in the review. When AI writes everything autonomously, you end up approving diffs you don't fully understand, catching regressions two blocks later, and losing the thread of what the system actually does.
Tierward sits between Claude and done. Teams adopt it tier by tier, from a zero-process discovery setup up to a fully governed pipeline: explicit STOP gates before implementation, audit skills that surface issues before they reach production, and a Stop hook that runs your tests when Claude says it is done and sends it back to fix them when they fail. Start at Tier 0 and move up when you need more structure.
Since v1.17.0, Tierward ships an MCP server alongside the CLI. Any MCP-aware client can read your project's doctor report, team-settings policy, last arch-audit, and skill inventory without running the Tierward CLI. See MCP server.
One thing drives Tierward: Claude Code doesn't become harder to work with because it gets less capable. It becomes harder to work with because autonomous decisions accumulate faster than anyone can review them. The pipeline enforces a review contract: scope confirmed before code, hypothesis written before a fix, tests passing before done. It doesn't slow down work that doesn't need that structure.
The tier system exists because process has a cost. A solo bugfix shouldn't pay the overhead of a team feature workflow. Two pipelines cover the range: Fast Lane (4 steps, scope-confirm) for quick fixes, Full (14 phases, 4 review gates) for team features. Both enforce the same contract: Claude works phase by phase, your team approves each step. Start at the tier that fits your current risk and add more as the stakes rise.
Built for the people who carry the result, product managers and developers alike, so the decisions stay with them, not the model.
Tierward works exclusively with Claude Code. No Cursor support, no Copilot layer, no multi-tool abstractions. That's intentional.
The enforcement mechanisms that make Tierward useful are Claude Code primitives: a Stop hook is a hard OS-level block in settings.json; a STOP gate lives in pipeline.md, a rules file Claude reads at session start; audit skills are structured programs that run inside the Claude Code agent loop. These aren't portable concepts wrapped in an abstraction layer. They're direct calls into Claude Code's architecture.
Supporting multiple tools would mean replacing these with lowest-common-denominator abstractions that strip out the enforcement layer. The value of Tierward is precisely that enforcement: the Stop hook doesn't ask Claude to run tests, it prevents Claude from completing a task until they pass.
If your team uses other AI coding tools alongside Claude Code, Tierward governs only the Claude Code sessions. The underlying principles (tests before done, requirements before code, audit before deploy) aren't Claude-specific, but the implementation is, by choice.
1. Scaffold once. npx tierward init detects your project type and scaffolds a pipeline, audit skills, security rules, and governance files matched to your stack and team size. Setup takes under two minutes.
2. Work inside the pipeline. The pipeline is a rules file Claude reads at session start. For Tier M: dependency scan before implementation, STOP gate after requirements, /simplify after writing code. You get the structure without managing it manually.
3. Run audit skills on demand. Skills like /security-audit, /arch-audit, and /systematic-debugging are multi-step programs that run inside Claude Code. Call them when you need them: before a deploy, when a test fails, after a migration wave. Each produces a structured report.
4. You or your team decides. STOP gates pause Claude to present its plan, and a commit gate blocks git commit until you have approved. On GitHub plans that support code owners, CODEOWNERS sends changes to .claude/ to a human reviewer, and blocks the merge too when branch protection requires code owner review. A Stop hook also verifies your tests pass before a task can close. No autonomous merges.
npx tierward init
The wizard detects your project state and routes setup. Three paths available:
| Path | Use when |
|---|---|
| Existing project | Add structure to a project that already has code |
| New project | Starting from scratch |
| From existing docs | Share repos or docs - Claude reads them and populates everything |
After init, open Claude Code and start working. The scaffold is active immediately.
Run context before init if you want the scaffold to reproduce consistently, with a written record of what you asked for:
npx tierward context # produces CONTEXT.md
npx tierward init # reads CONTEXT.md, scaffolds with no further prompts npx tierward context --all # one-shot: context then init npx tierward context --from-yaml file.md # bypass interview, validate + copy npx tierward validate-context # CI gate: exit 0/1 on schema check
CONTEXT.md is a schema-validated project context file. Greenfield runs a PM-friendly interview. Existing repos go through three-phase inference: algorithmic detection, LLM extraction, hybrid PM review. The first question routes you to a PM or developer flow. The developer flow reuses the technical questions from the legacy init wizards (projectName, stack, commands, scaffold options) and auto-derives tier.rationale from team size and work scope, so devs aren't asked to write PM rationale prose.
As of v1.27.0, the schema covers all four pipeline tiers: tier 0 (Discovery) and tier S (Fast Lane) for solo or bugfix work, tier M (Standard) for feature-block work with feature flags (has_api, has_database, has_frontend, has_design_system, has_prd), and tier L (Full) for complex domain projects.
One contract across four tiers. Solo bugfix or fully governed team pipeline, the rule is the same: Claude proposes, your team approves.
| Tier | Pipeline | Best for |
|---|---|---|
| 0 - Discovery | Stop hook only | First exploration - zero process |
| S - Fast Lane | 4 steps, scope-confirm | Single dev, low risk, quick fixes |
| M - Standard | 13 phases, 3 STOP gates | Feature blocks, 1-2 collaborators |
| L - Full | 14 phases, 4 STOP gates | Team projects, complex domain changes |
Start at Tier 0. Move up when you need more structure by re-running init with a higher tier (how).
The wizard also asks how changes reach main: through a staging branch (the default for web stacks), by a direct local merge (the default for native apps), or by a pull request (pr), with no staging branch and no push to main (promotion modes).
Executable multi-step programs that run inside Claude Code, not prompt instructions. Structured audit workflows with model routing (haiku for mechanical checks, sonnet for analysis).
/arch-audit, /security-audit, /perf-audit, /skill-dev, /simplify, /commit, /skill-security, /systematic-debugging/api-design, /skill-db, /migration-audit, /visual-audit, /ux-audit, /responsive-audit, /ui-audit, /accessibility-audit, /test-audit, /doc-audit, /api-contract-audit, /infra-audit, /compliance-audit, /dependency-audit, /pr-review, /skill-review, /dependency-scan, /repo-hygiene/context-reviewSkills are conditionally installed based on your project: hasApi, hasDatabase, hasFrontend, hasDesignSystem. What each skill does, when it is installed and what it needs: audit skills.
Node.js/TS, Node.js/JS, Python, Go, Swift, Kotlin, Rust, .NET, Ruby, Java - plus generic fallback. Security rules, permissions, and CLAUDE.md fields adapt automatically.
The tierward package ships an MCP server (tierward-mcp binary) alongside the CLI, version-locked, single npm install -g. Any MCP-aware client (Claude Desktop, ChatGPT desktop, Cursor, VS Code, Copilot Studio) can query Tierward governance state without the Tierward CLI running. Six read-only tools cover the doctor report, team-settings, last arch-audit, skill inventory, package metadata, and /pr-review comments. Full reference in the MCP server section below.
Tierward is also a Claude Code plugin (v1.32.0+), distributed through the plugin marketplace in this repository. The plugin adds 8 governance skills to Claude Code: commit, arch-audit, security-audit, perf-audit, simplify, skill-dev, skill-security and humanize. The MCP server isn't part of it, so install the npm package if you need that. Install the plugin from inside Claude Code (2.1.275 or later):
/plugin install tierward --marketplace marcoguillermaz/Tierward
Install individual components without a full scaffold:
npx tierward add skill security-audit # install one skill
npx tierward add rule git # install one rule npx tierward add rule security # install the security rule
Custom skills (custom-* prefix) are preserved across upgrades. See Custom Skills Guide.
your-project/
├── CLAUDE.md # Project context (<200 lines) ├── .claude/ │ ├── settings.json # Permissions + Stop hook (mechanical enforcement) │ ├── team-settings.json # Team policy: minTier / allowed / blocked / required (v1.16+) │ ├── rules/ │ │ ├── pipeline.md # Development workflow (tier-appropriate) │ │ ├── security.md # Stack-aware: web / apple / android / systems │ │ ├── git.md # Commit format, branch rules │ │ └── output-style.md # Communication rules │ ├── skills/ # Audit skills (conditional per project) │ ├── hooks/ # Governance gates and the audit log hook │ └── session/ # Session recovery (gitignored) ├── docs/ # Requirements, specs, backlog (M/L) ├── .github/ # PR template, CODEOWNERS └── .pre-commi