Overview

Description: The send alert workflow allows the infrastructure services to register alerts with an alert service. The alert service allows alert consumer to query for these alerts and send them out to health workers in whatever format is appropriate (sms, email, etc).

Sponsors: Eduardo Jezierski, Dykki Settle and Carl Leitner 

Status:  under development

Last Modified: 3 March 2016

Definitions

An alert is intended as a largely one way communication to a health worker.  Use cases for alerts include:

1. Crisis Response 

   In response to a crisis or emergency situation, such as the 2014 and 2015 outbreaks of Ebola in western Africa, it is critical to communicate to health workers within a particular health care network and to verify, to the extent possible, the receipt of such alert.

2. Care Reminders
   A subject of care may receive care from multiple providers across multiple health care networks, and coordination of care across providers and networks is difficult. If an Electronic Medical Record or Longitudinal/Shared Health Record is present, Care Reminder alerts can be triggered through the examination of clinical records about the subject of care. Care Reminder alerts are sent either to the subject of care or a designated health worker.

Though the infrastructure of the alerting workflow indicated below would permit communication of many types of additional messages, alerts, or notifications,  it is not intended that these messages exceed the above use cases.  In particular these do not include "Critical Findings" or other types of alerts which require immediate action by a health worker.

The IHE mACM standard on which this workflow expects that additional IHE profiles utilizing mACM would be developed to address broader alerting workflows.

Actors

• Alert Reporter - The point-of-service system that captures patient identifiers, is responsible for sending the identifiers to the HIE. 

  An Alert Reporter shall originate or relay alerts (an alarm, either physiological or technical, or an advisory) to the Alert Aggregator. 

  This actor can optionally query an Alert Aggregator Actor for statistics related to the dissemination of this alert to the intended recipient(s)

• Alert Aggregator - A system responsible for distributing an alert to a health worker.  The alert aggregator  manage these alerts according to the required jurisdiction defined business context, for example dispatching them onto a communications platform for delivery to an intended recipient.

  The Alert Aggregator may optionally collect statistics related to the dissemination of the alert such as delivery status or the value of a SMS response or acknowledgment.

Non-Exhaustive Examples of Alert Reporters

In the workflow below, the Alert Report is presented as a generic actor.   Examples include:

• An Health Management Information System (HMIS) notices that a threshold indicator on the number of cases of Cholera for a district.  An HMIS could act as an Alert Reporter by querying a health worker registry to determine a list of all Nurses in a district and generate an alert indicating that they should be advised of the increased number of cholera cases.
• A Ministry of Health employee wishes to notify health workers of a delay in payment.  The employee would interacting with an Human Resource Information System (HRIS) could act as an Alert Reporter by initiating an alert to all formal sector paid employees to indicate that there will be a delay.
• A Mediator in the Interoperability Layer could monitor a Shared Health Record  and notice that a child has missed a vaccination according to an established protocol of care. The Mediator would act as an Alert Reporter and issues an SMS reminder to send to the mother or other designated guardian.  In the case when a mother does not have access to a cell-phone or other electronic device, an alert should be generated and sent to the child’s caregiver. This caregiver could be a Community Health Worker, a village elder, or a sub-village chairman.
  
• A Mediator can monitor a central Electronic Referral System and a Shared Health Record to detect if the patient has missed their referral by checking if an encounter has been received at the Longitudinal Health Record within the time frame indicated in the referral. If an encounter has not been received the Mediator acts as an Alert Reporter and sends out an out an alert of the missed appointment to inform the health worker that originally interfaced with that client.
  

Workflow