May was a heavy month for Medplum, with 100+ commits from 20+ contributors and four patch releases — v5.1.10 through v5.1.13. [Scheduling](/content/docs/scheduling/index.html) was the headline: the full appointment operation suite — `$find`, `$hold`, `$book`, `$confirm`, and `$cancel` — landed in Alpha. The [Provider App](https://provider.medplum.com/) also gained medication ordering components, order set import, and operation-based claim submission. On the enterprise side, a new data warehouse export features were enabled, and the platform team shipped passwordless magic-link login, AWS GuardDuty malware protection, and a round of OAuth2 spec-compliance fixes. All of this continues to drive forward our [2026 roadmap priorities](/content/blog/2026-roadmap/index.html).

## Features

### Scheduling

**[Noah Silas](https://github.com/noahsilas)**

May completed the core scheduling operation suite that the [scheduling roadmap](/content/blog/2026-roadmap#scheduling/index.html) has been building toward. Each step of the booking lifecycle now has a dedicated, spec-aligned FHIR operation:

- **[`Appointment/$find` multi-schedule search](/content/docs/scheduling/appointment-find/index.html)** — Search for open slots across multiple schedules in a single request, the foundation for self-scheduling across providers and locations
- **[`$hold` operation](/content/docs/scheduling/appointment-hold/index.html)** — Temporarily reserve a slot while a patient completes booking, preventing double-booking during checkout
- **[`$book` for proposed appointments](/content/docs/scheduling/appointment-book/index.html)** — `$book` now accepts a proposed appointment as input, with test coverage for the patient self-booking path
- **[`$confirm` operation](/content/docs/scheduling/appointment-confirm/index.html)** — New `Appointment/:id/$confirm` operation to confirm a held or proposed appointment
- **[`$cancel` operation](/content/docs/scheduling/appointment-cancel/index.html)** — New scheduling cancel operation with improved error-path handling throughout the booking flow
- **Appointment-based Provider flow** — The [Provider scheduling calendar](/content/docs/provider/schedule/index.html) now uses the Appointment-based flow, reveals more slots in the schedule page, and is gated behind a scheduling feature flag for controlled rollout
- **Self-scheduling reference flow** — Foomedical, a sample patient-facing experience, now uses `Appointment/$find` + `$hold` to demonstrate the end-to-end patient booking pattern

### Provider App: Medication Ordering and Prescribing

**[Oleg Rocklin](https://github.com/oleg-mp)**

Medication ordering moved into the [Provider App](/content/blog/2026-roadmap#provider-application/index.html) this month:

- **Meds ordering components** — New React and Provider App components for ordering medications, bringing prescribing into the standard clinical workflow
- **Batched pharmacy/org searches** — Preferred pharmacies and organizations are now fetched with batched searches during prescribing for faster load times
- **Resilient draft handling** — Draft `MedicationRequest` resources are soft-deleted when an order-medication step fails, keeping the chart clean after errors

### Provider App: Order Sets and Billing

**[Andy Stoneman](https://github.com/andystoneman)** and **[David Yanez](https://github.com/techdavidy)**

- **Order set import** — An order set bundle and import button were added to the Provider App, with a sync bot trigger that runs automatically after an example order set is imported
- **Operation-based claim submission** — Claim submission now uses a server-side FHIR operation instead of a bot, simplifying the [billing](/content/docs/billing/index.html) integration and reducing moving parts
- **Self-pay coverage filtering** — Self-pay coverage is now filtered out of the visit eligibility check and removed from the `PatientSummary` insurance display, so eligibility reflects only billable payers ( [Insurance Eligibility Checks](/content/docs/billing/insurance-eligibility-checks/index.html))
- **`ClinicalImpression` in the timeline** — Clinical impressions now appear in the patient timeline ( [Maddy Li](https://github.com/maddyli))
- **Cancel Visit** — A "Cancel Visit" button and a fixed "Details" link tab round out the encounter workflow ( [Noah Silas](https://github.com/noahsilas))
- **Configurable onboarding** — The Provider App "Get Started" screen can now be hidden via a project setting ( [Ian Plunkett](https://github.com/ianplunkett))

### AI: Real-Time Clinical Documentation

**[David Yanez](https://github.com/techdavidy)**

AI work this month focused on real-time clinical documentation inside [Spaces](/content/docs/provider/spaces/index.html), the AI-powered chat workspace in the Provider App, as part of the [AI roadmap](/content/blog/2026-roadmap#ai/index.html):

- **Real-time speech-to-text** — Live speech-to-text in the Provider App for AI-assisted clinical documentation, backed by updates to the `$ai-realtime` operation
- **Markdown responses in Spaces** — Spaces now renders markdown in AI responses for clearer, better-formatted output
- **Whisper hook in `react-hooks`** — The Whisper transcription hook moved into the `@medplum/react-hooks` package so it can be reused across applications

### Enterprise: Data Warehouse Export

**[Karl Pietrzak](https://github.com/The-Alchemist)**

A major [Enterprise Scale](/content/blog/2026-roadmap#enterprise-scale--infrastructure/index.html) feature landed: Medplum can now export directly from PostgreSQL into [Apache Parquet](https://parquet.apache.org/) and [Apache Iceberg](https://iceberg.apache.org/) tables on [S3 Tables](https://docs.aws.amazon.com/AmazonS3/latest/userguide/s3-tables.html). This gives data teams an efficient, columnar path into modern lakehouse [analytics](/content/docs/analytics/index.html) without standing up a separate ETL pipeline. A new `startDate` parameter lets exports run incrementally. This is new functionality related to Medplum Enterprise.

### Platform, Security, and Infrastructure

**[Cody Ebberson](https://github.com/codyebberson)**

- **Passwordless magic-link login** — New OAuth2 pre-authorized code flow enables [magic-link sign-in](/content/docs/auth/pre-authorized-code/index.html), with the pre-authorized code lifetime extended to 7 days for email-based flows
- **Unified external authentication** — Consolidated the external identity-provider paths into a single [unified external auth](/content/docs/auth/external-identity-providers/index.html) flow, including Google Cloud Identity Platform userinfo support
- **AWS GuardDuty Malware Protection** — Added support for [AWS GuardDuty Malware Protection](https://docs.aws.amazon.com/guardduty/latest/ug/malware-protection.html) on uploaded files, with graceful handling of images quarantined by the scanner
- **HTTPS-only subscription URLs** — Rest-hook [`Subscription`](/content/docs/subscriptions/index.html) URLs now require HTTPS by default, and a server option can require a verified email address before login
- **OAuth2 spec-compliance fixes** — A batch of [OAuth2 token endpoint](/content/docs/api/oauth/token/index.html) corrections including `offline_access` handling when `refresh_token` is in `grant_types`, `www-authenticate: bearer` responses, and enforcing login membership before scope
- **`log-streaming` project feature** — A new [log-streaming](/content/docs/integration/log-streaming/index.html) project feature plus a `Project.features` search parameter for managing it

**[Derrick Farris](https://github.com/ThatOneBro)**

- **Bot Lambda lifecycle management** — Medplum now prunes old [bot Lambda](/content/docs/bots/bots-in-production/index.html) versions, deletes the Lambda when a bot is deleted, and removes stale versions, keeping cloud deployments tidy and within service limits
- **[`Agent/$stats` operation](/content/docs/agent/stats/index.html)** — New operation to retrieve statistics for a deployed [Agent](/content/docs/agent/index.html), Medplum's on-premise connectivity service for legacy healthcare systems
- **[`User/$rescope` operation](/content/docs/auth/index.html)** — New operation to change a user's project scope without re-issuing credentials
- **Rate-limit reliability** — Optimized Redis key access for [rate limiting](/content/docs/rate-limits/index.html), exposed the `RateLimit` header for CORS, and improved WebSocket subscription error messages

**[Maddy Li](https://github.com/maddyli)**

- **Rate-limit administration** — A new [project rate-limits operation](/content/docs/api/fhir/operations/project-rate-limits/index.html), an admin API endpoint for rate-limit utilization status, an active-consumer index, and a Rate Limits tab on the admin page give operators full visibility into [rate limiting](/content/docs/rate-limits/index.html)
- **NPI Lookup example bot** — A new example bot for NPI lookups using the [NPPES API](https://npiregistry.cms.hhs.gov/)

**[Matt Willer](https://github.com/mattwiller)**

- **Range search** — FHIR search now supports range queries with correct overlap and boundary handling
- **Patient scope hardening** — Patient-scoped tokens are now restricted to their context Patient compartment, and chained search and `_include` types are validated for safety
- **Vendored JSON Patch** — The JSON Patch library is now vendored, and FHIR quota-limit computation was unified into a single helper
- **Larger payload handling** — Oversized request bodies are transformed into a clean HTTP 413 response

**[Matt Long](https://github.com/mattlong)**

- **Transaction reliability** — Serialized transaction state transitions and more consistent repository connection-state tracking improve [site reliability](/content/blog/2026-roadmap#enterprise-scale--infrastructure/index.html) under load
- **`Project.link` search parameter** — New search parameter for navigating linked projects

## Documentation

May's documentation work spanned self-hosting, compliance, integrations, and the Provider App.

**Self-hosting and reliability**

**[Cody Ebberson](https://github.com/codyebberson)**

- **[Install on DigitalOcean](/content/docs/self-hosting/install-on-digital-ocean/index.html)** — New guide for self-hosting Medplum on DigitalOcean
- **[Uptime and reliability](/content/docs/uptime/index.html)** — New documentation covering Medplum's uptime and site reliability practices
- **[VM context bot security note](/content/docs/bots/bots-in-production/index.html)** — Added a security note for VM context bots in production

**Compliance and scale**

- **[Electronic prior authorization testing](/content/docs/integration/electronic-prior-auth/index.html)** — Testing documentation for electronic prior authorization, part of the [HTI-4 compliance initiative](/content/docs/compliance/hti-4/index.html) ahead of the January 2027 enforcement date ( [Cody Ebberson](https://github.com/codyebberson))
- **[Async batch processing](/content/docs/fhir-datastore/processing-async-bundles/index.html)** — New documentation for asynchronous batch processing, with a note on how FHIR quotas apply ( [Finn Bergquist](https://github.com/finnbergquist), [Andy Stoneman](https://github.com/andystoneman))

**Integrations**

- **[Health Gorilla sync-back resources](/content/docs/integration/health-gorilla/sync-resources-from-health-gorilla/index.html)** — Documentation for resources synced back from Health Gorilla ( [Maddy Li](https://github.com/maddyli))
- **[Self-service prescriber enrollment bot](/content/docs/integration/dosespot/enroll-user/index.html)** — Documented the self-service prescriber enrollment bot ( [Ian Plunkett](https://github.com/ianplunkett))

**Provider App and platform**

- **[Spaces feature documentation](/content/docs/provider/spaces/index.html)** — Added Spaces feature documentation for the Provider App, including a walkthrough video ( [Everett Williams](https://github.com/everett-williams))
- **[Charting documentation restructure](/content/docs/charting/index.html)** — Restructured the charting documentation with additional decision-guide content ( [Everett Williams](https://github.com/everett-williams))
- **[Project vs. server-scoped users](/content/docs/user-management/project-vs-server-scoped-users/index.html)** and **[direct external auth](/content/docs/auth/direct-external-auth/index.html)** — Clarified user scoping and external auth setup ( [Finn Bergquist](https://github.com/finnbergquist))
- **[Rate limits operation](/content/docs/api/fhir/operations/project-rate-limits/index.html)** — Documented the new rate-limits operation, plus a clarification on bots with `ProjectMembership` ( [Maddy Li](https://github.com/maddyli))
- **Trust center links** — Updated compliance links to point to the [Medplum Trust Center](https://trust.medplum.com/) ( [Reshma Khilnani](https://github.com/reshmakh))

**Testing infrastructure**

**[Karl Pietrzak](https://github.com/The-Alchemist)**

A broad effort migrated many internal packages — including `hl7`, `fhir-router`, `generator`, `create-medplum`, `cdk`, `ccda`, `mock`, and `definitions` — from Jest to [Vitest](https://vitest.dev/) for faster, more consistent test runs across the monorepo.

## Bug Fixes

**AWS and CDK**

- Fixed handling of complex server configuration, and corrected CDK to send the prefix instead of the bucket name (contributed by [Jim Fiorato](https://github.com/jimfiorato))

**Authentication**

- Serialized cross-tab token refresh using the Web Locks API to prevent race conditions across browser tabs (contributed by [Dillon Streator](https://github.com/dillonstreator))
- Fixed the `RECAPTCHA_SITE_KEY` always reverting to the default value (contributed by [Meade](https://github.com/TheDarkula))
- Added `defaultProjectFeatures` to the config object keys set (contributed by [Nate Watkins](https://github.com/nate-watkins))

**FHIR and Agent**

- Fixed indexing of fragment `CodeSystem` resources in the coding table (contributed by [Jeffry Looijestijn](https://github.com/jeffrylooijestijn))
- The Agent now returns an explicit error when an upgrade artifact is missing (contributed by [Agustin Bereciartua Castillo](https://github.com/galenzo17))
- Display of `onBehalfOf` was added to History, Timeline, and Blame views (contributed by [Alex Lin](https://github.com/alexanderxlin))

## Releases

- [**v5.1.10**](https://github.com/medplum/medplum/releases/tag/v5.1.10) — May 1
- [**v5.1.11**](https://github.com/medplum/medplum/releases/tag/v5.1.11) — May 6
- [**v5.1.12**](https://github.com/medplum/medplum/releases/tag/v5.1.12) — May 17
- [**v5.1.13**](https://github.com/medplum/medplum/releases/tag/v5.1.13) — May 20

## Looking Ahead

May brought the scheduling operation suite to completion — `$find`, `$hold`, `$book`, `$confirm`, and `$cancel` now cover the full booking lifecycle — and moved the Provider App onto an Appointment-based flow with medication ordering and order set import. Passwordless magic-link login and GuardDuty malware protection strengthen the platform's security posture.

Join us on [Discord](https://discord.gg/medplum) to share feedback or follow along on [GitHub](https://github.com/medplum/medplum).