HL7 releases FHIR R4B with increased potential for subscriptions

hl7 fhir

July 7, 2022By Rob Brull

On May 28, HL7 released the latest version of FHIR, 4.3.0, which is also known as FHIR R4B. The extent of this release was covered at the recent FHIR DevDays, which Infor attended. Probably the most exciting item included in the release is the advancement of how subscriptions are used in FHIR.

In a recent blog, it was noted that subscriptions play an important part in providing proactive care management in healthcare. Based on subscribed events, notifications can be generated and a series of intelligent interactions could occur for timely and targeted care.

While subscriptions are already a highly powerful feature of FHIR, the implementation reality of scaling many granular subscriptions on a high-volume FHIR server sometimes proved to be challenging. While great in theory, implementation was not always practical, especially in high-volume situations. Thus, the need surfaced to provide more flexibility to implementers to expose this powerful concept.

HL7 FHIR F5, expected to be released in 2023, has many new innovations planned for subscriptions to address these changes. In order to get these innovations into the hands of implementers quickly, these concepts are being backported to FHIR R4B which is available now. Thus, implementers can start taking advantage of these new capabilities.

Subscriptions in FHIR R4B will include the concept of topic-based subscriptions. FHIR servers can choose which topics they support, based on the clinical and administrative challenges they want to address, and make those available via a new SubscriptionTopic resource. Think of topics as events that clinicians want to keep close track of to keep their patient population healthy.

The SubscriptionTopic resource will also define allowed filters, enabling implementers to constrain the granularity in a controlled way so that scalability can be achieved. SubscriptionTopic will also allow returned resources to be defined so that the resources returned can be tailored for the specific workflow. Various other subscription aspects have been adopted for FHIR R4B as well, including a SubscriptionStatus resource, extensions and profiles for the Subscription resource, and leveraging the history-type bundle.

The key advantages of subscription implementation in FHIR R4B include:

  • Event determination—Chose the subscription topics that are important to you.
  • Scalability—Constrain the granularity without impacting workflow requirements.
  • Data definition—Customize the data in the notification that is important to your workflow.

When will the FHIR world be ready for this? The answer is now. There is already a large amount of interest in subscriptions, and FHIR R4B will make subscriptions viable for even more potential workflows. Infor already supports subscriptions in its FHIR product portfolio and will adopt FHIR R4B and the new subscription requirements in future releases. Given the power of subscriptions, and the ability of subscriptions to impact patient care, Infor has robust plans to work with its customers to leverage subscriptions as part of the FHIR ecosystem now and moving forward.

Written by

Rob Brull, Senior Product Director,

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