Carequality Subscription Implementation Guide for Push Notifications
0.1.1 - CI Build

Carequality Subscription Implementation Guide for Push Notifications, published by Carequality. This guide is not an authorized publication; it is the continuous build for version 0.1.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of and changes regularly. See the Directory of published versions

Notification Triggers

Triggering Events for Each Notification Type

Asserting that you support a Notification Type means that agree to abide by that Notification Type’s specific policies and requirements.


When a patient has been checked into the EHR system. The URLs vary by venue type.

Venue Definition Canonical URL
General Patient has been checked in to the EHR, includes all subsidiary admit events
ED Patient is triaged
Acute An admission order has been issued and bed is assigned
Ambulatory Admitted to an ambulatory encounter
Skilled Nursing/
Bed is assigned and patient has arrived


Push Notification Implementers should use the same criteria for the Discharge trigger that they use for meaningful use reporting. (i.e., patient’s status is changed to “discharged”). Notes, such as Against Medical Advice, are included in or attached to the resulting Encounter Resource.

The canonical URL for this event is


Only applies to Secondary Referrals (i.e., referrals not made by the Notification Recipient, e.g. Notification Recipient (PCP) orders a referral to specialist A, specialist A refers the patient to specialist B – A to B referral is a secondary referral ). Internal (e.g. within an IDN) consults are not included.

The canonical URL for this event is


Transfer Type 1: When a transfer is ordered to any external (any location that would not trigger an internal Admit notification) location. For example

  • Any transfer that crosses between EHRs (even when internal to one organization) shall generate a notification; and/or
  • Any transfer within a EHR that crosses between settings (ED, Skilled Nursing, etc.) shall generate a notification.

Transfer Type 2: Any time a transfer order is generated.

The canonical URLs for these events are (Type 1) and (Type 2)

Gaps in Care

A trigger based on the eCQM as defined by CMS or other request for follow-up based on Notification Generator policy or process.

The canonical URL for this event is

Termination of Subscriptions

To terminate subscriptions for all events for a patient, the subscription update event should be marked as “delete”.

The canonical URL for this event is