The FHIR Subscription lifecycle with AWS HealthLake

Create a SubscriptionTopic with status "unknown"

Create a Subscription with status "requested"

HealthLake validates the Subscription configuration

Subscription must reference an already existing topic (topic must be in status unknown, draft, active).

If valid, HealthLake updates status of Subscription to "active"

While creating a Subscription, if the topic given was in status "unknown", HealthLake updates the status to "active" once the Subscription is also active

Subscriptions usually take 5-10 minutes to create successfully

If Subscription does not create successfully, the status will change to error where you should perform a DELETE operation, then retry creation of a Subscription. You can view the "error" field in the Subscription resource to see why the Subscription did not create successfully.

HealthLake monitors for events matching your criteria

Notifications are sent to configured endpoint when matches occur

HealthLake attempts retries for 14 days and then stops retrying for those events

A Subscription can be deactivated by:

Setting an end date (automatic deactivation)

{
  "resourceType": "Subscription",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-subscription"
    ]
  },
  "status": "requested",
  "end": "2026-07-31T05:38:17.2404292+00:00",
  "reason": "Test subscription for walkthrough",
  "criteria": "https://healthlake.<AWS_REGION>.amazonaws.com/datastore/<datastoreId>/r4/SubscriptionTopic/<your topic id>",
  "_criteria": {
    "extension": [
      {
        "url": "http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-filter-criteria",
        "valueString": "Encounter?subject=Patient/<patient id>"
      }
    ]
  },
  "channel": {
    "type": "event-bridge",
    "endpoint": "<your event bus arn>",
    "payload": "application/fhir+json",
    "_payload": {
      "extension": [
        {
          "url": "http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-payload-content",
          "valueCode": "id-only"
        }
      ]
    }
  }
}

Deleting the Subscription resource

DELETE https://<baseHealthLakeURL>/Subscription/<your subscription resource id>