Abstract: A change associated with a component or entry in a data store is identified. A subscription registry is polled to determine which of a plurality of entities have subscriptions associated with the identified change. Using connection information, a synchronization operation at each of the determined entities is initiated to reflect the identified change. The change may include one or more of: a change to a server connected to a network, a change to a medical device connected to a network, a change to a software component residing on one or more medical devices, and/or a change to a data store subscribed to by at least one of one or more servers and one or more medical devices. The plurality of entities may include one or more of an infusion pump, a vital signs monitor, and a ventilator. Related apparatus, systems, techniques, articles, and computer readable media are also described.