ADT Reports: Frequently Asked Questions

Do you have concerns about CMS’s upcoming requirement for sending your patient’s admission, discharge, and/or transfer (ADTs) to their primary care provider? QHN participants already comply with this part of CMS’s rule.

While many were focused on COVID-19 response preparations, CMS published the Interoperability and Patient Access final rule on May 1, 2020.

As part of the rule, CMS modified its Conditions of Participation (CoPs) to require hospitals, including psychiatric hospitals and CAHs, to send electronic patient event notifications of a patient’s ADTs to the primary care provider identified by the patient and any applicable post-acute providers caring for the patient. This policy goes into effect on May 1, 2021.

As an innovative leader in data sharing, QHN has helped hospitals across western Colorado deliver patients’ ADTs to their primary care provider since 2006.

This data sharing has improved patient care and provider collaboration across our region by working through your workflows and existing EHRs. It’s one of the many pioneering health data solutions QHN provides.

Meeting Requirements in the CMS Interoperability and Patient Access Final Rule with QHN

How can I be assured that QHN sending ADT's on our behalf will allow the hospital to meet the requirement in the CoP?

The rule states that a hospital must make a “reasonable effort” to ensure that the system sends notifications to the designated providers and suppliers1. Further, the rule states that if a hospital demonstrates that an intermediary – in this case QHN – connects to a wide range of recipients and does not impose restrictions on which recipients are able to receive notifications, of an intermediary would satisfy the COP2. The rule specifically highlights partnering with intermediaries such as health information exchanges as a method by which hospitals can identify recipients for patient notifications. 

The rule does not require a specific measure of performance to demonstrate the hospital is meeting the requirement. The rule only requires that the hospital makes a “reasonable effort” to ensure that the system sends patient event notifications to the specified recipients.

The rule states the intermediary cannot impose restrictions on providers who can receive the ADT. Does QHN impose any restrictions on who can receive ADT?

QHN does not impose restrictions on providers who can receive ADT messages, and in fact via our Patient Centered Data Home (PCDH) solution, ADTs are sent to providers connected to other HIEs across the nation. QHN strives to deliver as many participant hospital ADTs as possible. QHN works with care providers to create the necessary agreements in alignment with Business Associate/e-Commerce, HIPAA, data use, and others.  QHN can help hospitals to improve the transmission and receipt of these valuable messages to other care providers.

One of the requirements for the rule is that we include the facility name on all of our ADT messages. Today we are only sending out mnemonics on our messages and not a facility name. Can this be corrected?

There are two options in this instance 1) You can make a change in the HIS or interface engine to include your facility name on each ADT message, or 2) QHN can provide a scope to insert the facility on your behalf on every ADT. Contact your QHN Community Advisor or email support@qualityhealthnetwork.org, and we can get you help.

How does QHN deliver ADT's on our behalf today?

QHN delivers ADT's in several formats which include HL7 messages, notifications like DIRECT messages or PDFs, or in reports. We deliver to recipients based upon the hospital sending us the provider ID, or because a provider in our network has subscribed to that patient. We also leverage the Patient-Centered Data Home (PCDH) to send ADT messages on your behalf to providers in health information exchanges across the country.

Reading your QHN ADT Reports

QHN has created reports to assist hospitals in reporting on the ADT Notifications sent.   If you would like to receive these reports ongoing, please contact your QHN Community Advisor or email support@qualityhealthnetwork.org

What ADT types are included in these reports?

These reports currently contain the delivery history for ADT messages with a patient class in Inpatient, or Emergency and the ADT Types of Admit (A01), Discharge (A03), Registration (A04), and Transfer to Inpatient (A06).  If there are other types that you would like us to deliver on your behalf, such as Observation, please contact your QHN Community Advisor or email support@qualityhealthnetwork.org.   

We are not always able to provide a primary care provider or other provider on the ADT for QHN to send on our behalf. How do I know which messages we're sending to QHN that don't have PCP information so I can work to improve it internally?

QHN can provide you a list of all ADT's you have sent us for a specified period of time. On that report we can include those that did not have a provider specified, those that were not sent, and for those that were sent to whom and how QHN sent them on your behalf.  You can use this list to start to identify which messages did not have a provider or service specified.   

In the report you provided us, it shows that you delivered more ADT's than we sent you. Why is that?

An ADT message can have multiple recipients, or a recipient may have multiple delivery types.  For instance, a recipient might have received a real-time notification and then we also included that notification in an ADT report sent the following Monday. This will result in more overall total deliveries than the count of messages you sent us.

What is PCDH that is showing up on my reports?

Patient Centered Data Home (PCDH) is how QHN delivers ADTs to other HIEs (Health Information Exchanges) across the country. If you see PCDH on your report, the ADT was delivered to a provider served by an HIE outside QHN.

On my report it shows "Filtered Out", what does that mean?

Filtered Out means the Provider has certain types of ADTs that they do not want to receive; filtered out messages were not delivered at the Provider’s request.

On my report, what does “Subscription Filtered Out” mean?

Some Practices send QHN a list of their patients so they can receive ADTs for their patients even if their Provider is not listed on the message. Even with the list, there may still be certain types of ADTs that the Providers do not want to receive and those are filtered out, so they are not delivered.

On the report, what does On Demand delivery type mean?

Some Practices send ADTs directly to their EHR from QHN Results and these appear on the report as On Demand. 

1 “We are finalizing 42 CFR 482.24(d)(5), 482.61(f)(5), and 485.638(d)(5) requirements that the hospital’s system send notifications to the following recipients as applicable: the patient’s established primary care practitioner; the patient’s established primary care practice group or entity; or other practitioners or practice groups or entities, identified by the patient as the practitioner, or practice group or entity, primarily responsible for his or her care.”  Page 314 of CMS-9115-F

2 page 334 of CMS-9115-F

3 page 337 of CMS-9115-F