Notifications & Patient Engagement Use Cases¶

Implementation Note: All SMS notifications require DLT (Distributed Ledger Technology) template registration for TRAI compliance in India. WhatsApp notifications use WhatsApp Business API with approved message templates.

UC-NOTIF-001: Critical Alert Delivery (Multi-Channel)¶

Purpose: Deliver critical clinical alerts (abnormal labs, urgent findings) to physicians via multiple channels with escalation.

Property	Value
Actor	Notification Service
Trigger	Critical alert generated (Lab/Imaging/AI)
Priority	P0

Main Success Scenario:

1. Receive critical alert event from Alert Service
2. Determine recipient(s) based on:
   - Treating physician
   - On-call physician (if after hours)
   - Department escalation chain
3. Attempt delivery in priority order:
   - Push notification (mobile app)
   - WhatsApp Business API
   - SMS
   - Email
4. Track delivery status per channel
5. If no acknowledgment within 5 minutes:
   - Escalate to next physician in chain
   - Repeat delivery attempts
6. Log all delivery attempts and acknowledgments

Acceptance Criteria: 1. [ ] Delivery within 30 seconds of alert generation 2. [ ] At least 2 channels attempted before escalation 3. [ ] Acknowledgment tracking with timestamp 4. [ ] Escalation chain configurable per department 5. [ ] Audit log for all notifications

India-Specific: - SMS via DLT-registered templates (TRAI compliant) - WhatsApp Business API with healthcare-approved templates - Fallback to voice call for P0 alerts (optional)

UC-NOTIF-002: Patient Appointment Reminders¶

Purpose: Send automated appointment reminders to patients via their preferred communication channel.

Property	Value
Actor	Scheduler Service
Trigger	Scheduled job (T-24h, T-2h before appointment)
Priority	P1

Main Success Scenario:

1. Query upcoming appointments (next 24-48 hours)
2. For each appointment:
   - Fetch patient contact preferences
   - Load localized message template (English/Hindi)
   - Include: Date, Time, Doctor Name, Location, Instructions
3. Send via preferred channel:
   - WhatsApp (primary for India)
   - SMS (fallback)
   - Email (optional)
4. Include:
   - Confirm/Reschedule action buttons (WhatsApp)
   - Clinic contact number
   - Pre-visit instructions (fasting, documents)
5. Log delivery status
6. Process patient responses (confirmation/reschedule requests)

Acceptance Criteria: 1. [ ] T-24h and T-2h reminders configurable 2. [ ] Bilingual templates (English + Hindi) 3. [ ] Confirmation tracking and response handling 4. [ ] Reschedule requests routed to scheduling queue 5. [ ] No-show prediction integration (optional)

India-Specific: - WhatsApp preferred (80%+ smartphone penetration) - Regional language support (Hindi, Tamil, Telugu, etc.) - Include Google Maps link for location

UC-NOTIF-003: Lab Result Notifications¶

Purpose: Notify patients and physicians when lab results are available, with appropriate urgency handling.

Property	Value
Actor	Lab Integration Service
Trigger	Lab result ingested (ORU message processed)
Priority	P1

Main Success Scenario:

1. Receive lab result event
2. Classify result:
   - Normal: Patient notification only
   - Abnormal: Patient + Physician notification
   - Critical: Physician immediate + Patient after review
3. For patient notification:
   - Send summary (not detailed values for critical)
   - "Your lab results are ready. Please check your patient portal or contact your doctor."
   - Include secure portal link
4. For physician notification:
   - Include key abnormal values
   - Link to full patient record
5. Track patient acknowledgment (portal login)

Acceptance Criteria: 1. [ ] Critical results have physician notification delay (5 min) before patient 2. [ ] Patient notifications do not contain raw critical values 3. [ ] Secure deep link to patient portal with JWT 4. [ ] Delivery confirmation logging 5. [ ] Configurable result classification thresholds

India-Specific: - DPDP Act compliant: Minimal PHI in SMS/WhatsApp - Portal link for detailed results - Consent-based notification preferences

UC-NOTIF-004: Treatment Schedule Reminders¶

Purpose: Remind patients of upcoming treatment sessions (chemotherapy, dialysis, radiation) with pre-treatment instructions.

Property	Value
Actor	Treatment Scheduler
Trigger	Scheduled job (T-48h, T-24h, T-4h before treatment)
Priority	P1

Main Success Scenario:

1. Query upcoming treatment sessions
2. For each session:
   - Fetch treatment type and protocol
   - Load treatment-specific instructions:
     - Chemotherapy: Hydration, fasting requirements, medications
     - Dialysis: Dietary restrictions, access care
     - Radiation: Skin care, clothing guidance
3. Send tiered reminders:
   - T-48h: Confirmation request + detailed instructions
   - T-24h: Reminder with checklist
   - T-4h: Final reminder with arrival time
4. Include:
   - What to bring (documents, medications)
   - Expected duration
   - Emergency contact
5. Capture confirmation response

Acceptance Criteria: 1. [ ] Treatment-specific instruction templates 2. [ ] Multi-tier reminder schedule (configurable) 3. [ ] Pre-medication reminders (if applicable) 4. [ ] Caregiver CC for dependent patients 5. [ ] Integration with transport/ambulance booking (optional)

India-Specific: - Include ABHA ID reminder for government schemes - PM-JAY beneficiary: Bring Ayushman card - Regional language instructions

UC-NOTIF-005: Caregiver & Family Notifications¶

Purpose: Keep designated caregivers/family members informed about patient's care events with appropriate consent controls.

Property	Value
Actor	Caregiver Notification Service
Trigger	Configurable care events
Priority	P1

Main Success Scenario:

1. Validate patient consent for caregiver notifications
2. For each configured care event:
   - Appointment scheduled/completed
   - Lab results available
   - Treatment session completed
   - Discharge from facility
   - Medication refill due
3. Filter notification based on caregiver access level:
   - Full: All clinical details
   - Summary: Status updates only
   - Emergency: Critical alerts only
4. Send notification via caregiver's preferred channel
5. Log notification with consent reference

Acceptance Criteria: 1. [ ] Consent-gated: No notifications without active consent 2. [ ] Multiple caregiver support (up to 3) 3. [ ] Access level configuration per caregiver 4. [ ] Consent revocation immediately stops notifications 5. [ ] Audit trail linking notification to consent artifact

India-Specific: - Joint family structure: Support for multiple caregivers - Elderly patient focus: Adult children as primary caregivers - DPDP Act: Explicit consent documentation

UC-NOTIF-006: Medication Adherence Reminders¶

Purpose: Send timely medication reminders to improve patient adherence, especially for chronic conditions.

Property	Value
Actor	Medication Reminder Service
Trigger	Scheduled based on medication regimen
Priority	P2

Main Success Scenario:

1. Load active medication regimen for patient
2. For each medication:
   - Calculate next dose time based on frequency
   - Account for timezone and patient preferences
3. Send reminder at appropriate time:
   - 15 minutes before scheduled dose (configurable)
   - Include: Drug name, dosage, instructions
4. Capture acknowledgment ("Taken" / "Skipped" / "Snooze")
5. Track adherence metrics:
   - Doses taken vs. scheduled
   - Common skip times
6. Alert physician if adherence drops below threshold

Acceptance Criteria: 1. [ ] Supports complex regimens (BID, TID, with meals) 2. [ ] Snooze functionality (15 min, 30 min, 1 hour) 3. [ ] Adherence dashboard for physicians 4. [ ] Caregiver copy for dependent patients 5. [ ] Refill reminder integration

India-Specific: - Generic drug names preferred (cost considerations) - Hindi/regional language drug instructions - Integration with Jan Aushadhi scheme reminders

UC-NOTIF-007: Discharge Follow-Up Notifications¶

Purpose: Send post-discharge follow-up reminders and check-ins to ensure continuity of care.

Property	Value
Actor	Care Coordination Service
Trigger	Discharge event + scheduled follow-up
Priority	P1

Main Success Scenario:

1. On patient discharge:
   - Extract follow-up appointments from discharge summary
   - Identify medication reconciliation needs
   - Note red flag symptoms to monitor
2. Schedule notification sequence:
   - T+24h: "How are you feeling?" check-in
   - T+48h: Medication adherence check
   - T-24h: Follow-up appointment reminder
3. Include:
   - Emergency symptoms to watch for
   - When to seek immediate care
   - Clinic contact for questions
4. Capture patient responses
5. Route concerns to care coordinator

Acceptance Criteria: 1. [ ] Automated extraction from discharge summary (NLP) 2. [ ] Symptom check-in with simple response options 3. [ ] Escalation path for concerning responses 4. [ ] Follow-up appointment confirmation 5. [ ] Readmission risk scoring integration (optional)

India-Specific: - Homecare instructions in regional languages - Include nearest PHC/CHC contact for emergencies - TPA claim submission reminders

Notification Channel Configuration¶

Channel Priority Matrix¶

Alert Type	Push	WhatsApp	SMS	Email	Voice
Critical Clinical	1	2	3	4	5 (escalation)
Appointment Reminder	2	1	3	4	—
Lab Results	2	1	3	4	—
Treatment Reminder	2	1	3	4	—
Medication Reminder	1	2	3	—	—
Caregiver Update	2	1	3	4	—

India Regulatory Compliance¶

Requirement	Implementation
TRAI DLT	All SMS templates registered with telecom DLT platform
DPDP Act	Minimal PHI in messages; links to secure portal
Consent	Opt-in required; easy opt-out via SMS keyword
Do Not Disturb	Respect DND preferences; critical alerts exempt
Regional Languages	Hindi, Tamil, Telugu, Bengali, Marathi templates

Integration Architecture¶

flowchart TB
    subgraph "Event Sources"
        A["Alert Service"]
        B["Scheduler"]
        C["Lab Integration"]
        D["Treatment Service"]
    end

    subgraph "Notification Engine"
        E["Event Router"]
        F["Template Engine"]
        G["Channel Selector"]
        H["Delivery Tracker"]
    end

    subgraph "Channels"
        I["Push (FCM/APNS)"]
        J["WhatsApp Business API"]
        K["SMS Gateway (DLT)"]
        L["Email (SES/SMTP)"]
        M["Voice (IVR)"]
    end

    A --> E
    B --> E
    C --> E
    D --> E
    E --> F
    F --> G
    G --> I
    G --> J
    G --> K
    G --> L
    G --> M
    I --> H
    J --> H
    K --> H
    L --> H
    M --> H

Document Owner: Integration Lead / Product Manager
Last Updated: 2024-12-09
Related: Alerts | Consent | APIs