diff --git a/Dockerfile b/Dockerfile
index 71e61bc..c517598 100644
--- a/Dockerfile
+++ b/Dockerfile
@@ -8,4 +8,6 @@ COPY . .
 
 RUN yarn install
 
+WORKDIR /app/packages/app
+
 EXPOSE 8080
diff --git a/Makefile b/Makefile
index 7db91ed..056dd59 100644
--- a/Makefile
+++ b/Makefile
@@ -13,7 +13,7 @@ pull:
 	$(compose) $(dev_env) $(dev_profile) pull
 
 build:
-	$(compose) $(dev_env) $(dev_profile) build
+	$(compose) $(dev_env) $(dev_profile) build --no-cache
 
 up:
 	$(compose) $(dev_env) $(dev_profile) up
diff --git a/package.json b/package.json
index fba7bfd..263192e 100644
--- a/package.json
+++ b/package.json
@@ -16,73 +16,7 @@
     "start:debug": "nest start --debug --watch",
     "start:prod": "node dist/main",
     "lint": "eslint \"{src,apps,libs,test}/**/*.ts\" --fix",
-    "test": "jest --testPathIgnorePatterns='/suites/'",
-    "test:watch": "jest --testPathIgnorePatterns='/suites/' --watch",
-    "test:cov": "jest --testPathIgnorePatterns='/suites/' --coverage",
-    "test:debug": "node --inspect-brk -r tsconfig-paths/register -r ts-node/register node_modules/.bin/jest --runInBand",
-    "test:e2e": "jest --testPathIgnorePatterns='/suites/' --config ./test/jest-e2e.json",
     "typecheck": "tsc --noEmit",
     "prepare": "npm run prepare --workspaces"
-  },
-  "dependencies": {
-    "@medplum/core": "^3.2.4",
-    "@nestjs/common": "^10.0.0",
-    "@nestjs/config": "^3.2.3",
-    "@nestjs/core": "^10.0.0",
-    "@nestjs/platform-express": "^10.0.0",
-    "@nestjs/swagger": "^7.4.0",
-    "@nestjs/typeorm": "^10.0.2",
-    "@types/fhir": "^0.0.41",
-    "axios": "^1.7.4",
-    "dotenv": "^16.4.5",
-    "flatted": "^3.3.1",
-    "http-proxy": "^1.18.1",
-    "http-proxy-middleware": "^3.0.0",
-    "pg": "^8.12.0",
-    "reflect-metadata": "^0.2.2",
-    "rxjs": "^7.8.1",
-    "swagger-ui-express": "^5.0.1",
-    "typeorm": "^0.3.20"
-  },
-  "devDependencies": {
-    "@nestjs/cli": "^10.0.0",
-    "@nestjs/schematics": "^10.0.0",
-    "@nestjs/testing": "^10.0.0",
-    "@types/express": "^4.17.17",
-    "@types/jest": "^29.5.2",
-    "@types/node": "^20.3.1",
-    "@types/supertest": "^6.0.0",
-    "@typescript-eslint/eslint-plugin": "^7.0.0",
-    "@typescript-eslint/parser": "^7.0.0",
-    "eslint": "^8.42.0",
-    "eslint-config-prettier": "^9.0.0",
-    "eslint-plugin-prettier": "^5.0.0",
-    "jest": "^29.5.0",
-    "prettier": "^3.0.0",
-    "source-map-support": "^0.5.21",
-    "supertest": "^7.0.0",
-    "ts-jest": "^29.1.0",
-    "ts-loader": "^9.4.3",
-    "ts-node": "^10.9.1",
-    "tsconfig-paths": "^4.2.0",
-    "typescript": "^5.1.3"
-  },
-  "jest": {
-    "moduleFileExtensions": [
-      "js",
-      "json",
-      "ts"
-    ],
-    "testTimeout": 30000,
-    "rootDir": "./",
-    "testRegex": ".*\\.spec\\.ts$",
-    "transform": {
-      "^.+\\.(t|j)s$": "ts-jest"
-    },
-    "collectCoverageFrom": [
-      "**/*.(t|j)s"
-    ],
-    "coverageDirectory": "../coverage",
-    "testEnvironment": "node"
   }
 }
diff --git a/README.md b/packages/app/README.md
similarity index 100%
rename from README.md
rename to packages/app/README.md
diff --git a/nest-cli.json b/packages/app/nest-cli.json
similarity index 100%
rename from nest-cli.json
rename to packages/app/nest-cli.json
diff --git a/packages/app/package.json b/packages/app/package.json
new file mode 100644
index 0000000..fdfe102
--- /dev/null
+++ b/packages/app/package.json
@@ -0,0 +1,85 @@
+{
+  "name": "backend",
+  "version": "0.0.1",
+  "description": "",
+  "author": "",
+  "private": true,
+  "license": "UNLICENSED",
+  "scripts": {
+    "build": "nest build",
+    "format": "prettier --write \"src/**/*.ts\" \"test/**/*.ts\"",
+    "start": "nest start",
+    "start:dev": "nest start --watch",
+    "start:debug": "nest start --debug --watch",
+    "start:prod": "node dist/main",
+    "lint": "eslint \"{src,apps,libs,test}/**/*.ts\" --fix",
+    "test": "jest --testPathIgnorePatterns='/suites/'",
+    "test:watch": "jest --testPathIgnorePatterns='/suites/' --watch",
+    "test:cov": "jest --testPathIgnorePatterns='/suites/' --coverage",
+    "test:debug": "node --inspect-brk -r tsconfig-paths/register -r ts-node/register node_modules/.bin/jest --runInBand",
+    "test:e2e": "jest --testPathIgnorePatterns='/suites/' --config ./test/jest-e2e.json",
+    "typecheck": "tsc --noEmit",
+    "prepare": "tsc"
+  },
+  "dependencies": {
+    "@medplum/core": "^3.2.4",
+    "@nestjs/common": "^10.0.0",
+    "@nestjs/config": "^3.2.3",
+    "@nestjs/core": "^10.0.0",
+    "@nestjs/platform-express": "^10.0.0",
+    "@nestjs/swagger": "^7.4.0",
+    "@nestjs/typeorm": "^10.0.2",
+    "@types/fhir": "^0.0.41",
+    "axios": "^1.7.4",
+    "dotenv": "^16.4.5",
+    "flatted": "^3.3.1",
+    "http-proxy": "^1.18.1",
+    "http-proxy-middleware": "^3.0.0",
+    "pg": "^8.12.0",
+    "reflect-metadata": "^0.2.2",
+    "rxjs": "^7.8.1",
+    "swagger-ui-express": "^5.0.1",
+    "typeorm": "^0.3.20"
+  },
+  "devDependencies": {
+    "@nestjs/cli": "^10.0.0",
+    "@nestjs/schematics": "^10.0.0",
+    "@nestjs/testing": "^10.0.0",
+    "@types/express": "^4.17.17",
+    "@types/jest": "^29.5.2",
+    "@types/node": "^20.3.1",
+    "@types/supertest": "^6.0.0",
+    "@typescript-eslint/eslint-plugin": "^7.0.0",
+    "@typescript-eslint/parser": "^7.0.0",
+    "eslint": "^8.42.0",
+    "eslint-config-prettier": "^9.0.0",
+    "eslint-plugin-prettier": "^5.0.0",
+    "jest": "^29.5.0",
+    "prettier": "^3.0.0",
+    "source-map-support": "^0.5.21",
+    "supertest": "^7.0.0",
+    "ts-jest": "^29.1.0",
+    "ts-loader": "^9.4.3",
+    "ts-node": "^10.9.1",
+    "tsconfig-paths": "^4.2.0",
+    "typescript": "^5.1.3"
+  },
+  "jest": {
+    "moduleFileExtensions": [
+      "js",
+      "json",
+      "ts"
+    ],
+    "testTimeout": 30000,
+    "rootDir": "./",
+    "testRegex": ".*\\.spec\\.ts$",
+    "transform": {
+      "^.+\\.(t|j)s$": "ts-jest"
+    },
+    "collectCoverageFrom": [
+      "**/*.(t|j)s"
+    ],
+    "coverageDirectory": "../coverage",
+    "testEnvironment": "node"
+  }
+}
diff --git a/src/app.module.ts b/packages/app/src/app.module.ts
similarity index 100%
rename from src/app.module.ts
rename to packages/app/src/app.module.ts
diff --git a/src/custom-reporter.js b/packages/app/src/custom-reporter.js
similarity index 100%
rename from src/custom-reporter.js
rename to packages/app/src/custom-reporter.js
diff --git a/src/main.ts b/packages/app/src/main.ts
similarity index 100%
rename from src/main.ts
rename to packages/app/src/main.ts
diff --git a/src/modules/proxyapp/proxyapp.controller.ts b/packages/app/src/modules/proxyapp/proxyapp.controller.ts
similarity index 96%
rename from src/modules/proxyapp/proxyapp.controller.ts
rename to packages/app/src/modules/proxyapp/proxyapp.controller.ts
index 3ff7b7b..63cd429 100644
--- a/src/modules/proxyapp/proxyapp.controller.ts
+++ b/packages/app/src/modules/proxyapp/proxyapp.controller.ts
@@ -1,10 +1,10 @@
 import { All, Controller, Param, Req, Res } from '@nestjs/common';
 import { ApiTags, ApiOperation, ApiParam } from '@nestjs/swagger';
-import { createRequestObject } from 'src/utils/data';
 import { captureResponseBody } from '@beda.software/client-testing-proxy-helpers';
 import { RequestService } from '../requests/request.service';
 import { SessionService } from '../sessions/session.service';
 import { Request, Response } from 'express';
+import { createRequestObject } from '../../utils/data';
 
 @ApiTags('proxy')
 @Controller('proxy')
diff --git a/src/modules/proxyapp/proxyapp.module.ts b/packages/app/src/modules/proxyapp/proxyapp.module.ts
similarity index 100%
rename from src/modules/proxyapp/proxyapp.module.ts
rename to packages/app/src/modules/proxyapp/proxyapp.module.ts
diff --git a/src/modules/requests/request.controller.ts b/packages/app/src/modules/requests/request.controller.ts
similarity index 100%
rename from src/modules/requests/request.controller.ts
rename to packages/app/src/modules/requests/request.controller.ts
diff --git a/src/modules/requests/request.dto.ts b/packages/app/src/modules/requests/request.dto.ts
similarity index 98%
rename from src/modules/requests/request.dto.ts
rename to packages/app/src/modules/requests/request.dto.ts
index 4468b9d..0e08a38 100644
--- a/src/modules/requests/request.dto.ts
+++ b/packages/app/src/modules/requests/request.dto.ts
@@ -1,7 +1,7 @@
 import { ApiProperty } from '@nestjs/swagger';
 import { Request as RequestType, Response } from 'express';
 import { Session } from '../sessions/session.entity';
-import { jsonbType } from 'src/utils/types';
+import { jsonbType } from '../../utils/types';
 
 export class CreateRequestDto {
     @ApiProperty({ description: 'Session associated with the request' })
diff --git a/src/modules/requests/request.entity.ts b/packages/app/src/modules/requests/request.entity.ts
similarity index 98%
rename from src/modules/requests/request.entity.ts
rename to packages/app/src/modules/requests/request.entity.ts
index e6c4303..828d646 100644
--- a/src/modules/requests/request.entity.ts
+++ b/packages/app/src/modules/requests/request.entity.ts
@@ -1,7 +1,7 @@
 import { Response, Request as RequestType } from 'express';
 import { Entity, PrimaryGeneratedColumn, Column, CreateDateColumn, ManyToOne } from 'typeorm';
 import { Session } from '../sessions/session.entity';
-import { jsonbType } from 'src/utils/types';
+import { jsonbType } from '../../utils/types';
 
 @Entity()
 export class Request {
diff --git a/src/modules/requests/request.module.ts b/packages/app/src/modules/requests/request.module.ts
similarity index 100%
rename from src/modules/requests/request.module.ts
rename to packages/app/src/modules/requests/request.module.ts
diff --git a/src/modules/requests/request.service.ts b/packages/app/src/modules/requests/request.service.ts
similarity index 100%
rename from src/modules/requests/request.service.ts
rename to packages/app/src/modules/requests/request.service.ts
diff --git a/src/modules/sessions/interfaces.ts b/packages/app/src/modules/sessions/interfaces.ts
similarity index 100%
rename from src/modules/sessions/interfaces.ts
rename to packages/app/src/modules/sessions/interfaces.ts
diff --git a/src/modules/sessions/session.controller.ts b/packages/app/src/modules/sessions/session.controller.ts
similarity index 100%
rename from src/modules/sessions/session.controller.ts
rename to packages/app/src/modules/sessions/session.controller.ts
diff --git a/src/modules/sessions/session.dto.ts b/packages/app/src/modules/sessions/session.dto.ts
similarity index 100%
rename from src/modules/sessions/session.dto.ts
rename to packages/app/src/modules/sessions/session.dto.ts
diff --git a/src/modules/sessions/session.entity.ts b/packages/app/src/modules/sessions/session.entity.ts
similarity index 100%
rename from src/modules/sessions/session.entity.ts
rename to packages/app/src/modules/sessions/session.entity.ts
diff --git a/src/modules/sessions/session.module.ts b/packages/app/src/modules/sessions/session.module.ts
similarity index 100%
rename from src/modules/sessions/session.module.ts
rename to packages/app/src/modules/sessions/session.module.ts
diff --git a/src/modules/sessions/session.service.ts b/packages/app/src/modules/sessions/session.service.ts
similarity index 100%
rename from src/modules/sessions/session.service.ts
rename to packages/app/src/modules/sessions/session.service.ts
diff --git a/src/modules/test_runs/testRun.controller.ts b/packages/app/src/modules/test_runs/testRun.controller.ts
similarity index 96%
rename from src/modules/test_runs/testRun.controller.ts
rename to packages/app/src/modules/test_runs/testRun.controller.ts
index c279793..8c077cb 100644
--- a/src/modules/test_runs/testRun.controller.ts
+++ b/packages/app/src/modules/test_runs/testRun.controller.ts
@@ -6,11 +6,11 @@ import { runCLI } from '@jest/core';
 import { TestRunService } from './testRun.service';
 import { SessionService } from '../sessions/session.service';
 import { TestRun } from './testRun.entity';
-import { createTestListObject } from 'src/utils/data';
+import { createTestListObject } from '../../utils/data';
 
 const testOptions = {
-    globalSetup: './src/utils/setup/jest.setup.ts',
-    globalTeardown: './src/utils/setup/jest.teardown.ts',
+    globalSetup: './../../utils/setup/jest.setup.ts',
+    globalTeardown: './../../utils/setup/jest.teardown.ts',
     rootDir: './',
     testEnvironment: 'node',
     moduleFileExtensions: ['ts', 'tsx', 'js', 'jsx', 'json', 'node'],
diff --git a/src/modules/test_runs/testRun.dto.ts b/packages/app/src/modules/test_runs/testRun.dto.ts
similarity index 96%
rename from src/modules/test_runs/testRun.dto.ts
rename to packages/app/src/modules/test_runs/testRun.dto.ts
index 00d312c..a6012fe 100644
--- a/src/modules/test_runs/testRun.dto.ts
+++ b/packages/app/src/modules/test_runs/testRun.dto.ts
@@ -1,6 +1,6 @@
 import { ApiProperty } from '@nestjs/swagger';
 import { json } from 'node:stream/consumers';
-import { jsonbType } from 'src/utils/types';
+import { jsonbType } from '../../utils/types';
 import { Session } from '../sessions/session.entity';
 
 export class CreateTestRunDto {
diff --git a/src/modules/test_runs/testRun.entity.ts b/packages/app/src/modules/test_runs/testRun.entity.ts
similarity index 96%
rename from src/modules/test_runs/testRun.entity.ts
rename to packages/app/src/modules/test_runs/testRun.entity.ts
index dd87a95..feb7208 100644
--- a/src/modules/test_runs/testRun.entity.ts
+++ b/packages/app/src/modules/test_runs/testRun.entity.ts
@@ -1,6 +1,6 @@
 import { Column, CreateDateColumn, Entity, ManyToOne, PrimaryGeneratedColumn } from 'typeorm';
 import { Session } from '../sessions/session.entity';
-import { jsonbType } from 'src/utils/types';
+import { jsonbType } from '../../utils/types';
 
 export enum TestRunStatus {
     NOT_STARTED = 'not-started',
diff --git a/src/modules/test_runs/testRun.module.ts b/packages/app/src/modules/test_runs/testRun.module.ts
similarity index 100%
rename from src/modules/test_runs/testRun.module.ts
rename to packages/app/src/modules/test_runs/testRun.module.ts
diff --git a/src/modules/test_runs/testRun.service.ts b/packages/app/src/modules/test_runs/testRun.service.ts
similarity index 100%
rename from src/modules/test_runs/testRun.service.ts
rename to packages/app/src/modules/test_runs/testRun.service.ts
diff --git a/src/suites/1.0.0-ballot/Patient/patients-2nd.spec.ts b/packages/app/src/suites/1.0.0-ballot/Patient/patients-2nd.spec.ts
similarity index 100%
rename from src/suites/1.0.0-ballot/Patient/patients-2nd.spec.ts
rename to packages/app/src/suites/1.0.0-ballot/Patient/patients-2nd.spec.ts
diff --git a/src/suites/1.0.0-ballot/Patient/patients.spec.ts b/packages/app/src/suites/1.0.0-ballot/Patient/patients.spec.ts
similarity index 100%
rename from src/suites/1.0.0-ballot/Patient/patients.spec.ts
rename to packages/app/src/suites/1.0.0-ballot/Patient/patients.spec.ts
diff --git a/src/utils/clientTestingHelpers.spec.ts b/packages/app/src/utils/clientTestingHelpers.spec.ts
similarity index 100%
rename from src/utils/clientTestingHelpers.spec.ts
rename to packages/app/src/utils/clientTestingHelpers.spec.ts
diff --git a/src/utils/clientTestingHelpers.ts b/packages/app/src/utils/clientTestingHelpers.ts
similarity index 97%
rename from src/utils/clientTestingHelpers.ts
rename to packages/app/src/utils/clientTestingHelpers.ts
index 5b0ff92..bf56053 100644
--- a/src/utils/clientTestingHelpers.ts
+++ b/packages/app/src/utils/clientTestingHelpers.ts
@@ -1,4 +1,4 @@
-import { Request } from 'src/modules/requests/request.entity';
+import { Request } from '../modules/requests/request.entity';
 import { Repository } from 'typeorm';
 
 /**
diff --git a/src/utils/data.spec.ts b/packages/app/src/utils/data.spec.ts
similarity index 100%
rename from src/utils/data.spec.ts
rename to packages/app/src/utils/data.spec.ts
diff --git a/src/utils/data.ts b/packages/app/src/utils/data.ts
similarity index 95%
rename from src/utils/data.ts
rename to packages/app/src/utils/data.ts
index ebd42ac..72942a0 100644
--- a/src/utils/data.ts
+++ b/packages/app/src/utils/data.ts
@@ -1,7 +1,7 @@
 import { parseSearchRequest } from '@medplum/core';
 import { Request, Response } from 'express';
-import { CreateRequestDto } from 'src/modules/requests/request.dto';
-import { Session } from 'src/modules/sessions/session.entity';
+import { CreateRequestDto } from '../modules/requests/request.dto';
+import { Session } from '../modules/sessions/session.entity';
 import { getFHIRAction } from '@beda.software/client-testing-helpers';
 
 export function createRequestObject(
diff --git a/src/utils/setup/jest.setup.ts b/packages/app/src/utils/setup/jest.setup.ts
similarity index 100%
rename from src/utils/setup/jest.setup.ts
rename to packages/app/src/utils/setup/jest.setup.ts
diff --git a/src/utils/setup/jest.teardown.ts b/packages/app/src/utils/setup/jest.teardown.ts
similarity index 100%
rename from src/utils/setup/jest.teardown.ts
rename to packages/app/src/utils/setup/jest.teardown.ts
diff --git a/src/utils/types.ts b/packages/app/src/utils/types.ts
similarity index 100%
rename from src/utils/types.ts
rename to packages/app/src/utils/types.ts
diff --git a/packages/app/tsconfig.build.json b/packages/app/tsconfig.build.json
new file mode 100644
index 0000000..64f86c6
--- /dev/null
+++ b/packages/app/tsconfig.build.json
@@ -0,0 +1,4 @@
+{
+  "extends": "./tsconfig.json",
+  "exclude": ["node_modules", "test", "dist", "**/*spec.ts"]
+}
diff --git a/packages/app/tsconfig.json b/packages/app/tsconfig.json
new file mode 100644
index 0000000..95f5641
--- /dev/null
+++ b/packages/app/tsconfig.json
@@ -0,0 +1,21 @@
+{
+  "compilerOptions": {
+    "module": "commonjs",
+    "declaration": true,
+    "removeComments": true,
+    "emitDecoratorMetadata": true,
+    "experimentalDecorators": true,
+    "allowSyntheticDefaultImports": true,
+    "target": "ES2021",
+    "sourceMap": true,
+    "outDir": "./dist",
+    "baseUrl": "./",
+    "incremental": true,
+    "skipLibCheck": true,
+    "strictNullChecks": false,
+    "noImplicitAny": false,
+    "strictBindCallApply": false,
+    "forceConsistentCasingInFileNames": false,
+    "noFallthroughCasesInSwitch": false
+  }
+}
diff --git a/test/app.e2e-spec.ts b/test/app.e2e-spec.ts
deleted file mode 100644
index 42edde7..0000000
--- a/test/app.e2e-spec.ts
+++ /dev/null
@@ -1,21 +0,0 @@
-import { Test, TestingModule } from '@nestjs/testing';
-import { INestApplication } from '@nestjs/common';
-import * as request from 'supertest';
-import { AppModule } from '../src/app.module';
-
-describe('AppController (e2e)', () => {
-    let app: INestApplication;
-
-    beforeEach(async () => {
-        const moduleFixture: TestingModule = await Test.createTestingModule({
-            imports: [AppModule],
-        }).compile();
-
-        app = moduleFixture.createNestApplication();
-        await app.init();
-    });
-
-    it('/ (GET)', () => {
-        return request(app.getHttpServer()).get('/').expect(200).expect('Hello World!');
-    });
-});
diff --git a/test/jest-e2e.json b/test/jest-e2e.json
deleted file mode 100644
index e9d912f..0000000
--- a/test/jest-e2e.json
+++ /dev/null
@@ -1,9 +0,0 @@
-{
-  "moduleFileExtensions": ["js", "json", "ts"],
-  "rootDir": ".",
-  "testEnvironment": "node",
-  "testRegex": ".e2e-spec.ts$",
-  "transform": {
-    "^.+\\.(t|j)s$": "ts-jest"
-  }
-}