Hermansky-Pudlak Syndrome (HPS) care technology platforms are the digital infrastructure underpinning modern management of Hermansky-Pudlak Syndrome — a rare autosomal recessive multisystem disorder caused by defects in lysosome-related organelle (LRO) biogenesis, characterized by oculocutaneous albinism (OCA) arising from melanin-deficient melanosomes in melanocytes, a bleeding diathesis caused by absent platelet dense granules (delta-granules) that fail to secrete ADP, ATP, serotonin, and calcium upon platelet activation, and in specific subtypes — HPS-1 (caused by mutations in HPS1 encoding a component of BLOC-3, the biogenesis of lysosome-related organelles complex-3) and HPS-4 (caused by mutations in HPS4 encoding the second BLOC-3 component) — a progressive, life-threatening pulmonary fibrosis that is the most common cause of HPS-related mortality in adults; HPS-2 (caused by mutations in AP3B1 encoding the β3A subunit of the AP-3 adaptor protein complex required for trafficking of CD63, CD107a, and other proteins to lysosomes and LROs) produces a combined immunodeficiency affecting natural killer cell cytotoxic granule biogenesis in addition to platelet dense granule and melanosome defects; and additional subtypes HPS-3, HPS-5, HPS-6, HPS-7, HPS-8, HPS-9, HPS-10, and HPS-11 affecting different BLOC complex subunits with variable severity profiles — integrating pulmonary function surveillance platforms, bleeding management coordination systems, vision care monitoring dashboards, immunodeficiency management platforms (for HPS-2), clinical colitis surveillance tools (particularly for HPS-1 and HPS-6), pirfenidone and nintedanib anti-fibrotic therapy management platforms, lung transplantation eligibility coordination systems, and ophthalmology care coordination tools that enable pulmonologists, hematologists, ophthalmologists, gastroenterologists, and immunologists to detect pulmonary fibrosis progression requiring anti-fibrotic therapy initiation or lung transplantation evaluation, bleeding events requiring desmopressin or platelet transfusion management, colitis exacerbations, vision impairment progression requiring low vision rehabilitation, and NK cell deficiency complications in HPS-2 before they produce preventable life-threatening pulmonary deterioration, hemorrhage, or infection. When an HPS care platform is unavailable or degraded, pulmonologists cannot access the pulmonary function trajectory data, HRCT fibrosis extent assessments, 6-minute walk distance trends, anti-fibrotic therapy adherence records, oxygen supplementation titration schedules, pre-transplant evaluation progress, bleeding event history, platelet count trends, ophthalmology assessment schedules, and gastroenterology colitis disease activity scores that guide treatment decisions across the complex multisystem involvement of HPS care — and the longitudinal clinical monitoring that distinguishes stable HPS pulmonary fibrosis from accelerating pulmonary deterioration requiring anti-fibrotic therapy initiation or urgent lung transplantation listing collapses. HPS pulmonary fibrosis — histologically indistinguishable from idiopathic pulmonary fibrosis (UIP pattern on HRCT and surgical lung biopsy) in HPS-1 and HPS-4, caused by defective BLOC-3 complex function impairing lysosomal biogenesis in type II alveolar epithelial cells and alveolar macrophages, leading to abnormal surfactant processing, lamellar body dysfunction, alveolar epithelial cell apoptosis, fibroblast activation, and progressive interstitial fibrosis — typically presents in the third to fifth decade of life in HPS-1 with accelerating decline often requiring lung transplantation by the fifth or sixth decade; the pulmonary fibrosis of HPS-1 is typically more rapidly progressive than sporadic IPF, responds to pirfenidone anti-fibrotic therapy with slowing of FVC decline, and benefits from early lung transplantation listing before pulmonary function deteriorates to the point where perioperative mortality risk is prohibitive. The platforms that track pulmonary function trajectories, anti-fibrotic therapy adherence, oxygen supplementation requirements, bleeding events, ophthalmological assessments, and colitis disease activity must remain continuously available — because missed pulmonary function deterioration alerts, delayed anti-fibrotic therapy initiation, lung transplantation listing delays, bleeding event management failures, and ophthalmology vision surveillance lapses lead to preventable accelerating pulmonary fibrosis, hemorrhagic complications, progressive visual impairment, and the life-threatening complications that define preventable mortality and morbidity in inadequately monitored HPS patients.
This guide covers what Hermansky-Pudlak Syndrome care technology platforms need to monitor, why continuous availability matters across the spectrum of HPS multisystem complications — pulmonary fibrosis, bleeding diathesis, oculocutaneous albinism, colitis, and NK cell deficiency in HPS-2 — and how to build a monitoring strategy that protects pulmonary function surveillance, anti-fibrotic therapy management, bleeding management, ophthalmology care coordination, and the subtype-specific clinical risk management workflows that HPS care requires.
Why HPS Care Tech Platforms Cannot Afford Downtime
HPS management requires subtype-specific, multisystem monitoring: HPS-1 and HPS-4 — the subtypes with pulmonary fibrosis — require pulmonary function testing every 3-6 months with forced vital capacity (FVC) as the primary efficacy and deterioration endpoint, HRCT imaging every 12-24 months to quantify fibrosis extent and detect ground-glass opacification, 6-minute walk distance testing every 6 months as a functional status endpoint, initiation of pirfenidone or nintedanib anti-fibrotic therapy when pulmonary fibrosis is confirmed on HRCT and FVC begins to decline, continuous oxygen supplementation titration as fibrosis progresses, lung transplantation eligibility evaluation and listing at appropriate FVC thresholds (typically FVC <50% predicted or rapid decline), and concurrent management of the bleeding diathesis and colitis; HPS-2 requires concurrent management of the NK cell cytotoxic granule deficiency with immunological surveillance for hemophagocytic lymphohistiocytosis (HLH) triggers and treatment if HLH is diagnosed; all HPS subtypes require ophthalmology monitoring for visual acuity, nystagmus, and strabismus management with low vision rehabilitation, dermatology surveillance for UV-related skin cancer risk from OCA-associated absent photoprotective melanin, and hematology management of the platelet dense granule deficiency with desmopressin or platelet transfusion protocols for surgical procedures and bleeding events. The platforms that support HPS programs must remain continuously available — because an HPS-1 patient whose FVC trajectory monitoring lapsed during a platform failure may have crossed the anti-fibrotic therapy initiation threshold undetected, or whose lung transplantation listing evaluation was delayed by coordination platform failures, represents a preventable mortality risk from irreversible pulmonary fibrosis progression.
Pulmonary function surveillance is the primary mortality risk monitoring target for HPS-1 and HPS-4. HPS pulmonary fibrosis in HPS-1 is the leading cause of disease-related mortality; FVC decline is the primary clinical endpoint used in clinical trials of anti-fibrotic therapy in both HPS and idiopathic pulmonary fibrosis; an FVC decline of ≥10% within 12 months identifies patients with significantly accelerated mortality risk requiring urgent therapeutic escalation; DLCO decline, 6-minute walk distance deterioration, and resting or exertional oxygen desaturation are secondary endpoints detecting functional deterioration before FVC decline crosses threshold; HRCT progression with increasing honeycombing extent signals advanced UIP-pattern fibrosis; pirfenidone or nintedanib therapy initiation early in the fibrotic process — before FVC falls below 80% predicted — achieves the greatest preservation of lung function in available cohort data. Digital platforms that integrate serial PFT result feeds, FVC decline trajectory alerts, HRCT report integration, 6-minute walk distance trends, oxygen saturation tracking, and anti-fibrotic therapy adherence monitoring provide the pulmonary fibrosis surveillance infrastructure that drives the most impactful treatment decisions in HPS-1.
Lung transplantation coordination requires continuous platform availability. HPS-1 pulmonary fibrosis has a natural history trajectory that makes lung transplantation timing critical: early referral before FVC drops below 50% predicted provides the greatest transplantation benefit; UNOS/ILTS listing criteria require documentation of FVC decline trajectory, 6-minute walk distance, HRCT extent, and functional status; post-listing surveillance with serial PFTs, 6-minute walk tests, and functional status assessments determines listing priority updates; platform failures that prevent FVC trajectory documentation or lung transplantation center coordination delays can cause eligible patients to deteriorate beyond transplantation candidacy before listing is completed.
Bleeding management coordination requires real-time platform availability for surgical procedures. The platelet dense granule deficiency in HPS causes impaired secondary platelet activation with prolonged bleeding time and a moderate bleeding diathesis that is typically well-tolerated in daily life but creates significant hemorrhagic risk during surgical procedures, dental procedures, and obstetric deliveries; desmopressin (DDAVP) administered before procedures partially corrects the platelet activation defect; platelet transfusions are reserved for life-threatening hemorrhage or when desmopressin is insufficient; pre-procedure desmopressin protocol documentation, surgical bleeding risk stratification, cross-match and platelet availability pre-authorization, and procedure-specific bleeding management protocol access must be available when patients are scheduled for any invasive procedure.
What to Monitor on an HPS Care Tech Platform
Pulmonary Function Surveillance and Anti-Fibrotic Therapy Management Platform
The pulmonary function surveillance and anti-fibrotic therapy coordination service — integrating serial PFT result feeds with FVC, DLCO, TLC, and RV tracking, FVC decline threshold alert generation (≥5% decline requiring immediate clinical review, ≥10% decline requiring urgent therapeutic escalation), HRCT imaging schedule management with quantitative fibrosis extent result integration, 6-minute walk distance test scheduling with deterioration trend analysis, resting and exertional oxygen saturation monitoring with supplemental oxygen requirement trend tracking, pirfenidone or nintedanib anti-fibrotic therapy prescription adherence monitoring with trough level tracking where available, anti-fibrotic therapy adverse effect monitoring (GI intolerance for pirfenidone, hepatotoxicity monitoring with LFT surveillance, photosensitivity management), acute exacerbation of HPS pulmonary fibrosis alert generation requiring immediate hospitalization, and pulmonary rehabilitation program scheduling — is the highest-priority monitoring target for HPS-1 and HPS-4 patients. Check at a 1-minute interval with immediate escalation. FVC decline alerts are the primary mortality risk signal in HPS-1; anti-fibrotic therapy adherence monitoring prevents the lapses that accelerate fibrosis; acute exacerbation alerts require immediate hospitalization for high-dose corticosteroid therapy; platform failures that prevent PFT result integration or FVC decline alert generation delay the therapeutic decisions that slow HPS pulmonary fibrosis progression.
Lung Transplantation Eligibility and Coordination Platform
Monitor the lung transplantation eligibility and coordination service — including HPS-1/HPS-4 pulmonary fibrosis severity scoring with UNOS/ILTS listing criteria assessment, FVC threshold monitoring for transplantation referral criteria (typically FVC <50% predicted or rapid decline documentation), transplantation center referral and pre-evaluation scheduling, pre-transplant evaluation completion tracking (right heart catheterization, echocardiography, 6-minute walk test, nutritional assessment, psychosocial evaluation, dental evaluation), UNOS listing submission and priority score documentation, post-listing FVC and functional status surveillance with listing priority update scheduling, transplant coordinator communication platform, and post-transplantation surveillance program coordination — at a 1-minute interval. HPS pulmonary fibrosis has a predictable trajectory that makes transplantation referral timing critical for survival; early referral and listing before irreversible functional deterioration gives the greatest benefit; documentation platform failures that prevent FVC trajectory capture or transplantation evaluation scheduling cause preventable mortality from fibrosis progression beyond transplantation candidacy.
Bleeding Management and Hematology Coordination Platform
Monitor the bleeding management and hematology coordination service — including platelet count monitoring with dense granule deficiency documentation, pre-procedural bleeding risk stratification scheduling, DDAVP protocol authorization tracking for planned procedures, platelet transfusion ordering and availability tracking for high-risk procedures, bleeding time and platelet function analyzer result feeds with documentation, surgical and dental procedure pre-authorization with bleeding management protocol distribution, obstetric delivery bleeding management coordination for HPS patients, post-procedural hemorrhage monitoring tracking, desmopressin response assessment documentation, and HPS bleeding severity scoring for escalation candidacy — at a 1-minute interval. HPS platelet dense granule deficiency creates substantial hemorrhagic risk during invasive procedures that is preventable with pre-procedural DDAVP and blood product preparation; platform failures that prevent pre-procedural DDAVP authorization or platelet availability confirmation create avoidable perioperative hemorrhage risk.
Ophthalmology Surveillance and Low Vision Rehabilitation Platform
Monitor the ophthalmology care coordination service — including serial visual acuity assessment scheduling, nystagmus evaluation and treatment coordination, strabismus assessment and surgical correction scheduling, refraction and corrective lens prescription management, low vision rehabilitation program enrollment and appointment adherence, UV-blocking lens and sun protection protocol education compliance monitoring, skin cancer UV-surveillance dermatology scheduling for OCA patients, macular hypoplasia assessment scheduling, OCT and fundus photography result tracking, and visual aid device and assistive technology provision coordination — at a 2-minute interval. HPS oculocutaneous albinism causes visual impairment from foveal hypoplasia, nystagmus, and photophobia that requires systematic ophthalmological monitoring and low vision rehabilitation; the absence of photoprotective melanin creates significant UV-related skin cancer risk requiring dermatological surveillance; platform failures that prevent ophthalmology appointment scheduling or dermatology UV-surveillance tracking allow preventable vision loss progression and undetected skin cancer.
HPS-2 NK Cell Deficiency and HLH Surveillance Platform
Monitor the HPS-2 NK cell deficiency and hemophagocytic lymphohistiocytosis surveillance service — including NK cell number and cytotoxic function monitoring (NK cell degranulation assay scheduling, perforin expression tracking), fever and hepatosplenomegaly threshold alert generation for HLH early warning, serum ferritin level monitoring with HLH threshold alerts, CBC with differential for cytopenias surveillance, triglyceride level monitoring with HLH threshold alert generation, fibrinogen level monitoring for HLH coagulopathy detection, HLH-2004 diagnostic criteria scoring at symptom onset, HLH treatment protocol coordination (etoposide-dexamethasone, cyclosporin A), and HLH trigger identification with infection viral panel scheduling (EBV, CMV, influenza triggers) — at a 1-minute interval. HPS-2 uniquely produces an NK cell cytotoxic deficiency from defective CTLA4 and perforin vesicle biogenesis in NK cells; HLH can be triggered by viral infections in HPS-2 and requires rapid diagnosis and immunosuppressive treatment; ferritin threshold alerts and NK cell function monitoring provide HLH early warning; platform failures that prevent HLH diagnostic criteria scoring or treatment protocol access can delay life-saving HLH therapy.
Colitis and GI Disease Surveillance Platform
Monitor the gastrointestinal disease surveillance service — including inflammatory bowel disease activity scoring for HPS-associated granulomatous colitis (particularly in HPS-1 and HPS-6), colonoscopy and biopsy scheduling with granulomatous colitis histology result tracking, anti-inflammatory therapy (5-ASA, corticosteroids, biologics) prescription adherence monitoring, colitis flare threshold alert generation, nutritional status monitoring for malabsorption assessment, and GI bleeding event tracking with hemorrhagic risk stratification in the context of concurrent platelet dense granule deficiency — at a 2-minute interval. HPS-associated colitis (particularly in HPS-1 and HPS-6) is a granulomatous inflammatory bowel disease that can cause significant morbidity; monitoring colitis disease activity alongside bleeding risk from the platelet deficiency requires integrated platform surveillance; GI bleeding in HPS colitis carries elevated hemorrhagic risk because the platelet dense granule deficiency impairs hemostasis at mucosal bleeding sites.
Telemedicine and HPS Coordinator Platform
Monitor the telemedicine session API, HPS program nurse coordinator messaging, pulmonology consultation scheduling, hematology consultation coordination, ophthalmology coordination, gastroenterology consultation scheduling, and lung transplantation center coordination communication at a 2-minute interval. HPS management requires continuous coordination across pulmonology, hematology, ophthalmology, gastroenterology, dermatology, immunology (for HPS-2), and transplant surgery; platform failures interrupt the multidisciplinary consultation that manages the overlapping pulmonary fibrosis surveillance, bleeding management, ophthalmology care, colitis management, and HPS-2 NK cell deficiency domains.
EHR Integration Endpoint
Monitor the EHR synchronization service at a 5-minute interval. HPS patients presenting for any invasive procedure require rapid provider access to their platelet dense granule deficiency documentation, DDAVP protocol, current pulmonary fibrosis FVC and oxygen status, anti-fibrotic therapy regimen, HPS subtype classification, and bleeding management history.
Authentication Service
Monitor authentication at a 1-minute interval. Auth failures lock pulmonologists, hematologists, and HPS care coordinators out of pulmonary function surveillance platforms, lung transplantation coordination systems, bleeding management tools, and ophthalmology care coordination simultaneously — disabling the entire HPS multisystem digital management infrastructure.
SSL Certificates Across All Platform Domains
Monitor certificate expiry 30 days in advance across all patient-facing, clinician-facing, and integration domains.
Alerting Strategy for HPS Care Tech Platforms
Immediate clinical escalation (24/7): Pulmonary function surveillance and anti-fibrotic therapy management, lung transplantation eligibility and coordination, bleeding management and hematology coordination, HPS-2 NK cell deficiency and HLH surveillance, authentication service. These affect real-time pulmonary fibrosis deterioration detection, transplantation eligibility monitoring, perioperative hemorrhage prevention, and HLH early warning that cannot tolerate delayed detection.
Immediate clinical operations escalation: Ophthalmology surveillance and low vision rehabilitation, colitis and GI disease surveillance. Failures here affect vision impairment surveillance and GI hemorrhage risk management in the context of concurrent platelet deficiency.
High-priority immediate escalation: Telemedicine and HPS coordinator platform. Access failures interrupt the multidisciplinary consultation that manages HPS's overlapping pulmonary fibrosis, bleeding diathesis, ophthalmology, colitis, and NK cell deficiency domains.
Business-hours engineering escalation: EHR synchronization. Investigate within one business hour.
Advance warning: SSL certificate expiry, 30 days in advance, across all patient-facing and integration domains.
Pulmonary function surveillance requires 24/7 alerting because HPS pulmonary fibrosis acute exacerbations — episodes of accelerated decline requiring immediate hospitalization and high-dose corticosteroids — can develop rapidly at any time; FVC decline alerts and acute exacerbation alerts require immediate response regardless of time of day because the window for therapeutic intervention in acute exacerbations is narrow.
Status Page as a Clinical Safety Signal
HPS program nurses and on-call pulmonologists managing after-hours contacts from HPS families reporting acute respiratory deterioration, new hemoptysis, severe bleeding after procedures, or adnexal symptoms of GI hemorrhage need immediate platform status awareness before initiating escalation protocols. A published status page allows on-call coordinators to distinguish a platform incident from patient connectivity problems — and to initiate phone-based triage, emergency hospitalization authorization, DDAVP protocol activation, and bleeding management escalation immediately when the digital platform is confirmed unavailable.
For HPS programs coordinating pulmonary function surveillance, lung transplantation eligibility tracking, bleeding management, ophthalmology care, colitis monitoring, and HPS-2 NK cell surveillance across geographically dispersed adult and pediatric patients — a status page enables rapid identification of platform failures and activation of manual emergency protocols. Publish the status page URL in care coordinator workstations, on-call pulmonology and hematology systems, and family caregiver emergency protocol documents.
The Business Case: Fibrosis Prevention, Transplant Optimization, and HPS Program Quality
HPS specialty programs face significant cost exposure from preventable pulmonary fibrosis acceleration in patients whose FVC trajectory monitoring lapsed during platform failures delaying anti-fibrotic therapy initiation, lung transplantation listing delays in HPS-1 patients who deteriorated beyond candidacy because evaluation coordination platforms were unavailable, perioperative hemorrhage from bleeding management protocol access failures during scheduled procedures, HLH treatment delays in HPS-2 patients whose HLH threshold alerts were not generated during platform outages, and colitis-related GI hemorrhage from unmonitored disease activity escalation in patients with concurrent platelet dense granule deficiency. Platform reliability that supports continuous pulmonary function surveillance, anti-fibrotic therapy management, lung transplantation coordination, bleeding management, and HLH surveillance is upstream of the most preventable and costly outcomes in HPS.
HPS program quality metrics increasingly include time-to-anti-fibrotic-therapy from FVC decline threshold crossing, lung transplantation evaluation completion time from referral, pre-procedural DDAVP protocol adherence rates, HLH diagnosis time from ferritin threshold alert, and colitis flare detection lead time from disease activity monitoring. Platform reliability directly determines whether these quality metrics are achievable or whether surveillance gaps allow the outcomes they measure to occur.
External monitoring from Vigilmon provides the documented, independent availability record that HPS program directors can present to hospital administration and payer medical directors as evidence that the program's digital infrastructure supports the level of continuous pulmonary fibrosis surveillance, lung transplantation coordination, bleeding management, and HLH surveillance that Hermansky-Pudlak Syndrome care requires.
Vigilmon Setup for HPS Care Tech Platforms
A practical starting configuration:
| Monitor | Check Interval | Alert Channel | |---------|----------------|---------------| | Pulmonary function surveillance and anti-fibrotic therapy | 1 min | PagerDuty (immediate, 24/7) | | Lung transplantation eligibility and coordination | 1 min | PagerDuty (immediate, 24/7) | | Bleeding management and hematology coordination | 1 min | PagerDuty (immediate, 24/7) | | HPS-2 NK cell deficiency and HLH surveillance | 1 min | PagerDuty (immediate, 24/7) | | Auth service | 1 min | PagerDuty (immediate) | | Ophthalmology surveillance and low vision rehabilitation | 2 min | PagerDuty (immediate) | | Colitis and GI disease surveillance | 2 min | PagerDuty + Slack (immediate) | | Telemedicine and HPS coordinator | 2 min | PagerDuty + Slack (immediate) | | EHR synchronization endpoint | 5 min | Slack (business hours) | | SSL: all platform domains | Daily | Email (30-day warning) |
Getting started:
- Create a free account at vigilmon.online
- Add the pulmonary function surveillance and anti-fibrotic therapy management platform at a 1-minute interval with 24/7 PagerDuty alerting
- Add lung transplantation eligibility and coordination at a 1-minute interval with immediate 24/7 escalation
- Add bleeding management and hematology coordination at a 1-minute interval with immediate alerting
- Add HPS-2 NK cell deficiency and HLH surveillance at a 1-minute interval with immediate alerting
- Add ophthalmology surveillance and low vision rehabilitation at a 2-minute interval with immediate alerting
- Add colitis and GI disease surveillance with immediate alerting
- Add telemedicine and coordinator platform monitoring with immediate alerting
- Add authentication and EHR synchronization
- Enable SSL monitoring across all patient-facing and integration domains
- Publish the automatic status page URL in care coordinator workstations, on-call pulmonology and hematology systems, and family caregiver emergency protocol documents
Conclusion
HPS care tech platforms hold the clinical surveillance infrastructure that makes Hermansky-Pudlak Syndrome survivable across its complex multisystem involvement — pulmonary function tracking platforms, lung transplantation coordination systems, anti-fibrotic therapy management dashboards, bleeding management tools, ophthalmology care coordination platforms, HLH surveillance systems, and colitis disease activity monitoring dashboards that cannot undo the preventable pulmonary fibrosis acceleration, fatal transplantation listing delays, perioperative hemorrhages, HLH treatment delays, and progressive visual impairment accumulated during periods of unmonitored FVC decline, absent bleeding management protocol access, and inaccessible transplantation coordination. Their availability is a prerequisite for pulmonary fibrosis deterioration detection, anti-fibrotic therapy initiation, lung transplantation eligibility documentation, perioperative hemorrhage prevention, HLH early warning, ophthalmology care coordination, and the specialist access that patients with HPS depend on across a lifelong multisystem illness that — while presenting in childhood with OCA and bleeding diathesis — culminates in most HPS-1 patients in progressive pulmonary fibrosis requiring anti-fibrotic therapy and ultimately lung transplantation to prevent premature respiratory failure, and in HPS-2 patients in an overlapping NK cell cytotoxic deficiency that creates HLH vulnerability on top of the pulmonary and bleeding manifestations. When pulmonary function monitoring platforms go offline, lung transplantation coordination systems fail, or bleeding management protocol platforms are unavailable, the clinical consequences extend to a disease where the difference between adequate and inadequate monitoring is measured in the FVC percentage points lost before anti-fibrotic therapy was initiated, the months of transplantation eligibility window closed while coordination platforms were unavailable, and the perioperative hemorrhages that occurred because DDAVP protocol platforms were unreachable when procedures were scheduled.
External monitoring from Vigilmon provides the independent, outside-in availability view that HPS program directors and health system IT teams need to catch failures before they affect pulmonary function surveillance or lung transplantation coordination — with the documented incident record that accreditation bodies and payer audit teams accept as evidence of operational maturity.
Start monitoring your HPS care tech platform for free at vigilmon.online — HTTP/HTTPS monitoring, multi-region consensus alerting, SSL certificate monitoring, automatic status page, Slack and PagerDuty integration. No agent required. No credit card.
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