Authentication - Conformance Criteria
3.4.8  Notifications
Nathan E Botts

3.4.8 Notifications

Managing Health App Notifications and Alerts


This category is about notifications and alerts, which may be used to inform consumers of important situations that they should know about. This includes, but is not limited to, information about the app itself (e.g., important updates) or about the health information that the app handles (e.g., the specific consumer’s personal health data warrants special attention).

Related Regulations and Standards

See platform-specific guidelines.

Implementation Guidance

In the realm of alerts and notifications, the following table proposed suggested standardized (generic) terms in the left column, with mappings to the leading two platforms in the middle columns, and comments in the right column. The platform-specific definitions have been derived from web sources, with preference given to information from the creators of the platforms (Apple, Google). Note: the mapping cannot be made an exact 1:1. In some cases, the platform-specific term may be more precise (e.g., subtypes) than the generic term, but we do not require a generic equivalent for every platform-specific term. In other cases, there may be substantial similarity of concepts across platforms, but not identical behavior, and certainly not identical appearance.

Despite the proposed granularity of these terms, that does not mean that there need to be separate cMHAFF conformance requirements for each type, but at least the opportunity is there if the need arises. In particular, there may be different conformance requirements for “alerts” vs other types of notifications.

Proposed Hierarchy
  • Message (overarching term)
    • Content Message (e.g., HL7 v2, C-CDA payload, FHIR resource) – out of the scope of this set of definitions. Probably need a better term for this.
    • Notification (overarching term)
      • Alert (requires user action, whereas all other types of notifications do not require it, though they may allow it)
      • Persistent notification
      • Temporary notification
      • Emergency Notification (government, outside app control)


Suggested “standardized” (generic) term for cMHAFF

Apple (iOS) equivalent

Google (Android OS) equivalent



Any computer to computer or computer-to-human interface, whether via visual, aural, haptic, olfactory, taste, or neural mediums. However, when discussing interoperability, the focus is on computer-to-computer[2] messaging. Note that the messages can be transmitted within the same physical computer, but between different software (e.g., APIs).

Generally refers to messages within specific types of apps, like email, text, IM, Facebook…

Generally used to refer to messages from one device (or server) to another.

Message, or Messaging, can describe cMHAFF’s overarching term for the data packages that are sent by apps. While we consider notifications and alerts as special types of messages, the specific term “message” is used a lot for messages within apps, but not generally used when describing alerts and notifications. We in HL7 also have the HIT-specific legacy of structured “messaging” formats that include healthcare content and sometimes PHI (e.g., HL7 v2 message).


A device-specific message communicated to a user to inform them of device or app activities that are deemed important to the user. Some types of notifications require a response from the user, while others do not.

Notification – generic term to cover many types of notifications.

Notification – generic term to cover many types of notifications.

Generic term that has subtypes.


While HIT also has “notifications” that may be delivered to an app, not just to a human user, cMHAFF uses a common consumer-based definition


A type of Notification that is communicated to a user and requires a response before the user can proceed with activity on the device. For example, it may take the form of a “modal” pop-up dialog that must be dismissed by clicking OK or taking some other action.


Alert Dialog, aka

Dialog Notification

These messages will always be seen by the user, except if the device is turned off or the user does not look at the device at all (nothing is guaranteed). In general, these are considered more “serious” than other types of notifications. Local or other policy make have more stringent rules for anything deemed an “alert” vs a “notification.”

Persistent Notification

A device-specific message communicated to a user to inform them of device or app activities and remain displayed on the device. These remain persistent until the user deletes them or takes an action that changes their status (e.g., checks text messages, checks email)

Notifications (in Notification Center)


Badge (on individual app icons)

Status Notification


Status Notifications can appear outside the app window and can be used to attract the user back to the app.

Android has more than one type of notification.



Temporary Notification

A subtype of Notification that does not remain displayed on the screen more than a short time period.



“Lock screen notifications” look like banners but appear on the lock screen.



Toasts appear within the app window, not outside of it

Since these messages fade after a short time, it is very possible that they will not be seen at all. In Android, Toasts appear within the app window (not outside the app). In iOS, they can appear outside the app.

Emergency Notification

A notification from an external source, such as the government, communicating important information about your area (e.g., emergency, disaster, weather…)

iPhone provides options for two types of Government Alerts, “AMBER Alerts” and “Emergency Alerts.”

Four types: presidential notifications, imminent extreme notifications, imminent severe alert and AMBER alert. You can turn off every alert except for the presidential alert.

These are outside the scope of an app, are not written by MH app developers, but can be configured to display on the device. They are mentioned so that we don’t use the same terms for something else.


[1] Also include discussion of where the same terms are used with different meanings in clinical/EHR space

[2] “Computer” is broadly defined to encompass smart mobile devices such as phones and tablets, as well as PCs, servers, and all other computing machinery.

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