CMS Interoperability Rule Compliance, ADT Messaging Hinge on HIEs

Connecting to a health information exchange (HIE) may be the best way for provider organizations to comply with new CMS interoperability regulations that require hospitals to send patient event notifications through the admission, discharge, and transfer (ADT) messaging standard, according to Paul Wilder, executive director of CommonWell Health Alliance.

The CMS Interoperability and Patient Access final rule requires provider organizations to demonstrate that their EHR system can send patient event notifications to all applicable post-acute care providers through the ADT messaging standard. This includes primary care practitioners and groups, and other practitioners and groups identified by the patient as primarily responsible for her care.

In an interview with EHRIntelligence, Wilder explained that event notifications encourage provider-to-provider communication for enhanced care coordination. He also noted that event notifications can help bend the quality cost curve.

If a PCP is notified that one of her patients was admitted to the ED for a heart attack, she can contact the ED with information that can drive clinical decision support. For instance, the PCP could tell the ED that she had prescribed the patient heart medication, so medication non-adherence could be the root cause of the heart attack. 

This input from a patient’s PCP could save the hospital from expensive testing and lab work.

Wilder emphasized that in recent years, CommonWell and other regional, local, and state HIEs around the country have worked to boost interoperability for patient data sharing. This new CMS regulation is a push towards national interoperability.

“The regulation is putting a stamp on these efforts from a federal level saying, ‘I know many of you have worked on this on the local level and that's great. It's time to finish the job. This should be a coordinated effort. Everybody should be connected if possible, and it's mandated that you try your best to do that,’” he said.

However, Wilder explained that compliance with the ADT messaging standard may come with challenges, as contact information for post-acute care providers is not common within EHR systems.

Additionally, while the final rule outlines expected ADT message transfer specifications, it doesn't clearly describe how care organizations are going to connect to send and receive the messages.

“Providers might have an entry somewhere of the patient’s primary care provider, but they’re actually not sure exactly how to get the message to them, or if the PCP wants it,” he told EHRIntelligence in an interview.

Wilder explained that intermediary connections to frameworks like CommonWell and regional HIEs often support ADT notifications, but a lot of networks are designed for pulling data first and later move toward pushing data. In fact, CommonWell originally only had data pulling capabilities, he added.

Now, CommonWell can send ADTs from any facility to every other facility that has that patient in its database. Wilder noted that this capability is relatively new. He estimated that two to three dozen facilities out of 24,000 have signed onto ADT messaging through the health alliance, highlighting the beginning of an adoption curve.

Care organizations that are not connected to intermediary connections need to set up the push notification functionality for EHR data exchange on an individual basis, which is a transformational effort, he added.

“ADT alerts require pushing data which is different than pulling data,” Wilder explained. “When I'm looking for data, I actually don't need to know the other parties at all. When I'm pushing something, I need to know exactly where to send it. The need for directories is clear as we move to the push side of interoperability.”

Once ADT notification use is widespread, it’s important that health IT systems help filter and triage the data for actionable use, Wilder explained.

This would eliminate the delivery of certain ADT messages that are not pertinent to a patient’s overall care journey.

For instance, all post-acute care providers should be aware if a patient has a heart attack, as it is a significant care event. However, breaking an arm is not something a patient’s PCP needs to know about, as it is not going to affect the patient’s long-term health.

These automated triage processes will aid in mitigating alert fatigue by only sending along actionable patient health data to post-acute care providers.

Wilder added that CommonWell has recently been working on improving data quality for these automation processes.

“We have to look at the data we're sharing with each other and make sure it's complete and accurate, so that the systems that receive that data can work with it automatically,” he said.

The health alliance is also expanding its offerings into new use cases such as streamlining patient access to health information to eliminate clinician burden and improve the patient experience.

“Interoperability efforts, while great for clinical care, can lead to administrative burden,” Wilder explained. “A lot of the use cases we're working on now are focused on that.”

CommonWell’s network has grown rapidly in recent months. In a draft comment to the ONC Wilder wrote six months ago, Wilder noted that CommonWell had 93 million enrollees. That number has now reached 135 million, a nearly 40 percent jump.

“We're seeing tremendous growth even when we've gotten to this level,” he said. “There's still more room to grow.”