Systems and methods can support managing clinical alerts presented to clinical care users. An integration management system can maintain models of clinical alert events in the context of user behaviors and in the context of patients. Alarm indications associated with the patient may be received along with context information associated with the patient. Patient information may be received from an electronic medical record system. Integrated decision processing can integrate two or more of the alarm indication, the models of clinical alert events, the patient context, and the information from the electronic medical record system. The integrated decision processing can determine if a clinical alert is to be generated, what type, and to whom. The clinical alert can be transmitted to a target user. A response can be received and interpreted. Information associated with the patient may be updated into the electronic medical record system.