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Subscription Extensions

Use the following FHIR extensions to customize the Subscription behavior. The behavior is non-standard, and will not necessarily work in other FHIR systems.

Interactions​

By default, FHIR Subscriptions will execute on both "create" and "update" operations.

To restrict the FHIR Subscription to only execute on "create", use the http://medplum.com/fhir/StructureDefinition/subscription-supported-interaction extension with valueCode of create:

{
  "resourceType": "Subscription",
  "reason": "test",
  "status": "active",
  "criteria": "Patient",
  "channel": {
    "type": "rest-hook",
    "endpoint": "https://example.com/webhook"
  },
  "extension": [
    {
      "url": "https://medplum.com/fhir/StructureDefinition/subscription-supported-interaction",
      "valueCode": "create"
    }
  ]
}

Signatures​

When a consumer receives a webhook request, you may want to verify that the request came from the expected sender.

Webhooks can optionally use a FHIR extension to enable an HMAC signature. To enable HMAC signatures, use the extension https://www.medplum.com/fhir/StructureDefinition/subscription-secret and valueString of a cryptographically secure secret.

{
  "resourceType": "Subscription",
  "reason": "test",
  "status": "active",
  "criteria": "DiagnosticReport?status=completed",
  "channel": {
    "type": "rest-hook",
    "endpoint": "https://example.com/webhook"
  },
  "extension": [
    {
      "url": "https://www.medplum.com/fhir/StructureDefinition/subscription-secret",
      "valueString": "abc"
    }
  ]
}

The valueString will be used to generate a signature. The signature is the payload encoded using SHA-256 (otherwise known as an HMAC). The key for the hash will be the valueString from the FHIR extension. API consumers are encouraged to encode the payload with the secret key and compare the signatures.

Example: TypeScript / Express

app.post('/webhook', (req, res) => {
  const secret = '...'; // Created separately
  const signature = crypto.createHmac('sha256', secret).update(JSON.stringify(req.body)).digest('hex');
  console.log('Signature:', req.headers['x-signature']);
  console.log('Expected:', signature);
  console.log('Received:', req.body);
  res.sendStatus(200);
});

Example: Python / Flask

@app.route("/webhook", methods=["POST"])
def handle_webhook():
    secret = b'...' # Created separately
    message = flask.request.get_data()
    signature = hmac.new(secret, message, hashlib.sha256).hexdigest()
    log('Expected: ' + signature)
    log('Received: ' + flask.request.headers.get('x-signature'))
    return {"ok":True}

Retry Policy​

If your subscription failed or threw an error, you can configure it to attempt to execute the operation multiple times.

To add an attempt number, use the http://medplum.com/fhir/StructureDefinition/subscription-max-attempts extension with the valueInteger set to a number between 1-18.

{
  "resourceType": "Subscription",
  "reason": "test",
  "status": "active",
  "criteria": "DiagnosticReport?status=completed",
  "channel": {
    "type": "rest-hook",
    "endpoint": "https://example.com/webhook"
  },
  "extension": [
    {
      "url": "http://medplum.com/fhir/StructureDefinition/subscription-max-attempts",
      "valueInteger": 3
    }
  ]
}

Custom Status Codes​

HTTP status codes can be customized to determine the success of the subscription operation.

To add custom codes, use the http://medplum.com/fhir/StructureDefinition/subscription-success-codes extension with the valueString having a comma separated list of HTTP status codes for success (i.e., "200,201"). We also allow ranges (i.e., "200-399,404")

Note

If you use custom success codes, you will need to implement ALL of the HTTP status codes that are determined to be successful

{
  "resourceType": "Subscription",
  "reason": "test",
  "status": "active",
  "criteria": "DiagnosticReport?status=completed",
  "channel": {
    "type": "rest-hook",
    "endpoint": "https://example.com/webhook"
  },
  "extension": [
    {
      "url": "http://medplum.com/fhir/StructureDefinition/subscription-success-codes",
      "valueString": "200-399,404",
    },
  ]
}