Send Health Worker Alert Workflow

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

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 an 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.

Workflow Maturity	Maturing	Workflow is defined and ARB Approved Workflow is supported by emerging IHE mACM standard in Trial Implementation
Standards*		1. FHIR DSTU2 search on Location, Provider or Patient resources / FHIR DSTU2 bundle search response OR ITI-73 Find Matching Services CSD Request / ITI-73 Find Matching Services response 2. FHIR search on Patient resources (PDQm) request / FHIR DSTU2 bundle search response OR PIX/PDQ request / PIX/PDQ response
Assumptions and Prerequisites		None
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) Examples include: A 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 interacting with a 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 issue 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 alert of the missed appointment to inform the health worker that originally interfaced with that client. Alert Aggregator - A system responsible for distributing an alert to a health worker. The alert aggregator manages 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 an SMS response or acknowledgment.

Interaction Description

#	Interaction	Data / Notes	Transaction Options
1	Notice an alert condition (Defined by business rules of Alert Reporter)
2	Search for provider, organization, and/or facility identifier(s)	Alert Report constructs query according to business rules under which alert was initiated. FHIR transactions are more aligned with the mACM ITI-84 transaction which has references to Organization, Location (e.g., facility), or Provider resources.	FHIR DSTU2 search on Location, Provider or Patient resources OR ITI-73 Find Matching Services CSD Request
3	Search for provider, organization and/or facility identifier(s)		FHIR DSTU2 search on Location, Provider or Patient resources OR ITI-73 Find Matching Services CSD Request
4,5	Return identifiers	FHIR transactions are more aligned with the mACM ITI-84 transaction which has references to Organization, Location (e.g., facility) or Provider resources	FHIR DSTU2 bundle search response OR ITI-73 Find Matching Services response
6	Report Alert	Identifiers of recipients passed either by reference to appropriate FHIR resource (requires FHIR server for those resources) OR Identifiers of recipients passed as embedded reference to appropriate FHIR resources (does not require FHIR server)	Mobile Report Alert ITI-84 (mACM)
7,8,9	Report Alert	Mobile Report Alert ITI-84 (mACM)	Mobile Report Alert ITI-84 (mACM)
10	Disseminate Alert	Disseminate alert(s) via appropriate communication mechanisms available to the HIE (SMS, email, POC system, etc). Transactions depend on the communication channel.
11,12	Update dissemination status	Transactions are not specified (currently) by mACM standard. Note: RapidPro uses custom FHIR compliant endpoint "Communication/$response" and "Communication/$sent" for this. We can submit a Change Proposal to standardize this
13	Request for Alert Status		Query for Alert Status ITI-85 (mACM) Request
14	Request for Alert Status		Query for Alert Status ITI-85 (mACM) Request
15	Request for Alert Status		Query for Alert Status ITI-85 (mACM) Response
16	Request for Alert Status		Query for Alert Status ITI-85 (mACM) Response