autogen-ccd subscription?

[Bo R.]

Hello, 

My goal is to retrieve CCD documents when they are updated. I was wondering if there is any way to either subscribe to updates to CCDs or more efficiently check if CCDs are updated today. 

The $autogen-ccd-if command just seems like the most efficient way to go about this. I could run ```https://.../Binary/$autogen-ccd-if?patient=<PATIENT ID HERE>

```

for all the patients in the population and then check where "lastUpdated" == today. Obviously, that's a lot of burden on Cerner (having to actually generate a full CCD for each patient), when most of the time the data will just be thrown away. Is there any work around here? I've considered looking at encounters/appointments to have an idea of where to expect changes but it all seems less efficient/less accurate than just checking the actual CCDs. 

[Lynn Hickey]

Prior to FHIR we used Clinical Reporting XR to generate "charts" sent outbound.  One of the triggers is called "chart activity" - I'm uncertain if there is a resource for this, but you may want to explore.  Another option is 3 days after discharge date...most charting should be complete.  I'm from the acute care side and as client, the Cerner cost model of query calls towards us...is a rough patch.

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[Michael Turman]

There is not a subscription model available for FHIR R4 resources today.

For your use case, could you query DocRef to find CCDs and the desired _lastUpdated, and then only pull the CCDs you are interested in from that superset? It still requires calling for each patient, but you should be able to tell from the metadata on the CCD whether you want it or not, without generating it wholesale. It looks like the attachment in a DocRef for a CCD is using the Binary...$autogen-ccd-if operation, so it would achieve your same end-goal, perhaps a little more efficently.

Also, this maybe a use case where FHIR Bulk Data Access can help when it comes on-line later this year. Stay tuned for that.