Prerequisites

Before you create an advanced subscription, ensure the following:

• Clinical Alerts are enabled for your tenant
• Your system supports FHIR R4 Subscriptions and can receive notifications via HTTPS POST
• Patients have been enrolled using a FHIR Group resource or direct patient references

To create a Clinical Alerts subscription

1. Send a POST request to the Subscription endpoint using the criteria field to define the event type and enable Clinical Alerts filtering.

Endpoint: POST /fhir/R4/Subscription

Sample payload:

{
  "resourceType": "Subscription",
  "status": "active",
  "reason": "Receive Clinical Alerts for enrolled patients",
  "criteria": "Bundle?message.event=admin-notify&clinicalAlerts=true",
  "channel": {
    "type": "rest-hook",
    "endpoint": "https://your-system.com/alerts",
    "payload": "application/fhir+json"
  }
}

2. Store the returned Subscription ID for managing or deleting the subscription later.
3. Confirm the delivery behavior so that your endpoint is prepared to receive Bundle messages that wrap the generated ADT A08 resources and any linked FHIR Encounter or DocumentReference records.

Subscription Filtering

• The clinicalAlerts=true parameter limits notifications to synthetic ADT events generated by the Clinical Alerts engine.
• Regular ADT messages (e.g., directly from HL7 v2 feeds) are excluded unless you create a separate subscription without the Clinical Alerts filter.
• You can run multiple subscriptions with different filtering logic to support distinct workflows.

Best Practices

• Use separate endpoints for different subscription types to simplify downstream processing.
• Log subscription delivery events for traceability and diagnostics.
• Periodically audit your active Subscriptions to ensure alignment with roster changes and alerting logic.