FHIR Event Notifications: Advancing interoperability

Why real-time matters in healthcare

Timing is always critical in healthcare. Whether it’s a lab result that arrives too late, an appointment update that doesn’t reach the right person, or a billing change that sits unnoticed, these delays can slow care, create confusion, and add stress for patients and staff alike.

FHIR Event Notifications are redefining interoperability, and athenahealth is leading the way. Until now, many practices and health systems have relied on a “check back later” approach to respond to new information, requiring constant system polling and leaving teams waiting for updates that could be critical.

With this new event-driven process, customers can now access changes to information in near real time.

For practices, this means faster clinical decisions, smoother operations, and less time spent chasing information. Care teams can act on critical updates as they happen, from urgent lab results to last-minute appointment changes. Billing and administrative staff can resolve issues sooner, reducing delays and improving the patient experience, all while providing more efficient technical processes.

The evolution of interoperability standards

Historically, much healthcare data sharing occurred at scheduled intervals, with systems collecting and transmitting updates hours or even days apart, despite existing capabilities for querying and pushing data as needed. If a care team needed new information sooner, the only option was to “poll” the system, repeatedly checking for changes. This created delays, added technical complexity, and consumed resources without always delivering what was needed.

The HL7® FHIR® standard has been a major step forward, giving healthcare organizations and technology partners a shared language for exchanging information. It made it easier for systems to talk to each other, but most exchanges still relied on that same “check back later” approach.

Event-driven architecture changes the equation. Instead of waiting for someone to ask, systems can now send a “push” notification the moment something important happens—whether that’s a new prescription, a lab result, or an update to a patient’s record.

That shift delivers real benefits:

• For providers and patients: faster action and better-informed care.
• For developers: fewer workarounds and more streamlined solutions.

What FHIR Event Notifications are and why they’re a breakthrough

At their core, FHIR Event Notifications are simple: an application signs up to be notified when a specific event happens – like when a lab result posts, a claim status changes, or a prescription is updated. The moment that event occurs, the app gets a notification so it can act right away.

For healthcare, that shift brings opportunities:

• Faster clinical decision-making: updates reach care teams immediately, not hours later
• More efficient technical processes: no need to repeatedly check for changes that may not exist
• Better patient and provider experiences: fewer delays, fewer missed opportunities, and smoother communication

The polling-based Changed Data Subscription approach worked in reverse. Instead of the system saying, “here's something new,” developers had to ask repeatedly, “has anything changed yet?” Constant polling like this meant extra work, slower updates, and wasted system resources. FHIR Event Notifications help remove those barriers, making information flow with the fast pace of healthcare.

athenahealth’s implementation: Raising the bar

athenahealth is one of the first major EHRs to release an implementation largely based on the FHIR Event Notifications specification, bringing real-time notifications to a broad range of clinical, operational, and financial events.

Here are some examples of resources partners and practices can monitor for changes:

• Appointments
• Claims
• Encounters
• Historic medications and vaccines
• Imaging and lab results
• Orders
• Patients and patient cases
• Problems (conditions)
• Prescriptions
• Providers and referring providers

When a change occurs within one of these resources, athenahealth sends a notification to the subscribed application. The developer can then query the appropriate FHIR or proprietary API to retrieve the new information in full. It’s fast, flexible, and designed to work across many different workflows — whether updating a patient portal, triggering a follow-up task, or alerting a care team to urgent results.

Real-world impact for practices and health tech innovators

FHIR Event Notifications aren’t just a behind-the-scenes improvement — they change how people experience healthcare and how teams get work done every day.

For practices

FHIR Event Notifications can positively influence daily workflows. By providing real-time alerts, care teams can stay informed about patient and practice needs, helping to minimize the chance that important details are missed. Coordination with external partners — such as labs, imaging centers, and referral networks — can become more seamless, while operational tasks like scheduling, billing, and follow-up may run more smoothly.

For developers and technology partners

Subscriptions can help reduce maintenance demands by limiting the need for constant polling and workarounds. They also enable more dynamic and responsive integrations that have the potential to better support real-world care scenarios. For example, care teams might receive critical lab results more promptly, enabling quicker patient outreach, or revenue cycle teams might monitor claim status changes nearer to real time, potentially accelerating reimbursement workflows.

Together, these improvements highlight how event-driven APIs can contribute to making healthcare faster, smarter, and more connected, for both the people delivering care and the technology teams supporting them.

Beyond data: Integrating into the clinical workflow

Real-time notifications represent one part of the overall picture. The real impact occurs when insights are embedded more seamlessly into provider and care team workflows, aiming to avoid adding extra steps or contributing to alert fatigue.

Real-time alerts can become even more effective when combined with tools that embed context-relevant information directly into the provider workflow, such as CDS Hooks. CDS Hooks are a standard designed to allow external clinical decision support services to send recommendations or prompts to a provider at moments aligned with their EHR tasks, such as when selecting an order or reviewing a patient encounter.

For example, after a provider selects an order, a CDS service may automatically evaluate relevant information — like clinical guidelines, payer requirements, or potential care gaps — and offer an appropriate action. athenahealth’s implementation aims to ensure these prompts are integrated thoughtfully into the user interface, so they support decision-making without causing disruption. Prefetching key patient information, providing actionable suggestions, and feeding back overridden recommendations all work together to make these insights practical and reliable.

Paired with event-driven notifications, this approach can provide practices with faster, actionable data, potentially helping teams work smarter and deliver care more efficiently.

FHIR Event Notifications aren’t just a behind-the-scenes improvement — they change how people experience healthcare and how teams get work done every day.

Looking ahead: The future of event-driven interoperability

Event-driven FHIR APIs and FHIR Event Notifications can help deliver faster, smarter, more connected healthcare. As more EHRs adopt these standards and evolve alongside FHIR R5 and future updates, real-time, actionable data could become the norm rather than the exception. Practices and technology partners can prepare now by exploring integrations that support event-driven workflows, building applications that respond to notifications, and aligning internal processes to act on real-time information.

Next steps in event-driven interoperability

As FHIR interoperability continues to evolve, practices and partners who embrace event-driven APIs will be ready for the next generation of connected care. By combining event-driven APIs with FHIR Event Notifications, healthcare organizations can achieve faster, smarter, and more connected care. athenahealth is leading the way, giving practices and partners the tools to access critical data the moment it’s available and integrate it seamlessly into workflows.

To see how these capabilities can benefit your organization, explore the athenahealth Marketplace or visit our developer resources to learn more about building integrations that make real-time care possible.