Delays in health data sharing can put patient safety and health at risk.

Health care delivery increasingly depends on timely, data‑driven digital health tools to ensure safe, high‑quality care across diverse clinical scenarios. Yet many digital health interventions are limited by delays in how electronic health records (EHRs) exchange critical information with third‑party applications. When systems rely on periodic polling or manual queries, clinicians may not receive important event updates quickly enough to act, creating risks for patients whose conditions require prompt attention. These challenges are especially evident in scenarios such as postpartum monitoring for hypertensive disorders of pregnancy, where delays in responding to elevated blood pressure readings can jeopardize maternal health and safety.

HL7^® FHIR^® Subscriptions offer a standards‑based mechanism for real‑time event notifications, enabling EHRs to automatically push updates when relevant clinical changes occur. However, adoption has been limited by technical, operational, and workflow integration challenges.

To address this need, the Office of the National Coordinator for Health Information Technology (ONC) sought a real‑world pilot demonstrating the value and feasibility of FHIR Subscriptions for enhancing digital health applications, with postpartum hypertension as the initial use case.

NORC and partners are piloting FHIR Subscriptions for real-time clinical decision support, with postpartum hypertension as the use case.

NORC, in partnership with Elimu Informatics and Emory Healthcare, is enhancing a Hypertensive Disorders of Pregnancy Monitoring (HDPM) app by integrating FHIR Subscriptions and piloting its use in clinical settings. The app enables timely notifications of relevant clinical events, eliminating the need for manual screening and frequent polling.

The pilot enrolls postpartum patients at Emory Healthcare, with clinicians and patients actively engaged in workflow development and usability testing. The solution is being developed and tested through a collaborative, stakeholder-driven process that includes requirements gathering, technical design, integration, and iterative refinement.

We are also conducting a mixed-methods evaluation to assess feasibility, effectiveness, and scalability. This evaluation will generate actionable insights for broader adoption of FHIR Subscriptions across diverse health care settings.