Guest post from Larry Garber, MD, Medical Director for Informatics and Internist, Reliant Medical Group

ADT Notifications have changed the way I practice medicine.

That may sound like a strong statement, but it’s true – knowing that my patient has shown up in the ER, or has been admitted to, transferred, or discharged from (ADT) a hospital opens up whole possibilities of care coordination and follow up care that may have been missed without this timely information.

For over a decade, I’ve had the benefit of receiving these ADT notifications and the information that accompanies them.  Patients now expect that I am fully informed about their treatment at the ER or hospital, and not that they are responsible for filling me in on their care.  Over and over again, I see how these notifications allow coordinated follow up care to keep patients from going back to the hospital, or delivering the care or services patients need most in their time of need.

Now, with CMS mandates of these ADT Notifications on the horizon, I want to encourage other practices and providers to dive in, as I can no longer imagine patient care without this level of coordination — it’s truly what’s best for the patient.

Experiencing an ADT Notification

Before I share more how we got started on our ADT Notifications journey and lessons learned, I want you to imagine a scenario with me.

A patient shows up at the Emergency Room of the local hospital, where they complete intake information, including indicating their Primary Care Provider (PCP). While the patient is roomed, an Admission Notification triggers in the ER’s Electronic Health Record (EHR) and is automatically sent to the patient’s PCP. The PCP’s EHR receives the Admission Notification in real-time, and within seconds an ER Encounter is created in the patient’s chart, the PCP receives notice of the admission in their EHR in-basket, and the EHR generates and sends back to the ER’s EHR a clinical summary of the patient, including their diagnoses, medications, allergies, recent diagnostic test results, and other relevant information.  In less than the time it took for the patient to be roomed, this exchange occurred – but it’s not over yet.

Before the patient is seen, the ER care team, including the provider, are able to review the summary document about the patient in their EHR.  Meanwhile, the PCP reviews the in-basket notice, and decides to call the ER to provide other relevant information about this patient.  The PCP catches the ER provider before the patient is seen, and relays the supplemental information.  Now, as the ER provider enters the patient room, they aren’t starting from scratch – they have a breadth and depth of knowledge that will allow for the best care decisions and course of action to be made for that particular patient, in an expedited fashion.  The information provided in that exchange lays a foundation otherwise needed to be created anecdotally by the patient, and possibly by repeat testing.  Put simply, this ADT exchange avoids wasted time and resources, and allows the ER provider to get straight to providing informed care.

When the patient is discharged from the ER, the EHR triggers another message to the PCP automatically, this time a Discharge Notification. Because the message is about a Discharge, it’s routed to the PCP’s nurse.  The nurse receives the Discharge Notification in their EHR inbox, and notes the patient needs a follow up appointment and some additional services to keep the patient from returning to the ER.  The nurse helps schedule a follow up appointment.

The home health agency that has been caring for this patient was also automatically notified by the Admission Notification that their shared patient was in the ER, and from the Discharge Notification that they were sent home. They arrange to have a nurse visit the patient the next day to ensure they are doing well.

Sound incredible? This is my reality as an internist.  I believe in the power of ADT Notifications because I get to experience this informed care day in and day out, and I’d never go back.

How we got started with ADT Notifications

My organization, Reliant Medical Group, prides itself on maximizing the care of our patients, which we do through employing innovative, coordinated, and team-based approaches.  We know how important it is to see the whole person and the big picture while delivering care.  We were an early adopter of EHR technology, long before regulatory incentives.  Recognizing that if ER’s had the most up to date information about our patients, it could facilitate better care, we worked with local organizations to set up terminals in their facilities so ER providers could log into our system and see the patient’s record.  ERs are a fast-paced environment, and ultimately this solution didn’t work out because the information wasn’t in their own EHR and they didn’t want to login to a second EHR, but we didn’t give up.

When the Direct Standard™ and Direct Secure Messaging came along, we recognized the opportunity to transmit data between EHRs, regardless of whether they were different platforms.  With a much lower barrier to implementation and adoption, we set up Subscription services with our local hospitals, meaning that we were subscribed to ADT notifications about our particular patient population. We used Direct addresses to automate the secure exchange of clinical information between EHRs.

Today, our workflow looks like the scenario I previously described, and as a Next Generation Accountable Care Organization (ACO), these ADT notifications allow us to not only keep our patient care costs down, but they also allow us to have our care team practice to the top of their licenses, increasing both provider and patient satisfaction, and most importantly, facilitate more informed and better quality care.

Lessons learned about ADT Notifications

You know that old saying “When you know better, you do better?” The benefits of ADT Notifications certainly hold true with that statement.  After experiencing this flow of sharing information for tightly knit patient care across organizational boundaries, my patients and I have experienced “better”, and will never go back to a life in medicine without these ADT Notifications.

In addition to being an internist, I am also a clinical informaticist, and there certainly have been lessons learned along the way.  For instance,

  • EHRs have come a long way. There are so many different ways to configure systems, there are workflows and functionality to help make strong workflows for these ADT Notifications happen.  Ask your EHR vendor for assistance!
  • Manual is not reliable. Don’t count on pushing this information by hand to the ER, or on the ER manually pushing these notifications to you.  Set up automated processes so you can set it and forget it, and just enjoy the benefits of these notifications.
  • Communicate your Direct addresses to your local community providers. Let your local ERs and hospitals know this is your preferred way of communication, and what the Direct addresses are where you want to receive this information.
  • Review your workflows and encourage your team to function at the top of their license. A thorough review of what is actionable and for whom can be illuminating.  For instance, a Discharge Notification is not actionable for me, as I am not the care team member calling the patient to schedule a follow up appointment, but it is actionable for my nurse and others on our team.  By reviewing and defining our workflows, everyone is on the same page as to who is the primary team member responsible for a certain task, and we can work together efficiently.
  • Take advantage of message routing and context. The new Implementation Guide for Event Notifications via Direct includes context, meaning these ADT Notifications delivered via Direct have useful information embedded within them, like what type of message it is, and what patient it’s about.  We’ve configured our EHR to recognize that when a Direct Secure Message is sent to my Direct address but is a message type of Discharge Notification, it should be routed instead to my nurse and care team to handle.  This message routing is huge in decreasing the number of steps to get the right information to the right person on the care team, and to act quickly on behalf of the patient.

Many healthcare providers already embrace ADT Notifications.  So should you!

ADT Notifications are a huge tool in practicing informed medicine.  Not only has the workflow of these notifications created increased team satisfaction, but our patients benefit – we’re able to make the most competent decisions, the right decisions, for that individual when we have all of the necessary information. High performing ACOs like those Reliant Medical Group participates in have been leveraging the power of ADT Notifications for years. ADT Notifications have become the standard of care in many communities. Don’t be the last to adopt this powerful tool.

My advice after experiencing the benefits of these ADT Notifications for years? Embrace technology and make these notifications work for you.  When done correctly, quality and safety of patient care increases.  Communicate with your preferred Direct addresses with your community partners so they join you in this endeavor, and enjoy the patient care benefits.  Soon you too won’t be able to imagine care coordinated any other way.


If you’re interested in learning more about ADT Notifications and the Event Notifications via the Direct Standard™ solution, find more resources and the Implementation Guide here.