Alert Rules

Clinical Alerts function through a structured observation window that governs when an alert is generated and when it is suppressed.

Observation Window

The window begins when a qualifying network query is detected and remains active for up to 10 days. Document retrieval and analysis must complete within this period for an alert to be generated. If no qualifying documents are evaluated within the window, no alert is produced.

Observation windows are evaluated per patient and per qualifying query event. Overlapping windows may occur if multiple qualifying queries are detected for the same patient.

Alert Conditions

An alert is generated only when the following conditions align:

• Patient is actively enrolled for Clinical Alerts at the time processing occurs.
• A qualifying network query is detected for that patient. A query qualifies when the organization making it declares the treatment exchange purpose.
• One or more clinical documents are successfully retrieved and evaluated.
• Retrieved content contains sufficient clinical context to support encounter inference.
• Analysis completes successfully within the active observation window.

Leading Indicator Conditions

A Leading Indicator is generated when another organization queries an enrolled patient and all of the following hold:

• Your organization is subscribed to indicators, which is a subscription separate from Clinical Alerts.
• The query carries the treatment exchange purpose, declared as either TREATMENT or T-TRTMNT. Both satisfy the condition.
• The querying organization is identified and isn't your own organization, so a query your own organization initiates produces no indicator.
• The query arrives on a network your organization is licensed for.
• The patient is matched to your enrolled population.

A query submitted for payment, health care operations, or any other exchange purpose produces no alert of either type, and neither does a query that declares no purpose at all. Synthetic queries produce no indicator, so traffic you generate for testing doesn't appear.

Document-Related Suppression

Alerts are not generated when:

• Documents lack encounter-level elements required for inference.
• Documents contain only administrative, financial, scheduling, or eligibility content.
• References within the document are invalid or unresolvable.
• Some unstructured or incomplete documents do not contain sufficient information to support encounter inference.

Query-Related Suppression

Some queries never reach the document stage at all. Clinical Alerts responds only to a query that another organization submits with the treatment exchange purpose, meaning the reason that organization gives for requesting the record. Both treatment codes qualify: TREATMENT, used on Carequality, CommonWell, and eHealth Exchange, and T-TRTMNT, used on the Health Gorilla QHIN path.

No alert is generated when:

• The querying organization submits its request for payment, health care operations, or any other exchange purpose.
• The querying organization declares no exchange purpose at all.

The declared purpose is set by the organization making the query rather than by your organization, and your configuration doesn't affect it. Health Gorilla doesn't notify you when a query is suppressed, so a fall in alert volume looks the same whether no organization queried your enrolled patients or several did and none qualified.

Enrollment Timing

Enrollment is evaluated prospectively. A patient must be enrolled at the moment activity is processed. Enrolling a patient after document retrieval and analysis have completed does not generate an alert for prior activity, and alerts are not re-emitted for previously processed activity.

Source and Network Considerations

Alert generation depends on actual document exchange between organizations on participating networks and reflects observed document availability rather than the occurrence of care itself.

Alert Processing and Delays

Alert generation and delivery are event-driven and asynchronous. Alerts are processed and delivered as soon as possible once a qualifying document is found, and timing depends on source-system processing, network transmission, and document analysis. Strict ordering between clinical events is not guaranteed.

Delays may occur due to:

• Source system timing in making documents available.
• Network transmission behavior.
• Document parsing and inference processing.

Limitations

Clinical Alerts provides situational awareness based on observed document exchange activity. It does not replace HL7 v2 ADT messages or guarantee detection of all patient encounters, and it should not be used as the sole source of truth for clinical activity.