When R4B was proposed, it was pitched as a very limited release with very few changes that needed to be pushed out and that it would not delay R5. When I asked about including some of the Subscriptions work, it was described as out of scope for the release.

Part of that decision was based on the creation of the Subscription R4 backport IG, which was still in its early stages.

Currently, we have more experience with the IG and it appears that R5 has been significantly delayed.

With that in mind, I request adding the two new Subscription resources from R5 (SubscriptionTopic and SubscriptionStatus):

• Both are new resources, so there is no issue with backwards compatibility.
• The addition of SubscriptionTopic:
  • allows topics to start being added to the FHIR registry
  • resolves the issue of topics being 'out of scope' for the backport IG (they were left out of scope due to the complexity of trying to add a resource that is not defined)
• The addition of SubscriptionStatus:
  • prevents inertia on a stopgap method (the backport uses Parameters for the meta information, since there was no access to the new resource)

Adding the new resources will allow for better implementation today as well as a smoother transition to R5. This is a time-sensitive concern given the upcoming regulatory requirements for patient and care-team notifications, since it appears that implementations will need to be in production before R5 is released.

Note, this is NOT a request to modify the existing Subscription resource. While we are confident in the changes made for R5, there are implementations in production that use and I do not suggest making any changes that would constitute a breaking change.