Industry Voices—Farzad Mostashari, Claudia Williams make the case for requiring hospital ADT alerts

Anybody who has had a loved one with an acute hospitalization or a chronic illness will have experienced some of the many ways in which healthcare systems fail to live up to the values and ideals of the people who have chosen healthcare as a calling.

Healthcare is complicated indeed, but there are rare instances where the problem and solution are shockingly clear.

Farzad Mostashari
Farzad Mostashari, M.D.

When a patient—let’s call her “Mom”—is discharged home from the hospital, she, like many other patients, is in danger. Mom is weakened by her illness and immobility. She is taking several new medications begun just days or even hours before discharge. The illness that led her to be hospitalized may linger or recrudesce, or she may have acquired a new infection or complication during her stay. Her family doctor no longer rounds in the hospital, and the “hospitalist” physicians rotating through never really got to know her during her pressured short stay at the hospital.

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The hospital that discharged her also neglected to do the one thing that would have greatly reduced the danger she’s in. They never told her primary care doctor when she was seen in the emergency room, and they didn’t notify that physician when she was transferred to an inpatient ward, or even when she was discharged home. In this day and age of constant electronic notifications, the technologies needed to provide these admission, discharge and transfer (ADT) notifications are well established.

And yet, physicians rarely find out about emergency department visits before the patient’s next office appointment. ADT alerts fix that. They give care teams a nudge when patients need their help the most. They help primary care providers check on elderly patients when they are hospitalized and follow up promptly when they are discharged.

The results are clear. Almost 60% of clinicians report that ADT notifications improved patient safety by increasing their awareness of patients’ clinical events and medication changes, according to a study published in Informatics in Primary Care. In New York, patients whose providers received ADT alerts were less likely to be readmitted to the hospital, according to a study published in the Journal of the American Medical Informatics Association. In another study in that journal, accessing patient information in a health information exchange, including ADT alerts, within 30 days after discharge was associated with 57% lower adjusted odds of readmission.

Claudia Williams
Claudia Williams
(Manifest MedEx)
Why has such a clear solution not been adopted more widely?

Hospitals may not prioritize what happens to patients after discharge, and some may even want to limit access to this vital information as an inducement to bring community physicians into their ever-widening contracting networks, to increase referrals to their hospitals and improve their leverage with insurers.

Through new proposals to its Interoperability & Patient Access to Health Data Rule, the Centers for Medicare & Medicaid Services has outlined a smart strategy of simply requiring that hospitals provide these notifications if they want to receive reimbursement from Medicare or Medicaid. Despite the protestations of the hospital lobbies in Washington, the barriers to widespread sharing of ADT notifications are not technological—hospitals are able to send these notifications today using their existing systems by working with a health information exchange, contracting with a vendor who can send the alerts on their behalf or building their own interfaces. This is an approach that has been proven at the state level. States such as Florida, New York, and Tennessee have exponentially increased this vital information sharing by tying hospital funding to ADT alert requirements.

With out-of-pocket spending placing a heavy burden on America’s families, we owe it to our communities to make sure every dollar is spent wisely. Widespread implementation of ADT alerts has the potential to save billions in unnecessary healthcare costs per year. It improves healthcare while saving money. 
The Medicare program has a rare opportunity to cut through the complexity of healthcare with a simple solution. We should all hope that what’s good for Mom will prevail over the hospital lobby.

Farzad Mostashari, M.D., is the CEO and co-founder of Aledade, which leads a national network of physician-led accountable care organizations, and is the former National Coordinator for Health Information Technology at HHS. Claudia Williams is the CEO of Manifest MedEx, a nonprofit which facilitates the exchange of patient medical information in California, and is former senior adviser for health technology and innovation at the White House for President Barrack Obama.