Monitoring and Operations

Ongoing monitoring helps ensure reliable alert delivery and appropriate downstream handling.

Clinical Alerts is event-driven and dependent on network document exchange activity. Alert volume and timing may vary based on enrollment scope, network behavior, document availability, and successful encounter inference.

Monitoring Delivery

Your organization should monitor delivery behavior based on the configured method.

For FHIR Subscription delivery:

Log inbound HTTP requests and response status codes.
Confirm that your system consistently returns 2xx acknowledgments.
Monitor for repeated retry attempts or delivery failures.

For SFTP delivery:

Monitor file arrival in the configured directory.
Validate file ingestion and downstream processing.
Confirm expected file naming and ingestion patterns.

Monitoring delivery confirms successful transmission. It does not confirm that alerts were eligible for generation or that qualifying document-driven activity occurred.

Alert Volume Expectations

Alert volume depends primarily on:

The number of enrolled patients.
The frequency of network queries for those patients.
Document availability across participating organizations.
Successful encounter inference.

Because Clinical Alerts is document-driven, alert volume may fluctuate over time. Increases or decreases in volume may reflect changes in enrollment, care activity, network participation, or document availability.

The absence of an alert does not necessarily indicate the absence of care. Alerts are generated only when qualifying document exchange activity is observed and processed successfully.

Deduplication and Idempotency

Delivery retries may result in repeated notification attempts. Your system should implement idempotent processing using stable identifiers such as:

Encounter identifier
Patient reference
Message control identifier (for HL7 v2)

Clinical Alerts does not guarantee strict ordering of notifications.

Timing Considerations

Alert generation and delivery are asynchronous.

Notification timing reflects document availability and processing completion. Alerts may be delivered hours or, in some cases, days after the underlying care event.

Ordering relative to other clinical events is not guaranteed.

Investigating Unexpected Behavior

If expected alerts are not received:

Confirm patient enrollment status.
Confirm delivery configuration and endpoint availability.
Confirm that qualifying document-driven activity occurred within an active observation window.

If unexpected alert volume or timing patterns occur, contact Health Gorilla for investigation.

Operational Considerations

Clinical Alerts provides situational awareness based on observed document exchange activity. It should not be used as the sole source of truth for care activity.

Alert-driven workflows should account for variability in timing, document availability, enrollment scope, and network participation.