What It Means to Go Beyond ADT Notification Requirement: Part II

A new condition of participation for all hospitals to send the admission, discharge, and transfer (ADT) event notifications to all providers primarily responsible for a patient's care is intended to improve care coordination and lead to timely and appropriate follow-up.

Through the Interoperability and Patient Access final rule, the Centers for Medicare & Medicaid Services aims to rectify limitations in health data exchange. A new condition of participation for all hospitals to send the admission, discharge, and transfer (ADT) event notifications to all providers primarily responsible for a patient's care is intended to improve care coordination and lead to timely and appropriate follow-up.

In this follow-up to our breakdown of the ADT CoP requirement, we delve deeper into how hospitals can ensure that critical patient health information is made available to the right provider at the right time.

The True Intent of the Rule

A growing body of evidence demonstrates that a lack of effective communication between hospitals and other providers is detrimental to patient care.

According to the Joint Commission, nearly 80 percent of serious medical errors involve miscommunication between caregivers during transitions of care. A University of Colorado Hospital study found that patients lacking timely follow-up by their primary care provider post-discharge were ten times more likely to be readmitted to a hospital. Yet a recent study by the Commonwealth Fund revealed that nearly two-thirds of primary care physicians are not routinely notified by specialists, after-hours care centers, emergency departments, or hospitals to help manage care for their patients.

By the letter of new ADT CoP, hospitals — including behavioral health and critical access hospitals — must demonstrate reasonable effort in sending in near real-time electronic ADT event notifications comprising, at minimum, the name of the patient, treating practitioner to a patient's primary care provider and other providers responsible for that patient's care following a transition to a post-acute care facility.

However, the spirit of the requirement very much envisions a healthcare environment where both sending and receiving entities are using ADT data to make a meaningful impact on a patient's health across the continuum of care. And for good reason.

For providers and patients to truly benefit from ADT event notifications, hospitals must realize that organizations unable to receive electronic notifications are unlikely to be receiving the critical information necessary to enhance care coordination and ensure continuity of care. Without the receiving provider involved in the continuity of care, a greater number of readmissions will happen. So ultimately, the hospital will pay the penalty in the long run, which is a good incentive to work closely with the provider community to ensure they can receive electronic notifications.

Post-acute care facilities are instrumental to a patient's journey home. Yet some post-acute care facilities — namely, skilled nursing facilities, assisted living communities, rehabilitation centers, and home health providers — have historically lagged behind their acute care counterparts in the adoption of health information technology. Therefore, those without the capability to receive electronic ADT event notifications will be at a serious disadvantage when trying to provide timely and appropriate care to patients. Referrals to these care settings may suffer as the hospital will prefer to send referral requests to those entities that can accept an electronic referral notice.

Going Above and Beyond Compliance

Hospitals are in the driving seat when it comes to ensuring continuity of care by closing care gaps due to the lack of available patient data.

As with federal health IT requirements in the past, hospital compliance can be achieved relatively simply. By using a widely adopted HL7 standard, the HL7 2.5.1 content exchange standard, hospitals can generate the ADT event notifications and check the box. But that approach is fraught with challenges when considered from the perspective of the recipient.

First, these messages are not easily formatted, which prevents the receiving provider from easily reading and understanding the contents. Second, it's not necessarily placed in a position that allows the provider easy access to that data in their current workflow. Meeting of the ADT condition of participation could require a provider to go to a web portal, log in, and then go look at these messages. Worse still, a provider could end up receiving raw data, further complicating the process of parsing important information.

Allowing ADT event notifications to lead to tangible improvements in care coordination and patient outcomes means going above and beyond. This approach is essential to provider satisfaction and high-quality care delivery, which directly impacts patient experience and health outcomes.

The first step? Meet providers in their existing workflows. Hospitals and providers responsible for a patient's care post-discharge need convenient access to patient health information. The two groups need to evaluate their ADT technology to ensure that caregivers receiving information are not forced to access yet another system or, worse, pick up the phone. Delivering information within care workflows and integrated into the EHR is the recipe for the most successful interactions between providers.

The second step calls for putting the data in a location and a format that is easy to understand and read. Giving providers a choice of alert formats (e.g., CDA/XML, PDF, text) and delivery methods (e.g., EHR, mobile, email) guarantees access to readable and actionable information. Hospitals should work with their post-acute care partners to understand their technical capabilities so that data is received and put into action.

For the ADT CoP to have a meaningful impact on patient care, hospitals must take the lead and make patient health information available where and when it's most needed.

*Editor's note: Portions of this article have been updated to conform with the CMS compliance date.

See the other articles in this series on the ADT Notification Requirement:

• How Hospitals Comply with the ADT CoP Requirement: Part I
• Two Use Cases for Improving Outcomes with ADT Notifications: Part III