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


Scenario 1

  • Jerry is a 68-year-old male in the mid-Atlantic with asthma and Type 2 Diabetes. He is a member of a patient-centered medical home. He recently became ill, and required EMS assistance and transport to the hospital where he was diagnosed with a community acquired pneumonia with severe dehydration, fever, and coughing.


  1. Authentication and Authorization conducted as per Carequality Implementation Guide.
  2. PCP either has knowledge of or PCP EHR does query by demographics to determine Hospital PatientID.
  3. PCP/Care Coordinator is the Notification Recipient.
  4. Subscription, when created, knows Patient, PCP, Care Coordinator, etc.
  5. Consent has been captured (if needed).
  6. Notification Recipient and Hospital know the patient, so they can create a subscription or find via RLS/eMPI call.
  7. Phase 1 assume patients are “known” by both Notification Recipient and Hospital (Notification Generator).


  • Jerry’s prior events are stored in the care team notifications service in an actionable way and aligned with computable reimbursement incentive rules for his health plan.
Subscription FlowPCP(Subscriber)PCP(Subscriber)Hospital(Generator)Hospital(Generator)1.0 Patient has a Treatment relationshipwith PCP (with consent as needed),and patient is known to exist at the Hospital1.1 PCP subscribes for Admits & Discharges1.2 EMR creates subscription(assume patient is known)1.2 Subscription Acknowledgement response(or send an error if the patient does not exist)
Figure 1: PCP Subscribes to Events at Hospital


  • Jerry’s PCP at the patient-centered medical home received a clinical encounter notification that Jerry was admitted to the hospital. The Notification Recipient EHR fetched the resource giving details and the PCP was able to push a C-CDA to the hospital providing a patient summary including Jerry’s co-morbidities, (problem list), medications, allergies and immunizations which improved Jerry’s hospital care and recovery.
Notification FlowPCP(Subscriber)PCP(Subscriber)Hospital(Notification Generator)Hospital(Notification Generator)2.1 Patient enters the ED “Admit Event”2.2 EMR generatessubscription notification2.3 EMR sends notificationto the endpoint2.4 PCP’s EMRreceives notification2.5 PCP requests EncounterResource from notification2.6 PCP’s EMR Distributes admitalert to PCP (and/or CC)
Figure 2: PCP Receives Admit Notification from Hospital