Clinical Notifications (Da Vinci Alerts)

I posted yesterday looking at (standard) ways how to integrate a new EPR with wider health system and I focused on documents as PDF’s and/or FHIR Documents.

However documents/letters often are produced hours after the event.
E.g. if a patient is discharged, the discharge letter may be completed hours/days after the event.
If a patient attends an ED, the GP would receive details when the patient has been discharged. Similarly if this ED patient has had an asthma attack, guidelines recommend the GP conducts a medication review on the patient.
These letters are not real time, so not ideal where coordination between providers is required (e.g. ambulance and ED) and I’m not sure embedding important clinical information in letters is good practice - will the letter be read?

Do we need a real time alert or notification system? Covering perhaps:

The image above was taken from the US Da Vinci Alerts project. Readers familiar with HL7v2 will recognise many of the alerts - I’ve worked on hospital systems which sent HL7v2 messages to GP Systems which partly achieved the initial use cases. This didn’t cater for multi-disciplinary teams (community, mental health, etc) and v2 tends to focus on the health admin side.

So back to the EPR. I’m seeing a requirement to support alerts and aligning with the DaVinci project is a sensible. So the EPR will generate light weight messages such as:

Patient A admitted to ED suspected Asthma Attack
Patient A needs Medication Review
Patient A admitted for observation because …
Patient A discharged after asthma attack

These could be sent (real time) as both HL7v2 to PAS (and so GP) and FHIR Message Bundles to other providers and hospital systems. Clinical documentation would still be sent when completed. (Ideally the GP would get the clinical content in the FHIR Message not the health admin HL7v2 but thats outside the scope of the EPR).