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garotm - add samples for testing and change to gemma4:26b for default model.
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‎backend/src/llmDefaults.ts‎

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/** Defaults aligned with Ollama’s OpenAI-compatible API (`/v1/chat/completions` on port 11434). */
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export const DEFAULT_LLM_BASE_URL = "http://127.0.0.1:11434/v1";
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/** Common tag; change in Settings to match `ollama list` (e.g. `llama3.2`, `mistral`, `qwen2.5:14b`). */
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export const DEFAULT_LLM_MODEL = "llama3.2";
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export const DEFAULT_LLM_MODEL_GEMMA="gemma4:26b"

‎samples/README.md‎

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# Sample records
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Three realistic (fictional) clinical records for testing Sift end-to-end.
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All patient names, dates, and values are entirely fabricated.
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| File | Format | What it contains |
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| -------------------------- | ---------------- | ------------------------------------------------------------------------------------------------------------------ |
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| `patient-fhir-bundle.json` | FHIR R4 Bundle | Patient demographics, 3 active conditions, 3 medications, 3 lab observations (A1c, creatinine, BP), 1 allergy |
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| `lab-result-hl7.hl7` | HL7 v2.5 ORU^R01 | Comprehensive metabolic panel with critical eGFR, elevated HbA1c, and abnormal lipids — includes NTE warning notes |
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| `referral-letter.txt` | Plain text | Cardiology referral letter for a complex patient with new wall motion abnormality, reduced EF, and elevated BNP |
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## How to test
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1. Start the app: `node sift.mjs run`
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2. Open **Settings** → pick any folder as your **Records folder** (or create a
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dedicated test folder).
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3. Copy one or more files from this `samples/` directory into that folder:
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```bash
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cp samples/patient-fhir-bundle.json ~/your-watch-folder/
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cp samples/lab-result-hl7.hl7 ~/your-watch-folder/
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cp samples/referral-letter.txt ~/your-watch-folder/
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```
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4. Switch to the **Documents** tab — each file should appear within a few
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seconds as the watcher picks it up.
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5. Click a document to see the **clinical synthesis** (LLM summary) and the
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**extracted context** (what was passed to the model).
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6. Hit **Print report** to get a printable clinical brief.
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## What good output looks like
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**FHIR bundle** — Sift should extract patient name, DOB, active diagnoses
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(T2DM, hypertension, CKD stage 3), current medications, and recent labs (A1c
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8.9%, creatinine 1.8, BP 148/92). The LLM summary should note the poorly
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controlled diabetes and the nephrology recommendation.
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**HL7 lab result** — Sift should parse the OBX segments and surface the
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critical eGFR (36), elevated HbA1c (9.2%), and abnormal lipids. The NTE
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fields contain clinical comments that the model will incorporate.
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**Referral letter** — plain text, so extraction relies entirely on the LLM.
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The summary should capture the new inferior hypokinesis, reduced LVEF (45%),
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elevated BNP, and the direct admission plan.

‎samples/lab-result-hl7.hl7‎

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MSH|^~\&|LABSYS|SPRINGFIELD_LAB|CLINIC_EMR|MAIN_CLINIC|20260318143022||ORU^R01|MSG20260318001|P|2.5
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PID|1||PT-00456^^^CLINIC^MR||Delgado^Carlos^Miguel||19720905|M|||88 Maple Court^^Chicago^IL^60601||312-555-0847|||||
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PV1|1|O|CLINIC^^^MAIN_CLINIC||||DR-0042^Nguyen^Sarah^L^^^MD|||||||||||V-20260318-1
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ORC|RE|ORD-20260318-042||||||||||DR-0042^Nguyen^Sarah^L^^^MD
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OBR|1|ORD-20260318-042||80053^Comprehensive Metabolic Panel^CPT|||20260318090000|||||||20260318143000||DR-0042^Nguyen^Sarah^L^^^MD||||||F
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OBX|1|NM|2951-2^Sodium^LN||138|mmol/L|136-145||||F|||20260318143000
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OBX|2|NM|2823-3^Potassium^LN||3.4|mmol/L|3.5-5.1|L|||F|||20260318143000
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OBX|3|NM|2075-0^Chloride^LN||101|mmol/L|98-107||||F|||20260318143000
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OBX|4|NM|1963-8^Bicarbonate^LN||22|mmol/L|22-29||||F|||20260318143000
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OBX|5|NM|3094-0^BUN^LN||28|mg/dL|7-20|H|||F|||20260318143000
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OBX|6|NM|2160-0^Creatinine^LN||2.1|mg/dL|0.7-1.3|H|||F|||20260318143000
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OBX|7|NM|33914-3^eGFR^LN||36|mL/min/1.73m2|>60|L|||F|||20260318143000
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OBX|8|NM|2345-7^Glucose^LN||214|mg/dL|70-100|H|||F|||20260318143000
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OBX|9|NM|1742-6^ALT^LN||52|U/L|7-56||||F|||20260318143000
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OBX|10|NM|1920-8^AST^LN||48|U/L|10-40|H|||F|||20260318143000
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OBX|11|NM|17856-6^HbA1c^LN||9.2|%|<5.7|H|||F|||20260318143000
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OBX|12|NM|2093-3^Cholesterol^LN||224|mg/dL|<200|H|||F|||20260318143000
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OBX|13|NM|13457-7^LDL^LN||148|mg/dL|<100|H|||F|||20260318143000
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OBX|14|NM|2085-9^HDL^LN||38|mg/dL|>40|L|||F|||20260318143000
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OBX|15|NM|2571-8^Triglycerides^LN||310|mg/dL|<150|H|||F|||20260318143000
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NTE|1||CRITICAL VALUES ALERT: eGFR 36 indicates Stage 3b CKD. Recommend nephrology referral and medication review for renal dosing.
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NTE|2||HbA1c 9.2% indicates poorly controlled diabetes. Consider intensification of diabetic regimen.
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NTE|3||Lipid panel markedly abnormal. LDL 148 well above goal for diabetic patient. Statin therapy review recommended.

‎samples/patient-fhir-bundle.json‎

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{
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"resourceType": "Bundle",
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"type": "collection",
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"entry": [
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{
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"resource": {
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"resourceType": "Patient",
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"id": "pt-00123",
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"name": [{ "family": "Hartwell", "given": ["Margaret", "Ann"], "use": "official" }],
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"birthDate": "1958-03-14",
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"gender": "female",
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"telecom": [{ "system": "phone", "value": "555-304-1192", "use": "home" }],
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"address": [{ "line": ["44 Birchwood Lane"], "city": "Springfield", "state": "IL", "postalCode": "62704" }]
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}
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},
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{
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"resource": {
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"resourceType": "Condition",
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"id": "cond-001",
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"subject": { "reference": "Patient/pt-00123" },
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"code": {
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"coding": [{ "system": "http://snomed.info/sct", "code": "44054006", "display": "Type 2 diabetes mellitus" }]
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},
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"clinicalStatus": { "coding": [{ "code": "active" }] },
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"onsetDateTime": "2014-07-22",
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"note": [{ "text": "Poorly controlled. A1c trending up over last 18 months." }]
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}
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},
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{
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"resource": {
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"resourceType": "Condition",
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"id": "cond-002",
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"subject": { "reference": "Patient/pt-00123" },
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"code": {
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"coding": [{ "system": "http://snomed.info/sct", "code": "38341003", "display": "Hypertension" }]
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},
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"clinicalStatus": { "coding": [{ "code": "active" }] },
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"onsetDateTime": "2011-02-10"
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}
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},
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{
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"resource": {
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"resourceType": "Condition",
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"id": "cond-003",
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"subject": { "reference": "Patient/pt-00123" },
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"code": {
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"coding": [{ "system": "http://snomed.info/sct", "code": "267425008", "display": "Chronic kidney disease stage 3" }]
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},
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"clinicalStatus": { "coding": [{ "code": "active" }] },
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"onsetDateTime": "2021-09-15",
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"note": [{ "text": "eGFR 42 on last draw. Nephrology follow-up recommended." }]
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}
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},
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{
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"resource": {
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"resourceType": "MedicationRequest",
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"id": "med-001",
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"subject": { "reference": "Patient/pt-00123" },
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"status": "active",
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"intent": "order",
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"medicationCodeableConcept": {
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"coding": [{ "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "860975", "display": "Metformin 1000 mg oral tablet" }]
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},
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"dosageInstruction": [{ "text": "1 tablet twice daily with meals" }]
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}
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},
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{
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"resource": {
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"resourceType": "MedicationRequest",
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"id": "med-002",
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"subject": { "reference": "Patient/pt-00123" },
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"status": "active",
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"intent": "order",
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"medicationCodeableConcept": {
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"coding": [{ "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "29046", "display": "Lisinopril 10 mg oral tablet" }]
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},
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"dosageInstruction": [{ "text": "1 tablet once daily" }]
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}
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},
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{
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"resource": {
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"resourceType": "MedicationRequest",
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"id": "med-003",
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"subject": { "reference": "Patient/pt-00123" },
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"status": "active",
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"intent": "order",
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"medicationCodeableConcept": {
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"coding": [{ "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "83367", "display": "Atorvastatin 40 mg oral tablet" }]
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},
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"dosageInstruction": [{ "text": "1 tablet at bedtime" }]
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}
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},
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{
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"resource": {
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"resourceType": "Observation",
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"id": "obs-001",
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"subject": { "reference": "Patient/pt-00123" },
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"status": "final",
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"code": {
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"coding": [{ "system": "http://loinc.org", "code": "4548-4", "display": "Hemoglobin A1c/Hemoglobin.total in Blood" }]
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},
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"effectiveDateTime": "2026-01-18",
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"valueQuantity": { "value": 8.9, "unit": "%", "system": "http://unitsofmeasure.org" },
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"interpretation": [{ "coding": [{ "code": "H", "display": "High" }] }]
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}
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},
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{
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"resource": {
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"resourceType": "Observation",
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"id": "obs-002",
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"subject": { "reference": "Patient/pt-00123" },
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"status": "final",
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"code": {
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"coding": [{ "system": "http://loinc.org", "code": "2160-0", "display": "Creatinine [Mass/volume] in Serum or Plasma" }]
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},
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"effectiveDateTime": "2026-01-18",
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"valueQuantity": { "value": 1.8, "unit": "mg/dL", "system": "http://unitsofmeasure.org" },
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"interpretation": [{ "coding": [{ "code": "H", "display": "High" }] }]
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}
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},
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{
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"resource": {
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"resourceType": "Observation",
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"id": "obs-003",
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"subject": { "reference": "Patient/pt-00123" },
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"status": "final",
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"code": {
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"coding": [{ "system": "http://loinc.org", "code": "55284-4", "display": "Blood pressure systolic and diastolic" }]
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},
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"effectiveDateTime": "2026-01-18",
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"component": [
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{
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"code": { "coding": [{ "code": "8480-6", "display": "Systolic blood pressure" }] },
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"valueQuantity": { "value": 148, "unit": "mmHg" }
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},
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{
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"code": { "coding": [{ "code": "8462-4", "display": "Diastolic blood pressure" }] },
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"valueQuantity": { "value": 92, "unit": "mmHg" }
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}
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]
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}
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},
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{
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"resource": {
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"resourceType": "AllergyIntolerance",
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"id": "allergy-001",
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"patient": { "reference": "Patient/pt-00123" },
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"clinicalStatus": { "coding": [{ "code": "active" }] },
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"code": { "coding": [{ "system": "http://www.nlm.nih.gov/research/umls/rxnorm", "code": "7980", "display": "Penicillin" }] },
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"reaction": [{ "manifestation": [{ "coding": [{ "display": "Anaphylaxis" }] }], "severity": "severe" }]
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}
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}
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]
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}

‎samples/referral-letter.txt‎

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SPRINGFIELD CARDIOLOGY ASSOCIATES
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1200 Medical Plaza Drive, Suite 400
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Springfield, IL 62704
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Tel: (217) 555-8800 Fax: (217) 555-8801
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DATE: March 20, 2026
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RE: Patient Referral — Cardiology Consultation
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TO: Dr. Patricia Okonkwo, MD
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Springfield Internal Medicine Group
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FROM: Dr. James Whitfield, MD, FACC
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Interventional Cardiology
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PATIENT: Thomas R. Beaumont
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DOB: 09/14/1951 | MRN: SCA-10392
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INSURANCE: Medicare Part B | ID: 1EG4-TE5-MK72
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Dear Dr. Okonkwo,
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Thank you for referring Mr. Beaumont for cardiology evaluation. I saw him in my
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office on March 18, 2026 for a new patient consultation regarding exertional
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chest pain and dyspnea on exertion.
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PRESENTING COMPLAINT:
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Mr. Beaumont is a 74-year-old male with a 3-week history of progressive exertional
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chest tightness and shortness of breath occurring with moderate activity (walking
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two blocks, climbing one flight of stairs). He denies rest pain, orthopnea, or
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paroxysmal nocturnal dyspnea. One episode of near-syncope occurred last Tuesday
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while mowing the lawn.
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PAST MEDICAL HISTORY:
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- Coronary artery disease, 3-vessel (catheterization 2019 — 70% LAD stenosis,
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60% RCA stenosis, managed medically)
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- Hypertension (15+ years, currently controlled)
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- Hyperlipidemia
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- Type 2 diabetes mellitus (diet-controlled)
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- Prior tobacco use — 30 pack-years, quit 2008
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CURRENT MEDICATIONS:
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- Aspirin 81 mg daily
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- Carvedilol 12.5 mg twice daily
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- Lisinopril 20 mg daily
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- Atorvastatin 80 mg nightly
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- Amlodipine 5 mg daily
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- Metformin 500 mg twice daily
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ALLERGIES: Clopidogrel (rash), Sulfa drugs (anaphylaxis)
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EXAMINATION FINDINGS (03/18/2026):
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- BP: 138/84 mmHg (right arm), HR: 68 bpm (regular), SpO2: 96% on room air
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- Weight: 201 lbs, BMI: 28.9
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- Cardiovascular: Regular rate and rhythm. Grade II/VI systolic murmur at RUSB.
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No S3/S4. JVP not elevated.
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- Respiratory: Clear to auscultation bilaterally, no crackles.
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- Extremities: Trace bilateral ankle edema.
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DIAGNOSTIC RESULTS:
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- 12-lead ECG (03/18/2026): Normal sinus rhythm. Left ventricular hypertrophy
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by voltage. Old inferior Q waves (leads II, III, aVF) consistent with prior
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inferior MI — NOTE: this was not documented in prior records. Possible silent MI.
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- Echocardiogram (03/18/2026): LVEF 45% (mildly reduced, previously 60% in 2022).
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Inferior wall hypokinesis. Mild mitral regurgitation. No pericardial effusion.
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- BNP: 410 pg/mL (elevated; reference <100 pg/mL)
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- Troponin I (x2, 3h apart): 0.02 ng/mL, 0.02 ng/mL (negative for acute MI)
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IMPRESSION:
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1. New wall motion abnormality (inferior hypokinesis) with decline in LVEF from
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60% to 45% — highly suspicious for interval silent MI or ischemic
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cardiomyopathy progression.
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2. Exertional symptoms consistent with heart failure with mildly reduced EF
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(HFmrEF) and/or active ischemia.
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3. Elevated BNP supporting volume overload / early decompensation.
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4. Previously undocumented inferior MI pattern on ECG.
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PLAN:
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1. Admitting Mr. Beaumont directly to Springfield Memorial Hospital for further
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evaluation and monitoring. Cardiology team notified.
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2. Nuclear stress test scheduled for 03/21/2026 to assess ischemic burden.
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3. Coronary angiography likely indicated if stress test confirms ischemia —
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previously placed on medical management but clinical picture has changed.
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4. Initiating low-dose furosemide 20 mg daily for fluid management.
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5. Increasing carvedilol to 25 mg twice daily as tolerated.
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6. GDMT optimization per current HFmrEF guidelines.
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7. Patient educated on daily weight monitoring, sodium restriction (<2g/day),
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and activity limitations. Return to cardiology within 1 week post-discharge.
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Please feel free to contact my office directly at (217) 555-8800 with any questions.
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We will keep you updated on Mr. Beaumont's hospital course.
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Sincerely,
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Dr. James Whitfield, MD, FACC
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Interventional Cardiology
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Springfield Cardiology Associates

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