This page is part of the Subscriptions R5 Backport (v1.1.0: STU 1.1) based on FHIR v4.3.0. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Safety and Security

Applications are responsible for following FHIR security guidance. Some recommendations specific to subscriptions are provided below.

A subscription is a request for future event notifications. As with any client-initiated interaction, a Subscription could request information a client is not allowed to see. Applications SHALL enforce authorization in accordance with their policy requirements. Applications SHOULD take a subscription’s topic and filters into account when authorizing the creation of a Subscription, and SHOULD ensure that authorization is (still) in place when sending any event notifications.

When sending an event notification, applications can adopt various strategies to ensure that authorization is still in place. Some strategies may provide imperfect assurance (e.g., a server might rely on signed tokens with some pre-specified lifetime as evidence of authorization). In addition to these strategies, servers can mitigate the risk of disclosing sensitive information by limiting the payload types it supports (e.g., by prohibiting certain clients from requesting full-resource notification payloads and relying instead on id-only payloads).

Subscription resources are not intended to be secure storage for secrets (e.g., OAuth access tokens, etc.). Implementers MAY use their judgement on including limited-use secrets (e.g., a token supplied in Subscription.header to verify that a message is from the desired source).

Each notification sent by the application could reveal information about the application and subscriber relationship, as well as sensitive administrative or clinical information. Applications are responsible for ensuring appropriate security is employed for each channel they support. The Subscription resource does not address these concerns directly; it is assumed that these are administered by other configuration processes. For instance, an application might maintain a allow-list of acceptable endpoints or trusted certificate authorities for rest-hook channels.

Some topic and server implementation combinations may trigger internal notification workflows when notifications should NOT be sent. For example, if a topic is designed around Observation resources being removed (e.g., deleted), an implementation may be triggered if an Observation is moved to a higher security level and is no longer available to a user. These types of situations are implementation-specific, so this note is to raise awareness of potential pitfalls when implementing subscriptions.

Subscribers should ensure an appropriate process to validate incoming messages. For example, if the full-resource content type is used, clients should provide a header or some other secret to the server so that messages can be verified prior to being used for health decisions. Using content types of empty or id-only can mitigate this risk, as resources must be retrieved from a trusted location prior to use.

Subscribers should be aware of, and protect against, the possibility of being used as part of an attack on a FHIR server. For example, a malicious client may send a large volume of fake notifications with empty notifications, which would cause the subscriber to send many (potentially expensive) queries to a server.