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#Generative AI (GenAI)

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Generative AI refers to algorithms and models in artificial intelligence that are capable of generating new data or content that is similar to existing data. These models are trained on large datasets and learn to generate new examples that mimic the patterns and characteristics of the original data.

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10:47 AM — Jose Garcia's creatinine test results arrive at the hospital FHIR server.
2.1 mg/dL — a 35% increase from last month.

What happens next?

  • Most systems: ❌ The result sits in a queue until a clinician reviews it manually — hours or days later.
  • This system: 👍 An AI agent evaluates the trend, consults clinical guidelines, and generates evidence-based recommendations — in seconds, automatically.

No chatbot. No manual prompts. No black-box reasoning.

This is event-driven clinical decision support with full explainability:

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✅ Triggered automatically by FHIR events
✅ Multi-agent reasoning (context, guidelines, recommendations)
✅ Complete audit trail in SQL (every decision, every evidence source)
✅ FHIR-native outputs (DiagnosticReport published to server)

Built with:
- InterSystems IRIS for Health — Orchestration, FHIR, persistence, vector search
- CrewAI — Multi-agent framework for structured reasoning

You'll learn: 🖋️ How to orchestrate agentic AI workflows within production-grade interoperability systems — and why explainability matters more than accuracy alone.

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Ever since I started using IRIS, I have wondered if we could create agents on IRIS. It seemed obvious: we have an Interoperability GUI that can trace messages, we have an underlying object database that can store SQL, Vectors and even Base64 images. We currently have a Python SDK that allows us to interface with the platform using Python, but not particularly optimized for developing agentic workflows. This was my attempt to create a Python SDK that can leverage several parts of IRIS to support development of agentic systems.

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Introduction

Earlier this year, I set about creating kit to introduce young techy folk at a Health Tech hackathon to using InterSystems IRIS for health, particularly focusing on using FHIR and vector search.

I wanted to publish this to the developer community because the tutorials included in the kit make a great introduction to using FHIR and to building a basic RAG system in IRIS. Its an all inclusive set of tutorials to show in detail how to:

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How I Vibecoded a Backend (and Frontend) on InterSystems IRIS

I wanted to try vibecoding a real backend + frontend setup on InterSystems IRIS, ideally using something realistic rather than a toy example. The goal was simple: take an existing, well-known persistent package in IRIS and quickly build a usable UI and API around it — letting AI handle as much of the boilerplate as possible. Here is the result of the experiments.

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Vector search is a retrieval method that converts text, images, audio, and other data into numeric vectors using an AI model, and then searches for items that are semantically close. It enables “semantic similarity search” from free text, which is difficult with keyword search alone.

However, in real use, I encountered cases where results that are “close in meaning” but logically the opposite appeared near the top of the search results.

This is a serious issue in situations where affirmation vs. negation matters. If the system returns the wrong answer, the impact can be significant, so we cannot ignore this problem.

This article does not propose a new algorithm. I wrote it to share a practical way I found useful when semantic search fails due to negation.

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