Feature Friday - Document Notifications

In our Feature Friday series this time we'll discuss how the Founda Health platform offers? publish/subscribe base functionality to allow 3rd party applications (and their users) to be notified when clinical information is made available of changes inside an health information exchange.

What are Document Notifications

As the transition from analogue to digital health information advanced, and the way clinical users access health information changed, an unintended side effect that emerged was the absence of a notification or trigger announcing that new information for a patient had become available.

Back in the "paper days" just the fact that a lab report landed on someone's desk, or a fax machine starting to make noise was a reminder/notification to start with some follow up activity. In an health information exchange network where all information is exchanged digitally such "process triggers" were lacking resulting in information being available, but not noticed.?

Within IHE the Document Metadata Subscription (DSUB) profile came about, defining a framework for applications to subscribe to being notified when certain changes happen inside an IHE XDS-based health information exchange.

The DSUB profile is based on the well-known publish/subscribe pattern. It introduces the key actors playing a role in managing subscriptions (DSUB Broker and Subscriber), creating trigger events (DSUB Publisher), and receiving notifications (DSUB Recipient).?

Upon a change in a document's metadata in a XDS registry these updates are sent to a broker. The broker evaluates a list of pre-created subscriptions to determine which recipients should be notified of the change.?

The Founda Health Platform supports all four actors from the DSUB profile.

How does it work

Through its DSUB support the Founda Health platform can operate in different ways. In its basic form it acts as a DSUB Publisher sending out event notifications to an external DSUB broker that takes care of the rest of the notification workflow.

Turning on these event notifications is done by enabling notifications in the registry component.??

<notification enabled="true" url="[a url pointing to a notification broker]" />        

The Founda Health platform also comes with its own embedded notification broker. This broker allows any 3rd party notification recipient to subscribe itself to being notified when document metadata changes happen.

The notification broker functionality is controlled by the following configuration that defines the maximum subscription time a notification subscription stays active. It is activated by the configuration snippet above when the url attribute is pointing to the embedded notification broker.

 <notificationBroker maximumSubscriptionDuration="1d" />        

The design thought behind subscriptions is that there are many that are dynamic and short-lived. Hence, although it is possible to set the subscription duration to a very long time, it is advised to keep it short.?

As an example, think of a 3rd party application acting as a Document Consumer actor connected to an IHE XDS-based health information exchange. When a user of such an application opens a patient record the application can automatically create a subscription with the Founda Health platform, allowing the application's user to be notified when new health information of that patient becomes available within the HIE, allowing that user to retrieve that information if so required. This example is also referred to as a "notified pull".?

It is also possible to turn the document notifications in different event methods such as an email altering a user, or a HL7 message pushed to a system. More about that in a future article.

Summary

Clinical processes can be triggered through information that is made available through a health information exchange network. The electronic notifications of so-called trigger events can be managed through a publish/subscribe method supported by the Founda Health platform. It enables (3rd party) applications to automatically create subscriptions to be notified when clinical information becomes available or is modified. The Founda Health platform supports the publish/subscribe functionality through its support for the IHE DSUB profile.

If you like to know more about Founda Health solutions for Health Information Exchange in general, or Image Exchange in particular please check out our website or contact us for more information.