Diving Deeper into CMS’ Interoperability Proposal: Enhancing ADT Data

One of the cornerstones of the interoperability policy proposal that CMS announced earlier this year was the requirement that hospitals share ADT (admissions, discharge, and transfer) data for electronic patient event notifications. The logic is simple—CMS believes that increased data sharing will give providers a more complete picture of patient health and make them better equipped to deliver consistent, quality care. In fact, many acute organizations have already taken the lead on sharing their ADTs for this very purpose. While CMS is taking an important step toward erasing the silos that exist between providers with this proposal, there are still many roadblocks to interoperability that need to be addressed. In this post we’ll explore how care coordination technology works in tandem with existing systems, makes patient event notification data more actionable, and provides greater visibility into high-cost care settings.

Extend the Value of EHR Data

Thanks to the HITECH Act of 2009, EHRs are an industry standard. But, while EHRs are a wealth of valuable clinical data, even providers that use the same EHR vendor – not to mention those that use different systems – cannot easily share data with one another. Sending patient event notifications is a great first step but creating bridges between these systems is key to extending and augmenting the value of the patient data housed in EHRs. Some of the country’s top performing health systems rely on EHR-agnostic care coordination technology platforms like CarePort to streamline transitions of care for their populations and connect disparate technologies. And it’s not just health systems and hospitals that benefit; payers, post-acute providers, primary care providers, and a host of specialists – who all are using separate EHRs – can improve the quality of care they deliver when they gain greater access to real-time patient data aggregated across multiple systems.

Add Clinical Context to Make Data Actionable

While it’s helpful for providers to know when their patients have been admitted or discharged from the hospital, that alert alone is not enough. Adding clinical context to ADT notifications gives providers a more complete picture of patient health and empowers them to intervene if needed. Whether it’s a complete history of the care settings a patient has been in previously or its updated information on new diagnoses and medication—clinical context brings providers up to speed and makes patient event notification information actionable. If a patient readmits to the hospital multiple times from the same post-acute care facility, for example, a care manager could see that prior history and plan to discharge the patient to another facility with more appropriate clinical capabilities.

Gain Insight into an Overutilized Care Setting

In our comments to CMS, we recommend expanding the ADT requirement from just the inpatient setting to include emergency departments (ED) in the ADT data sharing mandate. Providing insight and visibility into patient care in the ED would give care coordinators, PCPs, post-acute providers, health plans, and other care management teams the opportunity to intervene and ensure that patients receive the right treatment at the right setting when appropriate, and potentially a less costly level of care. Many patients who wind up getting readmitted to the hospital from the ED could safely be rerouted to other settings including a post-acute facility if their providers were alerted to the ED visit in real time. Patients who present at the ED with non-urgent symptoms like a sore throat could be redirected to urgent care or a primary care physician. The clinical context and the real-time notification that a care coordination platform like CarePort offers helps providers make these decisions. CarePort also supports deeper analysis of the data on ED visits, making providers aware of overutilization trends, which then empowers them to look into the root causes, evaluate social determinants of health such as housing or food needs, and take action to decrease overutilization of this high-cost setting.

Create Meaningful Incentives to Effect Real Change

Value-based reimbursement programs have shown that measuring results and holding providers accountable for outcomes is what drives change in this industry. Going back to CMS’ interoperability proposal, we suggest that CMS publish guidance at some point within twelve months of publication of the final rule to share how they will measure if a provider is successfully using patient event notifications. How will the hospital demonstrate that their system sends notifications that are helping to coordinate care, not just checking the box on functionality? Without some type of closed loop process, there is the potential for critical patient information to fall through the cracks.

We applaud CMS for taking an important step toward furthering interoperability through its proposal since formalizing care coordination efforts is a priority for improving patient care.

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