8 Architectural Pillars to Boost GenAI LLM Accuracy and Performance in Low Cost
Smarter AI architecture, not bigger LLM models - how engineering teams push LLM accuracy and high performance in low cost. Enterprises using LLM (Large Language Models) hits the same ceiling and paying big price! A raw API call to a frontier model- GPT-4, Claude, Gemini delivers only 35-40% accuracy on structured output tasks like code generation, NL to DAX query generation, domain-specific reasoning. Prompt engineering pushes that to ~60%. But the final 35+ percentage points? Those come from system architecture, not model upgrades. This guide presents 8 architectural pillars, distilled from production GenAI systems, that compound to close the accuracy gap. These patterns are model-agnostic and domain-agnostic, they apply equally to chatbots, coding assistants, content/query generators, automation agents, and any application where an LLM produces structured or semi-structured output. It’s based on my recent GenAI projects. The key takeaway: use the LLM as one component in a larger system, not as the system itself. Surround it with deterministic guardrails, verified knowledge, and feedback loops. Pillar 1: Enhance Prompts with Verified Knowledge Context Impact: +35-40% accuracy the single biggest improvement Top source of LLM errors in production is hallucinated identifiers knowledgebase, the model invents names, references, or structures that don't exist in the target system. This happens because LLMs are trained on general knowledge but deployed against specific, private enterprise systems they've never seen local database and knowledgebase. The fix is straightforward: inject verified, system-specific context (type definitions, API specs, ontologies, configuration schemas, entity catalogues) directly into the prompt so the model composes from known-good elements rather than recalling from training data. Use Knowledge Graph for better sematic knowledge. How to Implement Provide explicit context, never implicit- Whatever the LLM needs to reference identifiers, valid values, semantic knowledge, structures must appear verbatim in the prompt or retrieved context window. Filter aggressively. A full knowledge base with thousands of entities overwhelms the context window and confuses the model. Use intelligent filtering to surface only needed 5-10 most relevant elements per request. Store structured semantic knowledge in a graph or searchable index. This enables relationship-aware retrieval: "given entity X, what related entities, attributes, and constraints are also needed?" Include rich Semantic metadata. Names alone are insufficient. Include types, constraints, valid value ranges, relationships, and usage notes to minimize ambiguity. Keep context fresh. Stale context causes a different class of hallucination the model generates valid-looking output that references outdated structures. Sync your knowledge store with your source of truth. Why This Works LLMs excel at composition and reasoning — combining elements, applying logic, following patterns. They are unreliable at recall of specific identifiers — exact names, valid values, structural constraints. By offloading recall to a deterministic retrieval system and giving the LLM only composition tasks, you play to each system's strengths. Pillar 2: Tiered LLM Approach: Route Deterministically First, Use LLMs Last Impact: 80% cost reduction, 85% latency reduction, eliminates non-deterministic errors for most traffic. The most impactful architectural insight: most production requests don't need an LLM at all. A well-designed system handles 60-70% of traffic with deterministic logic templates, composition rules, cached results and reserves expensive, non-deterministic LLM calls only for genuinely novel inputs. The Three-Tier Model These metrics are from a real use case to convert NLP to Power BI DAX query. Tier Strategy Uses LLM? Latency Accuracy Tier 0 Template slot-filling - handles requests that match known patterns exactly — the system fills slots in a pre-built template with extracted parameters. No LLM, no non-determinism, near-perfect accuracy, sub-100ms response. No ~50ms 95-98% Tier 1 Compose from pre-validated fragments- handles requests that combine known patterns in new ways. The system retrieves pre-validated building blocks via search, composes them using deterministic rules, and validates the result. Still no LLM call. No ~200ms 90-95% Tier 2 Full LLM generation with enriched context- is reserved for genuinely novel requests that can't be served deterministically. Even here, the LLM receives maximum support: filtered context, relevant examples, explicit rules, and structured planning. Yes (1 call) 2-5s 88-93% Complexity-Based Routing A lightweight scoring function (evaluated in <1ms) routes each incoming request: Factors: reasoning depth, number of components, cross-references, constraints, nesting depth, novelty (distance from known patterns) Score 0-39: Tier 0 (deterministic template) Score 40-59: Tier 1 if confidence ≥ 85%, else Tier 2 Score 60+: Tier 2 (LLM generation) This routing achieves 96%+ accuracy in tier assignment and ensures the expensive path is only taken when necessary. Why This Matters Cost: 70-80% of requests cost zero LLM tokens Latency: Majority of responses in <200ms instead of 2-5s Reliability: Deterministic tiers produce identical output for identical input. Scalability: Deterministic tiers scale horizontally with trivial compute Pillar 3: Encode Prompt Anti-Patterns as Explicit Rules Impact: +8-10% accuracy, ~80% reduction in common structural errors LLM mistakes are patterned, not random. In any domain, 80% of errors cluster around a small set of 6-13 recurring structural mistakes. Instead of hoping the model avoids them through general instruction-following, compile these mistakes into explicit WRONG => CORRECT rules embedded directly in the system prompt. How to Implement Collect error data. Run 100+ requests through your system and categorize the failures. You'll find the same 6-13 patterns appearing repeatedly. Write concrete rules. For each pattern, show the exact wrong output and the exact correct alternative, with a one-line explanation of why. Embed in system prompt. Place rules prominently — after the task description, before examples. Use formatting that's hard to ignore (headers, bold, explicit "NEVER" language). Keep the list short. 6-13 rules maximum. Beyond that, attention dilutes and the model starts ignoring rules. Prioritize by frequency. Refresh continuously. As the system improves (via other pillars), some errors disappear. New error types emerge. Update the rule set quarterly. Why This Works LLMs respond strongly to explicit negative examples. A generic instruction like "be careful with X" has minimal impact. But showing the exact wrong output the model tends to produce, paired with the correction, creates a strong avoidance signal. It's analogous to unit tests. Pillar 4: Retrieve Few-Shot Examples Dynamically Impact: +5-15% accuracy depending on domain complexity Static examples hardcoded in a prompt become stale, irrelevant of context tokens. Dynamic few-shot retrieval selects the 3-5 most relevant examples for each specific request, maximizing the signal-to-noise ratio in the prompt. Hybrid Retrieval Architecture The most effective approach combines two search strategies for intent searc to understand natural language (NL) context: Keyword search (BM25) — Finds examples with exact matching terms, identifiers, and domain vocabulary Vector search (semantic similarity) — Finds examples with similar intent and structure, even if wording differs Rank fusion — Merges results from both strategies, re-ranking by combined relevance This hybrid approach outperforms either strategy alone because keyword search catches exact identifier matches that vector search dilutes, while vector search captures semantic similarity that keyword search misses entirely. Best GenAI Architectural Practices Match complexity to complexity. Simple requests should see simple examples. Complex requests should see complex examples. Mismatched examples confuse the model. Include negative examples. For the detected request type, include 1-2 "wrong => correct" pairs alongside positive examples. This reinforces Pillar 3's anti-pattern rules with concrete, contextually relevant demonstrations. Pre-compute embeddings. Generate vector embeddings at indexing time, not at query time. Cache retrieval results for repeated patterns. Curate quality over quantity. 3 excellent, diverse examples beat 10 mediocre ones. Each example should demonstrate a distinct pattern or edge case. Keep examples current. As your system evolves, old examples may demonstrate outdated patterns. Review and refresh the example store periodically. Pillar 5: Feedback Loop- Validate and Auto-Fix Every Output Deterministically Impact: +3-5% accuracy as a safety net, plus continuous improvement via feedback No matter how well-prompted, LLMs will occasionally produce outputs with minor structural errors - wrong casing, missing delimiters, references to slightly-incorrect identifiers, or subtle format violations. A deterministic post-processing pipeline catches and fixes these without any additional LLM calls. The Validation Pipeline LLM Output => Parse (grammar/AST) => Rule-Based Fixes => Compliance Check/validation => Final Output Each stage is fully deterministic: Parsing: Use a formal grammar or AST parser (ANTLR, tree-sitter, language-native parsers) to structurally analyse the output. Never regex-parse structured output - it's fragile and misses edge cases. Rule-based fixes: 10-20 deterministic transformation rules that correct known error patterns - name normalization, casing fixes, missing delimiters, structural repairs. Compliance check: Verify every identifier referenced in the output actually exists in the provided context. Flag unknown references. Design Principles Zero LLM calls in the fix pipeline. Every fix is a regex, an AST transformation, or a lookup table operation. Instant, free, deterministic, 100% reliable. Fail safe. If a fix is ambiguous (multiple valid corrections possible), pass through rather than corrupt. A minor error is better than a confident wrong "fix." Log everything. Track every fix applied, categorized by type. This data drives the feedback loop. The Critical Feedback Loop- The validation pipeline's most important function isn't fixing outputs — it's generating improvement signals: This creates a feedback loop: the auto-fix catches errors → the errors get promoted to upstream prevention → fewer errors reach the auto-fix → the system continuously tightens. Pillar 6: Multi-Agent Orchestration with Fewer Agents and Clear Contracts Impact: Reduced latency, clearer debugging, fewer failure modes The multi-agent pattern is powerful but commonly over-applied. The counter-intuitive lesson from production systems: fewer agents with well-defined responsibilities outperform many fine-grained agents. Why Fewer Is Better Each agent handoff introduces: Latency - serialization, network calls, context assembly Context loss - information dropped between boundaries Failure modes - each handoff is a potential error point Debugging complexity - tracing issues across many agents is exponentially harder Multi-Agent Orchestration Principles Merge agents that always run sequentially. If Agent A always feeds into Agent B with no branching or conditional logic, they should be one agent with two internal steps. Parallelize independent operations. Context retrieval and example lookup are independent — run them concurrently to halve retrieval latency. Route sub-tasks to cheaper models. Decomposed sub-problems are simpler by design. Use a smaller, faster, cheaper model (3x cost savings, 2x speed improvement). Define strict contracts. Each agent boundary should have an explicit schema defining inputs and outputs. No implicit assumptions about what crosses the boundary. Only 2 of 4 agents should call an LLM. The rest are purely deterministic. This minimizes non-deterministic behavior and cost. Pillar 7: Multi-Agent Cache at Multiple Hierarchical Levels Impact: 40-50% faster responses, 85%+ combined hit rate, significant cost reduction A single cache layer captures only one type of repetition. Production systems need hierarchical caching where multiple levels catch different repetition patterns — from exact duplicates to semantic near-misses. Pillar 8: Measure Everything, Learn Continuously Impact: Enables data-driven iteration and prevents accuracy regressions. Architecture without observability is guesswork. The final pillar ensures every other pillar stays effective over time through comprehensive metrics and automated feedback loops. This isn't a one-time setup; it's a perpetual feedback loop. Every week, the top error patterns shift slightly. The auto-fix metrics tell you exactly where to focus next. Over months, this flywheel compounds into dramatic accuracy gains that no single prompt rewrite could achieve. Auto-Learning for New Domains When extending your system to new domains or knowledge areas: Auto-classify elements using naming conventions, type analysis, and structural patterns Auto-generate templates from universal patterns (transformations, comparisons, compositions, sequences) Bootstrap few-shot examples from successful template outputs Monitor for the first 100 requests, then curate only the edge cases manually This reduces domain onboarding from days of manual work to minutes of automated bootstrapping plus focused human review of outliers. Key Takeaways Architecture beats model size. A well-architected system with a smaller model outperforms a raw frontier model call on structured tasks at a fraction of the cost. Deterministic systems should do the heavy lifting. Reserve LLMs for genuinely novel, creative tasks. 70-80% of production requests should never touch an LLM. Verified knowledge is your top accuracy lever. Ground every prompt in context the model can trust. Errors are patterned, not random- Track them, compile them, and explicitly forbid them. Build feedback loops, not static systems- Every auto-fix, every cache miss, every routing decision is a signal for improvement. Fewer agents, done well- Fewer agents with strict contracts outperform 9 agents with fuzzy boundaries — in accuracy, latency, and debuggability. Measure what matters and iterates- The system that wins isn't the one with the best day-one prompt, it's the one that improves fastest over time. Production-grade GenAI isn't about finding the perfect prompt or waiting for the next LLM model release. It's about building architectural guardrails that make failure nearly impossible — and when failure does occur, the system learns from it automatically. These 8 pillars, applied together, transform any LLM from an unreliable black box into a precise, efficient, and continuously improving production system.Integrating Microsoft Foundry with OpenClaw: Step by Step Model Configuration
Step 1: Deploying Models on Microsoft Foundry Let us kick things off in the Azure portal. To get our OpenClaw agent thinking like a genius, we need to deploy our models in Microsoft Foundry. For this guide, we are going to focus on deploying gpt-5.2-codex on Microsoft Foundry with OpenClaw. Navigate to your AI Hub, head over to the model catalog, choose the model you wish to use with OpenClaw and hit deploy. Once your deployment is successful, head to the endpoints section. Important: Grab your Endpoint URL and your API Keys right now and save them in a secure note. We will need these exact values to connect OpenClaw in a few minutes. Step 2: Installing and Initializing OpenClaw Next up, we need to get OpenClaw running on your machine. Open up your terminal and run the official installation script: curl -fsSL https://openclaw.ai/install.sh | bash The wizard will walk you through a few prompts. Here is exactly how to answer them to link up with our Azure setup: First Page (Model Selection): Choose "Skip for now". Second Page (Provider): Select azure-openai-responses. Model Selection: Select gpt-5.2-codex , For now only the models listed (hosted on Microsoft Foundry) in the picture below are available to be used with OpenClaw. Follow the rest of the standard prompts to finish the initial setup. Step 3: Editing the OpenClaw Configuration File Now for the fun part. We need to manually configure OpenClaw to talk to Microsoft Foundry. Open your configuration file located at ~/.openclaw/openclaw.json in your favorite text editor. Replace the contents of the models and agents sections with the following code block: { "models": { "providers": { "azure-openai-responses": { "baseUrl": "https://<YOUR_RESOURCE_NAME>.openai.azure.com/openai/v1", "apiKey": "<YOUR_AZURE_OPENAI_API_KEY>", "api": "openai-responses", "authHeader": false, "headers": { "api-key": "<YOUR_AZURE_OPENAI_API_KEY>" }, "models": [ { "id": "gpt-5.2-codex", "name": "GPT-5.2-Codex (Azure)", "reasoning": true, "input": ["text", "image"], "cost": { "input": 0, "output": 0, "cacheRead": 0, "cacheWrite": 0 }, "contextWindow": 400000, "maxTokens": 16384, "compat": { "supportsStore": false } }, { "id": "gpt-5.2", "name": "GPT-5.2 (Azure)", "reasoning": false, "input": ["text", "image"], "cost": { "input": 0, "output": 0, "cacheRead": 0, "cacheWrite": 0 }, "contextWindow": 272000, "maxTokens": 16384, "compat": { "supportsStore": false } } ] } } }, "agents": { "defaults": { "model": { "primary": "azure-openai-responses/gpt-5.2-codex" }, "models": { "azure-openai-responses/gpt-5.2-codex": {} }, "workspace": "/home/<USERNAME>/.openclaw/workspace", "compaction": { "mode": "safeguard" }, "maxConcurrent": 4, "subagents": { "maxConcurrent": 8 } } } } You will notice a few placeholders in that JSON. Here is exactly what you need to swap out: Placeholder Variable What It Is Where to Find It <YOUR_RESOURCE_NAME> The unique name of your Azure OpenAI resource. Found in your Azure Portal under the Azure OpenAI resource overview. <YOUR_AZURE_OPENAI_API_KEY> The secret key required to authenticate your requests. Found in Microsoft Foundry under your project endpoints or Azure Portal keys section. <USERNAME> Your local computer's user profile name. Open your terminal and type whoami to find this. Step 4: Restart the Gateway After saving the configuration file, you must restart the OpenClaw gateway for the new Foundry settings to take effect. Run this simple command: openclaw gateway restart Configuration Notes & Deep Dive If you are curious about why we configured the JSON that way, here is a quick breakdown of the technical details. Authentication Differences Azure OpenAI uses the api-key HTTP header for authentication. This is entirely different from the standard OpenAI Authorization: Bearer header. Our configuration file addresses this in two ways: Setting "authHeader": false completely disables the default Bearer header. Adding "headers": { "api-key": "<key>" } forces OpenClaw to send the API key via Azure's native header format. Important Note: Your API key must appear in both the apiKey field AND the headers.api-key field within the JSON for this to work correctly. The Base URL Azure OpenAI's v1-compatible endpoint follows this specific format: https://<your_resource_name>.openai.azure.com/openai/v1 The beautiful thing about this v1 endpoint is that it is largely compatible with the standard OpenAI API and does not require you to manually pass an api-version query parameter. Model Compatibility Settings "compat": { "supportsStore": false } disables the store parameter since Azure OpenAI does not currently support it. "reasoning": true enables the thinking mode for GPT-5.2-Codex. This supports low, medium, high, and xhigh levels. "reasoning": false is set for GPT-5.2 because it is a standard, non-reasoning model. Model Specifications & Cost Tracking If you want OpenClaw to accurately track your token usage costs, you can update the cost fields from 0 to the current Azure pricing. Here are the specs and costs for the models we just deployed: Model Specifications Model Context Window Max Output Tokens Image Input Reasoning gpt-5.2-codex 400,000 tokens 16,384 tokens Yes Yes gpt-5.2 272,000 tokens 16,384 tokens Yes No Current Cost (Adjust in JSON) Model Input (per 1M tokens) Output (per 1M tokens) Cached Input (per 1M tokens) gpt-5.2-codex $1.75 $14.00 $0.175 gpt-5.2 $2.00 $8.00 $0.50 Conclusion: And there you have it! You have successfully bridged the gap between the enterprise-grade infrastructure of Microsoft Foundry and the local autonomy of OpenClaw. By following these steps, you are not just running a chatbot; you are running a sophisticated agent capable of reasoning, coding, and executing tasks with the full power of GPT-5.2-codex behind it. The combination of Azure's reliability and OpenClaw's flexibility opens up a world of possibilities. Whether you are building an automated devops assistant, a research agent, or just exploring the bleeding edge of AI, you now have a robust foundation to build upon. Now it is time to let your agent loose on some real tasks. Go forth, experiment with different system prompts, and see what you can build. If you run into any interesting edge cases or come up with a unique configuration, let me know in the comments below. Happy coding!Can you use AI to implement an Enterprise Master Patient Index (EMPI)?
The Short Answer: Yes. And It's Better Than You Think. If you've worked in healthcare IT for any length of time, you've dealt with this problem. Patient A shows up at Hospital 1 as "Jonathan Smith, DOB 03/15/1985." Patient B shows up at Hospital 2 as "Jon Smith, DOB 03/15/1985." Patient C shows up at a clinic as "John Smythe, DOB 03/15/1985." Same person? Probably. But how do you prove it at scale — across millions of records, dozens of source systems, and data quality that ranges from pristine to "someone fat-fingered a birth year"? That's the problem an Enterprise Master Patient Index (EMPI) solves. And traditionally, it's been solved with expensive commercial products, rigid rule engines, and a lot of manual review. We built one with AI. On Azure. With open-source tooling. And the results are genuinely impressive. This post walks through how it works, what the architecture looks like, and why the combination of deterministic matching, probabilistic algorithms, and AI-enhanced scoring produces better results than any single approach alone. 1. Why EMPI Still Matters (More Than Ever) Healthcare organizations don't have a "patient data problem." They have a patient identity problem. Every EHR, lab system, pharmacy platform, and claims processor creates its own patient record. When those systems exchange data via FHIR, HL7, or flat files, there's no universal patient identifier in the U.S. — Congress has blocked funding for one since 1998. The result: Duplicate records inflate costs and fragment care history Missed matches mean clinicians don't see a patient's full medical picture False positives can merge two different patients into one record — a patient safety risk Traditional EMPI solutions use deterministic matching (exact field comparisons) and sometimes probabilistic scoring (fuzzy string matching). They work. But they leave a significant gray zone of records that require human review — and that queue grows faster than teams can process it. What if AI could shrink that gray zone? 2. The Architecture: Three Layers of Matching Here's the core insight: no single matching technique is sufficient. Exact matches miss typos. Fuzzy matches produce false positives. AI alone hallucinates. But layer them together with calibrated weights, and you get something remarkably accurate. Let's break each layer down. 3. Layer 1: Deterministic Matching — The Foundation Deterministic matching is the bedrock. If two records share an Enterprise ID, they're the same person. Full stop. The system assigns trust levels to each identifier type: Identifier Weight Why Enterprise ID 1.0 Explicitly assigned by an authority SSN 0.9 Highly reliable when present and accurate MRN 0.8 System-dependent — only valid within the same healthcare system Date of Birth 0.35 Common but not unique — 0.3% of the population shares any given birthday Phone 0.3 Useful signal but changes frequently Email 0.3 Same — supportive evidence, not proof The key implementation detail here is MRN system validation. An MRN of "12345" at Hospital A is completely unrelated to MRN "12345" at Hospital B. The system checks the identifier's source system URI before considering it a match. Without this, you'd get a flood of false positives from coincidental MRN collisions. If an Enterprise ID match is found, the system short-circuits — no need for probabilistic or AI scoring. It's a guaranteed match. 4. Layer 2: Probabilistic Matching — Where It Gets Interesting This is where the system earns its keep. Probabilistic matching handles the messy reality of healthcare data: typos, nicknames, transposed digits, abbreviations, and inconsistent formatting. Name Similarity The system uses a multi-algorithm ensemble for name matching: Jaro-Winkler (60% weight): Optimized for short strings like names. Gives extra credit when strings share a common prefix — so "Jonathan" vs "Jon" scores higher than you'd expect. Soundex / Metaphone (phonetic boost): Catches "Smith" vs "Smythe," "Jon" vs "John," and other sound-alike variations that string distance alone would miss. Levenshtein distance (typo detection): Handles single-character errors — "Johanson" vs "Johansn." These scores are blended, and first name and last name are scored independently before combining. This prevents a matching last name from compensating for a wildly different first name. Date of Birth — Smarter Than You'd Think DOB matching goes beyond exact comparison. The system detects month/day transposition — one of the most common data entry errors in healthcare: Scenario Score Exact match 1.0 Month and day swapped (e.g., 03/15 vs 15/03) 0.8 Off by 1 day 0.9 Off by 2–30 days 0.5–0.8 (scaled) Different year 0.0 This alone catches a category of mismatches that pure deterministic systems miss entirely. Address Similarity Address matching uses a hybrid approach: Jaro-Winkler on the normalized full address (70% weight) Token-based Jaccard similarity (30% weight) to handle word reordering Bonus scoring for matching postal codes, city, and state Abbreviation expansion — "St" becomes "Street," "Ave" becomes "Avenue" 5. Layer 3: AI-Enhanced Matching — The Game Changer This is where the architecture diverges from traditional EMPI solutions. OpenAI Embeddings (Semantic Similarity) The system generates a text embedding for each patient's complete demographic profile using OpenAI's text-embedding-3-small model. Then it computes cosine similarity between patient pairs. Why does this work? Because embeddings capture semantic relationships that string-matching can't. "123 Main Street, Apt 4B, Springfield, IL" and "123 Main St #4B, Springfield, Illinois" are semantically identical even though they differ character-by-character. The embedding score carries only 10% of the total weight — it's a signal, not a verdict. But in ambiguous cases, it's the signal that tips the scale. GPT-5.2 LLM Analysis (Intelligent Reasoning) For matches that land in the human review zone (0.65–0.85), the system optionally invokes GPT-5.2 to analyze the patient pair and provide structured reasoning: { "match_score": 0.92, "confidence": "high", "reasoning": "Multiple strong signals: identical last name, DOB matches exactly, same city. First name 'Jon' is a common nickname for 'Jonathan'.", "name_analysis": "First name variation is a known nickname pattern.", "potential_issues": [], "recommendation": "merge" } The LLM doesn't just produce a number — it explains why it thinks two records match. This is enormously valuable for the human reviewers who make final decisions on ambiguous cases. Instead of staring at two records and guessing, they get AI-generated reasoning they can evaluate. When LLM analysis is enabled, the final score blends traditional and LLM scores: Final Score = (Traditional Score × 0.8) + (LLM Score × 0.2) The LLM temperature is set to 0.1 for consistency — you want deterministic outputs from your matching engine, not creative ones. 6. The Graph Database: Modeling Patient Relationships Records and scores are only half the story. The real power comes from how the system stores and traverses relationships. We use Azure Cosmos DB with the Gremlin API — a graph database that models patients, identifiers, addresses, and clinical data as vertices connected by typed edges. (:Patient)──[:HAS_IDENTIFIER]──▶(:Identifier) │ ├──[:HAS_ADDRESS]──▶(:Address) │ ├──[:HAS_CONTACT]──▶(:ContactPoint) │ ├──[:LINKED_TO]──▶(:EmpiRecord) ← Golden Record │ ├──[:POTENTIAL_MATCH {score, confidence}]──▶(:Patient) │ └──[:HAS_ENCOUNTER]──▶(:Encounter) └──[:HAS_OBSERVATION]──▶(:Observation) Why a Graph? Three reasons: Candidate retrieval is a graph traversal problem. "Find all patients who share an identifier with Patient X" is a natural graph query — traverse from the patient to their identifiers, then back to other patients who share those same identifiers. In Gremlin, this is a few lines. In SQL, it's a multi-table join with performance that degrades as data grows. Relationships are first-class citizens. A POTENTIAL_MATCH edge stores the match score, confidence level, and detailed breakdown directly on the relationship. You can query "show me all high-confidence matches" without any joins. EMPI records are naturally hierarchical. A golden record (EmpiRecord) links to multiple source patients via LINKED_TO edges. When you merge two patients, you're adding an edge — not rewriting rows in a relational table. Performance at Scale Cosmos DB's partition strategy uses source_system as the partition key, providing logical isolation between healthcare systems. The system handles Azure's 429 rate-limiting with automatic retry and exponential backoff, and uses batch operations for bulk loads to avoid RU exhaustion. 7. FHIR-Native Data Ingestion The system ingests HL7 FHIR R4 Bundles — the emerging interoperability standard for healthcare data exchange. Each FHIR Bundle is a JSON file containing a complete patient record: demographics, encounters, observations, conditions, procedures, immunizations, medication requests, and diagnostic reports. The FHIR loader: Maps FHIR identifier systems to internal types (SSN, MRN, Enterprise ID) Handles all three FHIR date formats (YYYY, YYYY-MM, YYYY-MM-DD) Extracts clinical data for comprehensive patient profiles Uses an iterator pattern for memory-efficient processing of thousands of patients Tracks source system provenance for audit compliance This means the service can ingest data directly from any FHIR-compliant EHR — Epic, Cerner, MEDITECH, or Synthea-generated test data — without custom integration work. 8. The Conversational Agent: Matching via Natural Language Here's where it gets fun. The system includes a conversational AI agent built on the Azure AI Foundry Agent Service. It's deployed as a GPT-5.2-powered agent with OpenAPI tools that call the matching service's REST API. Instead of navigating a complex UI to find matches, a data steward can simply ask: "Search patients named Aaron" "Compare patient abc-123 with patient xyz-456" "What matches are pending review?" "Approve the match between patient A and patient B" The agent is integrated directly into the Streamlit dashboard's Agent Chat tab, so users never leave their workflow. Under the hood, when the agent decides to call a tool (like "search patients"), Azure AI Foundry makes an HTTP request directly to the Container App API — no local function execution required. Available Agent Tools Tool What It Does searchPatients Search patients by name, DOB, or identifier getPatientDetails Get detailed patient demographics and history findPatientMatches Find potential duplicates for a patient compareTwoPatients Side-by-side comparison with detailed scoring getPendingReviews List matches awaiting human decision submitReviewDecision Approve or reject a match getServiceStatistics MPI dashboard metrics This same tool set is also exposed via a Model Context Protocol (MCP) server, making the matching engine accessible from AI-powered IDEs and coding assistants. 9. The Dashboard: Putting It All Together The Patient Matching Service includes a full-featured Streamlit dashboard for operational management. Page What You See Dashboard Key metrics, score distribution charts, recent match activity Match Results Filterable list with score breakdowns — deterministic, probabilistic, AI, and LLM tabs Patients Browse and search all loaded patients with clinical data Patient Graph Interactive graph visualization of patient relationships using streamlit-agraph Review Queue Pending matches with approve/reject actions Agent Chat Conversational AI for natural language queries Settings Configure match weights, thresholds, and display preferences The match detail view provides six tabs that walk reviewers through every scoring component: Summary, Deterministic, Probabilistic, AI/Embeddings, LLM Analysis, and Raw Data. Reviewers don't just see a number — they see exactly why the system scored a match the way it did. 10. Azure Architecture The full solution runs on Azure: Service Role Azure Cosmos DB (Gremlin + NoSQL) Patient graph storage and match result persistence Azure OpenAI (GPT-5.2 + text-embedding-3-small) LLM analysis and semantic embeddings Azure Container Apps Hosts the FastAPI REST API Azure AI Foundry Agent Service Conversational agent with OpenAPI tools Azure Log Analytics Centralized logging and monitoring The separation between Cosmos DB's Gremlin API (graph traversal) and NoSQL API (match result documents) is intentional. Graph queries excel at relationship traversal — "find all patients connected to this identifier." Document queries excel at filtering and aggregation — "show me all auto-merge matches from the last 24 hours." 11. What We Learned AI doesn't replace deterministic matching. It augments it. The three-layer approach works because each layer compensates for the others' weaknesses: Deterministic handles the easy cases quickly and with certainty Probabilistic catches the typos, nicknames, and formatting differences that exact matching misses AI provides semantic understanding and human-readable reasoning for the ambiguous middle ground The LLM is most valuable as a reviewer's assistant, not a decision-maker. We deliberately keep the LLM weight at 20% of the final score. Its real value is the structured reasoning it produces — the "why" behind a match score. Human reviewers process cases faster when they have AI-generated analysis explaining the matching signals. Graph databases are naturally suited for patient identity. Patient matching is fundamentally a relationship problem. "Who shares identifiers with whom?" "Which patients are linked to this golden record?" "Show me the cluster of records that might all be the same person." These are graph traversal queries. Trying to model this in relational tables works, but you're fighting the data model instead of leveraging it. FHIR interoperability reduces integration friction to near zero. By accepting FHIR R4 Bundles as the input format, the service can ingest data from any modern EHR without custom connectors. This is a massive practical advantage — the hardest part of any EMPI project is usually getting the data in, not matching it. 12. Try It Yourself The Patient Matching Service is built entirely on Azure services and open-source tooling https://github.com/dondinulos/patient-matching-service : Python with FastAPI, Streamlit, and the Azure AI SDKs Azure Cosmos DB (Gremlin API) for graph storage Azure OpenAI for embeddings and LLM analysis Azure AI Foundry for the conversational agent Azure Container Apps for deployment Synthea for FHIR test data generation The matching algorithms (Jaro-Winkler, Soundex, Metaphone, Levenshtein) use pure Python implementations — no proprietary matching engines required. Whether you're building a new EMPI from scratch or augmenting an existing one with AI capabilities, the three-layer approach gives you the best of all worlds: the certainty of deterministic matching, the flexibility of probabilistic scoring, and the intelligence of AI-enhanced analysis. Final Thoughts Can you use AI to implement an EMPI? Yes. And the answer isn't "replace everything with an LLM." It's "use AI where it adds the most value — semantic understanding, natural language reasoning, and augmenting human reviewers — while keeping deterministic and probabilistic matching as the foundation." The combination is more accurate than any single approach. The graph database makes relationships queryable. The conversational agent makes the system accessible. And the whole thing runs on Azure with FHIR-native data ingestion. Patient matching isn't a solved problem. But with AI in the stack, it's a much more manageable one. Tags: Healthcare, Azure, AI, EMPI, FHIR, Patient Matching, Azure Cosmos DB, Azure OpenAI, Graph Database, InteroperabilityHow to build Tool-calling Agents with Azure OpenAI and Lang Graph
Introducing MyTreat Our demo is a fictional website that shows customers their total bill in dollars, but they have the option of getting the total bill in their local currencies. The button sends a request to the Node.js service and a response is simply returned from our Agent given the tool it chooses. Let’s dive in and understand how this works from a broader perspective. Prerequisites An active Azure subscription. You can sign up for a free trial here or get $100 worth of credits on Azure every year if you are a student. A GitHub account (not necessarily) Node.js LTS 18 + VS Code installed (or your favorite IDE) Basic knowledge of HTML, CSS, JS Creating an Azure OpenAI Resource Go over to your browser and key in portal.azure.com to access the Microsoft Azure Portal. Over there navigate to the search bar and type Azure OpenAI. Go ahead and click on + Create. Fill in the input boxes with appropriate, for example, as shown below then press on next until you reach review and submit then finally click on Create. After the deployment is done, go to the deployment and access Azure AI Foundry portal using the button as show below. You can also use the link as demonstrated below. In the Azure AI Foundry portal, we have to create our model instance so we have to go over to Model Catalog on the left panel beneath Get Started. Select a desired model, in this case I used gpt-35-turbo for chat completion (in your case use gpt-4o). Below is a way of doing this. Choose a model (gpt-4o) Click on deploy Give the deployment a new name e.g. myTreatmodel, then click deploy and wait for it to finish On the left panel go over to deployments and you will see the model you have created. Access your Azure OpenAI Resource Key Go back to Azure portal and specifically to the deployment instance that we have and select on the left panel, Resource Management. Click on Keys and Endpoints. Copy any of the keys as shown below and keep it very safe as we will use it in our .env file. Configuring your project Create a new project folder on your local machine and add these variables to the .env file in the root folder. AZURE_OPENAI_API_INSTANCE_NAME= AZURE_OPENAI_API_DEPLOYMENT_NAME= AZURE_OPENAI_API_KEY= AZURE_OPENAI_API_VERSION="2024-08-01-preview" LANGCHAIN_TRACING_V2="false" LANGCHAIN_CALLBACKS_BACKGROUND = "false" PORT=4556 Starting a new project Go over to https://github.com/tiprock-network/mytreat.git and follow the instructions to setup the new project, if you do not have git installed, go over to the Code button and press Download ZIP. This will enable you get the project folder and follow the same procedure for setting up. Creating a custom tool In the utils folder the math tool was created, this code show below uses tool from Langchain to build a tool and the schema of the tool is created using zod.js, a library that helps in validating an object’s property value. The price function takes in an array of prices and the exchange rate, adds the prices up and converts them using the exchange rate as shown below. import { tool } from '@langchain/core/tools' import { z } from 'zod' const priceConv = tool((input) =>{ //get the prices and add them up after turning each into let sum = 0 input.prices.forEach((price) => { let price_check = parseFloat(price) sum += price_check }) //now change the price using exchange rate let final_price = parseFloat(input.exchange_rate) * sum //return return final_price },{ name: 'add_prices_and_convert', description: 'Add prices and convert based on exchange rate.', schema: z.object({ prices: z.number({ required_error: 'Price should not be empty.', invalid_type_error: 'Price must be a number.' }).array().nonempty().describe('Prices of items listed.'), exchange_rate: z.string().describe('Current currency exchange rate.') }) }) export { priceConv } Utilizing the tool In the controller’s folder we then bring the tool in by importing it. After that we pass it in to our array of tools. Notice that we have the Tavily Search Tool, you can learn how to implement in the Additional Reads Section or just remove it. Agent Model and the Call Process This code defines an AI agent using LangGraph and LangChain.js, powered by GPT-4o from Azure OpenAI. It initializes a ToolNode to manage tools like priceConv and binds them to the agent model. The StateGraph handles decision-making, determining whether the agent should call a tool or return a direct response. If a tool is needed, the workflow routes the request accordingly; otherwise, the agent responds to the user. The callModel function invokes the agent, processing messages and ensuring seamless tool integration. The searchAgentController is a GET endpoint that accepts user queries (text_message). It processes input through the compiled LangGraph workflow, invoking the agent to generate a response. If a tool is required, the agent calls it before finalizing the output. The response is then sent back to the user, ensuring dynamic and efficient tool-assisted reasoning. //create tools the agent will use //const agentTools = [new TavilySearchResults({maxResults:5}), priceConv] const agentTools = [ priceConv] const toolNode = new ToolNode(agentTools) const agentModel = new AzureChatOpenAI({ model:'gpt-4o', temperature:0, azureOpenAIApiKey: AZURE_OPENAI_API_KEY, azureOpenAIApiInstanceName:AZURE_OPENAI_API_INSTANCE_NAME, azureOpenAIApiDeploymentName:AZURE_OPENAI_API_DEPLOYMENT_NAME, azureOpenAIApiVersion:AZURE_OPENAI_API_VERSION }).bindTools(agentTools) //make a decision to continue or not const shouldContinue = ( state ) => { const { messages } = state const lastMessage = messages[messages.length -1] //upon tool call we go to tools if("tool_calls" in lastMessage && Array.isArray(lastMessage.tool_calls) && lastMessage.tool_calls?.length) return "tools"; //if no tool call is made we stop and return back to the user return END } const callModel = async (state) => { const response = await agentModel.invoke(state.messages) return { messages: [response] } } //define a new graph const workflow = new StateGraph(MessagesAnnotation) .addNode("agent", callModel) .addNode("tools", toolNode) .addEdge(START, "agent") .addConditionalEdges("agent", shouldContinue, ["tools", END]) .addEdge("tools", "agent") const appAgent = workflow.compile() The above is implemented with the following code: Frontend The frontend is a simple HTML+CSS+JS stack that demonstrated how you can use an API to integrate this AI Agent to your website. It sends a GET request and uses the response to get back the right answer. Below is an illustration of how fetch API has been used. const searchAgentController = async ( req, res ) => { //get human text const { text_message } = req.query if(!text_message) return res.status(400).json({ message:'No text sent.' }) //invoke the agent const agentFinalState = await appAgent.invoke( { messages: [new HumanMessage(text_message)] }, {streamMode: 'values'} ) //const agentFinalState_b = await agentModel.invoke(text_message) /*return res.status(200).json({ answer:agentFinalState.messages[agentFinalState.messages.length - 1].content })*/ //console.log(agentFinalState_b.tool_calls) res.status(200).json({ text: agentFinalState.messages[agentFinalState.messages.length - 1].content }) } There you go! We have created a basic tool-calling agent using Azure and Langchain successfully, go ahead and expand the code base to your liking. If you have questions you can comment below or reach out on my socials. Additional Reads Azure Open AI Service Models Generative AI for Beginners AI Agents for Beginners Course Lang Graph Tutorial Develop Generative AI Apps in Azure AI Foundry PortalUnderstanding Azure OpenAI Service Quotas and Limits: A Beginner-Friendly Guide
Azure OpenAI Service allows developers, researchers, and students to integrate powerful AI models like GPT-4, GPT-3.5, and DALL·E into their applications. But with great power comes great responsibility and limits. Before you dive into building your next AI-powered solution, it's crucial to understand how quotas and limits work in the Azure OpenAI ecosystem. This guide is designed to help students and beginners easily understand the concept of quotas, limits, and how to manage them effectively. What Are Quotas and Limits? Think of Azure's quotas as your "AI data pack." It defines how much you can use the service. Meanwhile, limits are hard boundaries set by Azure to ensure fair use and system stability. Quota The maximum number of resources (e.g., tokens, requests) allocated to your Azure subscription. Limit The technical cap imposed by Azure on specific resources (e.g., number of files, deployments). Key Metrics: TPM & RPM Tokens Per Minute (TPM) TPM refers to how many tokens you can use per minute across all your requests in each region. A token is a chunk of text. For example, the word "Hello" is 1 token, but "Understanding" might be 2 tokens. Each model has its own default TPM. Example: GPT-4 might allow 240,000 tokens per minute. You can split this quota across multiple deployments. Requests Per Minute (RPM) RPM defines how many API requests you can make every minute. For instance, GPT-3.5-turbo might allow 350 RPM. DALL·E image generation models might allow 6 RPM. Deployment, File, and Training Limits Here are some standard limits imposed on your OpenAI resource: Resource Type Limit Standard model deployments 32 Fine-tuned model deployments 5 Training jobs 100 total per resource (1 active at a time) Fine-tuning files 50 files (total size: 1 GB) Max prompt tokens per request Varies by model (e.g., 4096 tokens for GPT-3.5) How to View and Manage Your Quota Step-by-Step: Go to the Azure Portal. Navigate to your Azure OpenAI resource. Click on "Usage + quotas" in the left-hand menu. You will see TPM, RPM, and current usage status. To Request More Quota: In the same "Usage + quotas" panel, click on "Request quota increase". Fill in the form: Select the region. Choose the model family (e.g., GPT-4, GPT-3.5). Enter the desired TPM and RPM values. Submit and wait for Azure to review and approve. What is Dynamic Quota? Sometimes, Azure gives you extra quota based on demand and availability. “Dynamic quota” is not guaranteed and may increase or decrease. Useful for short-term spikes but should not be relied on for production apps. Example: During weekends, your GPT-3.5 TPM may temporarily increase if there's less traffic in your region. Best Practices for Students Monitor Regularly: Use the Azure Portal to keep an eye on your usage. Batch Requests: Combine multiple tasks in one API call to save tokens. Start Small: Begin with GPT-3.5 before requesting GPT-4 access. Plan Ahead: If you're preparing a demo or a project, request quota in advance. Handle Limits Gracefully: Code should manage 429 Too Many Requests errors. Quick Resources Azure OpenAI Quotas and Limits How to Request Quota in Azure Join the Conversation on Azure AI Foundry Discussions! Have ideas, questions, or insights about AI? Don't keep them to yourself! Share your thoughts, engage with experts, and connect with a community that’s shaping the future of artificial intelligence. 🧠✨ 👉 Click here to join the discussion!Create your own QA RAG Chatbot with LangChain.js + Azure OpenAI Service
Demo: Mpesa for Business Setup QA RAG Application In this tutorial we are going to build a Question-Answering RAG Chat Web App. We utilize Node.js and HTML, CSS, JS. We also incorporate Langchain.js + Azure OpenAI + MongoDB Vector Store (MongoDB Search Index). Get a quick look below. Note: Documents and illustrations shared here are for demo purposes only and Microsoft or its products are not part of Mpesa. The content demonstrated here should be used for educational purposes only. Additionally, all views shared here are solely mine. What you will need: An active Azure subscription, get Azure for Student for free or get started with Azure for 12 months free. VS Code Basic knowledge in JavaScript (not a must) Access to Azure OpenAI, click here if you don't have access. Create a MongoDB account (You can also use Azure Cosmos DB vector store) Setting Up the Project In order to build this project, you will have to fork this repository and clone it. GitHub Repository link: https://github.com/tiprock-network/azure-qa-rag-mpesa . Follow the steps highlighted in the README.md to setup the project under Setting Up the Node.js Application. Create Resources that you Need In order to do this, you will need to have Azure CLI or Azure Developer CLI installed in your computer. Go ahead and follow the steps indicated in the README.md to create Azure resources under Azure Resources Set Up with Azure CLI. You might want to use Azure CLI to login in differently use a code. Here's how you can do this. Instead of using az login. You can do az login --use-code-device OR you would prefer using Azure Developer CLI and execute this command instead azd auth login --use-device-code Remember to update the .env file with the values you have used to name Azure OpenAI instance, Azure models and even the API Keys you have obtained while creating your resources. Setting Up MongoDB After accessing you MongoDB account get the URI link to your database and add it to the .env file along with your database name and vector store collection name you specified while creating your indexes for a vector search. Running the Project In order to run this Node.js project you will need to start the project using the following command. npm run dev The Vector Store The vector store used in this project is MongoDB store where the word embeddings were stored in MongoDB. From the embeddings model instance we created on Azure AI Foundry we are able to create embeddings that can be stored in a vector store. The following code below shows our embeddings model instance. //create new embedding model instance const azOpenEmbedding = new AzureOpenAIEmbeddings({ azureADTokenProvider, azureOpenAIApiInstanceName: process.env.AZURE_OPENAI_API_INSTANCE_NAME, azureOpenAIApiEmbeddingsDeploymentName: process.env.AZURE_OPENAI_API_DEPLOYMENT_EMBEDDING_NAME, azureOpenAIApiVersion: process.env.AZURE_OPENAI_API_VERSION, azureOpenAIBasePath: "https://eastus2.api.cognitive.microsoft.com/openai/deployments" }); The code in uploadDoc.js offers a simple way to do embeddings and store them to MongoDB. In this approach the text from the documents is loaded using the PDFLoader from Langchain community. The following code demonstrates how the embeddings are stored in the vector store. // Call the function and handle the result with await const storeToCosmosVectorStore = async () => { try { const documents = await returnSplittedContent() //create store instance const store = await MongoDBAtlasVectorSearch.fromDocuments( documents, azOpenEmbedding, { collection: vectorCollection, indexName: "myrag_index", textKey: "text", embeddingKey: "embedding", } ) if(!store){ console.log('Something wrong happened while creating store or getting store!') return false } console.log('Done creating/getting and uploading to store.') return true } catch (e) { console.log(`This error occurred: ${e}`) return false } } In this setup, Question Answering (QA) is achieved by integrating Azure OpenAI’s GPT-4o with MongoDB Vector Search through LangChain.js. The system processes user queries via an LLM (Large Language Model), which retrieves relevant information from a vectorized database, ensuring contextual and accurate responses. Azure OpenAI Embeddings convert text into dense vector representations, enabling semantic search within MongoDB. The LangChain RunnableSequence structures the retrieval and response generation workflow, while the StringOutputParser ensures proper text formatting. The most relevant code snippets to include are: AzureChatOpenAI instantiation, MongoDB connection setup, and the API endpoint handling QA queries using vector search and embeddings. There are some code snippets below to explain major parts of the code. Azure AI Chat Completion Model This is the model used in this implementation of RAG, where we use it as the model for chat completion. Below is a code snippet for it. const llm = new AzureChatOpenAI({ azTokenProvider, azureOpenAIApiInstanceName: process.env.AZURE_OPENAI_API_INSTANCE_NAME, azureOpenAIApiDeploymentName: process.env.AZURE_OPENAI_API_DEPLOYMENT_NAME, azureOpenAIApiVersion: process.env.AZURE_OPENAI_API_VERSION }) Using a Runnable Sequence to give out Chat Output This shows how a runnable sequence can be used to give out a response given the particular output format/ output parser added on to the chain. //Stream response app.post(`${process.env.BASE_URL}/az-openai/runnable-sequence/stream/chat`, async (req,res) => { //check for human message const { chatMsg } = req.body if(!chatMsg) return res.status(201).json({ message:'Hey, you didn\'t send anything.' }) //put the code in an error-handler try{ //create a prompt template format template const prompt = ChatPromptTemplate.fromMessages( [ ["system", `You are a French-to-English translator that detects if a message isn't in French. If it's not, you respond, "This is not French." Otherwise, you translate it to English.`], ["human", `${chatMsg}`] ] ) //runnable chain const chain = RunnableSequence.from([prompt, llm, outPutParser]) //chain result let result_stream = await chain.stream() //set response headers res.setHeader('Content-Type','application/json') res.setHeader('Transfer-Encoding','chunked') //create readable stream const readable = Readable.from(result_stream) res.status(201).write(`{"message": "Successful translation.", "response": "`); readable.on('data', (chunk) => { // Convert chunk to string and write it res.write(`${chunk}`); }); readable.on('end', () => { // Close the JSON response properly res.write('" }'); res.end(); }); readable.on('error', (err) => { console.error("Stream error:", err); res.status(500).json({ message: "Translation failed.", error: err.message }); }); }catch(e){ //deliver a 500 error response return res.status(500).json( { message:'Failed to send request.', error:e } ) } }) To run the front end of the code, go to your BASE_URL with the port given. This enables you to run the chatbot above and achieve similar results. The chatbot is basically HTML+CSS+JS. Where JavaScript is mainly used with fetch API to get a response. Thanks for reading. I hope you play around with the code and learn some new things. Additional Reads Introduction to LangChain.js Create an FAQ Bot on Azure Build a basic chat app in Python using Azure AI Foundry SDK
