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Benjamen Pyle for AWS Community Builders

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Event Driven Architecture with AWS Healthlake

One of the features that I am currently missing with AWS Healthlake is a proper “event-ing” framework. With DynamoDB you’ve got streams. With RDS you can use DMS. But with Healthlake there is no native change data capture mechanism.

Being that I’m only working on event driven architectures these days, I needed a way to be able to handle change. What I’m going to show you below is not “sanctioned” but it is 100% AWS native and continues with the Serverless theme. With that said, here’s the Github Repository if you just want to jump ahead. The CDK code will deploy a Healthlake instance @ $.27 / hr so please runcdk destroy npx ts-node bin/app.ts` when you are done

The Need

Being in an EDA (Event Driven Architecture) I wanted to be able to trigger workflows downstream asynchronously in addition to being serverless. Without native support for this in Healthlake (yet) I ventured off to figure out if I could possibly check on trails/logs somewhere and make something happen. Below is the architecture this article discusses

Healthlake CDC architectureThe architecture is fairly straightforward. Here’s the breakdown though of how it works

  1. Every API call that is made to Healthlake is logged in AWS Cloudtrail
  2. Set up an Event Bridge rule that listens to these events and any event that is a PUT or POST I then forward onto a State Machine that can handle that event
  3. Then filter the events. As you’ll see below, you don’t get the ID of the thing that was mutated, just the time it was mutated. So I first need to find everything that has been changed
  4. Then do some dedup’ing. My clients are always idempotent but I don’t want to force unnecessary noise into the ecosystem that I can prevent.
  5. Write that change into a Custom Event Bus on Event Bridge and then let clients setup their own rules for working with the events

Working through the Cloudtrail and Audit

So to capture events from Cloudtrail I needed an EventBridge rule to make that happen. It looks like this

const rule = new events.Rule(this, 'rule', {
eventPattern: {
source: ["aws.healthlake"],
detailType: [
"AWS API Call via CloudTrail"
detail: {
eventSource: [
eventName: [
requestParameters: {
datastoreId: [hl.attrDatastoreId]
responseElements: {
statusCode: [200, 201]
ruleName: "capture-healthlake-events",

What this is doing is listening on Cloudtrail for all “CreateResource” and “UpdateResource” events that are sent to Healthlake. By further restricting the rule down to only those that have statusCode of 201 and 200 which will be those PUT and POST events.

Next add a target for the rule to be a Lambda handler

const queue = new sqs.Queue(this, 'Queue', {

rule.addTarget(new LambdaFunction(props.func, {
deadLetterQueue: queue, // Optional: add a dead letter queue
maxEventAge: cdk.Duration.hours(2), // Optional: set the maxEventAge retry policy
retryAttempts: 2, // Optional: set the max number of retry attempts
Once the event has been handled then kick off a State Machine that does the following

  • Find just the changed enties
  • Hydrate or back fill with data
  • Post into EventBridge

State Machine Workflow

If you really dig into the event that is logged in Cloudtrail, the rub boils down to this. The element that has the resourceID is going to be hidden from view. You’ll see this text


That’s all well and good but it makes things very difficult when trying to determine what has changed. The below is how the workflow shapes out

CDC Step functions state machineLet’s take a deeper dive into the Patient workflow.

First off, there is a pause at the beginning of the workflow as i noticed a small lag in reads as I know they aren’t consistent.

Next the patient hydrator is executing a search against the Patient resource to look for all changes since the event timestamp

url := fmt.Sprintf("https://%s/%s/r4/Patient?_lastUpdated=ge%s", h.HealthLakeEndpoint, h.HealthLakeDataStore, lastUpdated.Format(time.RFC3339))

Disclaimer, I could use native SDK integrations for the next two steps in terms of using DynamoDB but I opted for Lambdas. What I’m doing in those is preparing the record for publish and then checking to see if I’ve handled it already. I’ve got a simple DynamoDB table that keeps a daily log of things touched.

Lastly, if the record is a first timer, then I send on over to the EventBridge Bus I created earlier so that others could subscribe to it

Wrap Up

If you look at the repos to follow along, there is a lot going on with this solution.

  • Healthlake is the originator of the changes
  • Cloudtrail holds the events and operations that are happening to Healthlake
  • You need to build an EventBridge rule (has to be in the default bus) to listen to those changes
  • Build a handler or pipe to deal with the change
  • State machine work flow can be complex
    • Pauses
    • Hydrators / finding what changed
    • Multiple resource types must be implemented
    • Deduping
    • Posting into a custom Event Bridge Bus

But honestly, Healthlake needs to be a critical part of the ecosystem due to it’s natural FHIR and Patient centered data storage so these changes need to be propagated into the broader ecosystem. So until AWS builds this capability, this solution works great for what I need it to do.

Hopefully you can take and apply it and/or adapt it to fit your needs!

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