By Christine Duval, Director of Marketing

With almost all US hospitals now dependent on an electronic health record (EHR) system, there has been a dramatic uptick in technological capabilities meant to improve interoperability and provide better patient care. On-demand access to view and share patient data from anywhere is becoming easier. The ability to exchange patient information securely between hospitals, HIE’s, and providers is rapidly increasing as well.

There are many reasons why it is important for a physician to have on-demand access to their patients’ full medical history, and perhaps even more importantly, to be notified of their patients’ critical health events when they happen. That’s why a hospital’s ability to proactively send electronic notifications to a provider when their patient presents at the hospital is vital. Were they rushed to the ER after having a heart attack? Did they just go through a major surgery? Whatever the case for hospitalization, the patient would require considerable follow-up instructions and additional care after their stay to avoid potential complications or preventable readmissions. That can’t happen unless the care team is made aware of the event in the first place.

Today’s realities:

  • Less than 60% of hospitals routinely notify a PCP when a patient presents at the ED1
  • 80% of all serious medical errors involve miscommunication between care transitions2
  • It is 10 times more likely for a patient to be readmitted due to lack of follow up3

Inefficient access to data throughout the care community puts patients and hospitals at risk.  The purpose of the new CMS Ruling is to support seamless and secure access, exchange, and use of electronic health information. More specifically, hospitals, including psychiatric hospitals and critical access hospitals, are now required to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer (ADT) to another healthcare facility, community provider or practitioner. The rule is meant to improve care coordination by empowering providers to proactively reach out to their patients after medical emergencies to ensure proper follow-up care.

A closer look at the new CMS Conditions of Participation (CoPs):

By May 1, 2021, all Medicare and Medicaid hospitals are required to send real-time electronic ADT alerts to the patient’s community provider or practitioner. Read the Fact Sheet.

What ADT Notifications are Required?

  • Inpatient
  • Emergency department
    • Presented
    • Discharged/admitted
  • Observation admission/registration
  • Transfer
    • From outpatient to inpatient
    • Unit Transfers are not required
  • Discharge

Notifications must be sent to providers for the purposes of:

  • Treatment
    • Primary Care Practices (PCP)
    • Accountable Care Organizations (ACO)
    • Federally Qualified Health Centers (FQHC)
    • Physician Organizations (PO)
    • Independent Physician Associations (IPA)
    • Multi-specialty Practices
  • Care coordination
    • Post-acute care service providers and suppliers:
      • Skilled Nursing Facilities
      • Home Health Agencies
      • Hospices
  • Quality improvement
    • Practitioners, identified by the patient as primarily responsible for his or her care

**FAILURE TO COMPLY RESULTS IN LOSS OF CERTIFICATION AND REIMBURSEMENTS.**

With a significant increase in ADT alerts, it’s also important to think about the impact this will have on the HIM staff in your organization. With each ADT alert that goes out, you will most likely see an increased number of phone calls from providers seeking the documentation and data associated with the patient’s episode of care (lab reports, history and physicals, radiology reports, discharge summaries, CCD documents, etc.). Depending on how your organization handles these requests, that could mean a significant strain on time and resources, not to mention potential security concerns associated with faxing high volumes of sensitive patient data.

Summit Healthcare has flexible and customizable solutions to help your organization achieve the initiatives outlined in the CMS Interoperability and Patient Access final rule. Whether you’re simply interested in setting up ADT notifications for your area providers to comply by the May 1, 2021 deadline, or you’re in search of a more robust patient data exchange platform for enhanced interoperability capabilities with your providers, including customizable alerting, user management, and enrollment – we can work with you to meet your exact needs. Contact us to learn more!