Admission, Discharge, and Transfer (ADT) Data is essential – we know this. It makes processes more efficient and effective, allowing providers to get back to what they do best: providing quality patient care. It reduces hospital readmissions and overuse of emergency services, two of the more costly problems in healthcare, and ultimately improves outcomes.
But in today’s information-driven healthcare ecosystem, providers still grapple with either not enough data, because it resides in silos, or too much data that is unusable, unstructured, and just plain messy.
With Health Gorilla’s recent launch of ADT Data, the time was right to get together some experts and talk about the challenges we face when it comes to ADT Data and some of the solutions.
Moderated by Jitin Asnaani, Health Gorilla Executive Advisor and former Executive Director at CommonWell Health Alliance, the webinar discussion was recorded and can be found here. Our panelists were Dr. Steven Lane, Health Gorilla’s Chief Medical Officer, Chris Pugliese, Director of Product Interoperability at ResMed, and Farah Saeed, Interoperability Leader at eClinicalWorks.
A Connected Healthcare Ecosystem
Dr. Lane, a practicing primary care physician for more than three decades, offered some historical context. He said ADT alerts “just sort of launched on the scene” around six or seven years ago, showing up with no real direction on what to do with them.
However, their utility has become clear – particularly in a value-based care model.
“Whether you're thinking about just the optimized care of an individual or how the value is being driven through that process of care, you need to know what's going on,” Dr. Lane said. “By knowing what's going on, you can make the care you provide patients as valuable as possible – the lowest cost, the greatest benefits, and the best coordination across all the care that patient is receiving. That, to me, is the big picture.”
“In value-based care, a lot of burden falls to the primary provider and often they're the ones responsible for follow-up care,” Saeed said. “ADT alerts are so beneficial because the provider is proactively being notified of that event, and they can then reach out and do what they need to do to help the patient help themselves.”
In a collaborative healthcare ecosystem, care managers, nursing staff, scheduling staff, and other stakeholders are equally involved in a patient's care journey. Thus, it is essential to ensure that ADT alerts reach all relevant parties involved in providing care. Expanding the recipient pool of ADT alerts can enhance communication, facilitate coordination, and improve patient outcomes.
“A PCP is just one role. There's care managers, there's nursing staff, there's scheduling staff, there's all sorts of other folks who may be involved in the care of a patient who should be receiving these in addition to the provider themselves,” Dr. Lane said.
Bottom line, ADT alerts hold immense value for the entire healthcare ecosystem.
Pugliese, who serves on the board of the Post-Acute Care Interoperability Project (PACIO), outlined just one of many scenarios where a lack of ADT data creates millions of dollars in waste.
“You're a home health nurse and you knock on a door and no one answers because they’ve gone to the hospital. This happens daily, hundreds of visits, thousands of visits across the country,” he said. “Having [ADT] notifications routed to a post-acute provider can be a key saver. Resources are already stretched, people are already trying to provide the most care they can with the fewest possible nurses. So if you have a missed visit, that's just waste.”
“Healthcare doesn't just stop the moment the patient has that provider visit,” Asnaani said. “Patients go to their homes, they go to the nursing facilities, they go to community resource centers, they go elsewhere, and the care has to continue and actually be connected.”
Filtering and Normalization Matters
ADT alerts play a crucial role in ensuring seamless communication and coordination among healthcare providers, but their potential can be undermined by overwhelming volumes of information.
Pugliese emphasized the need to provide filtered ADT alerts. Because a vast majority of alerts may not be relevant or actionable, Pugliese urged healthcare systems to streamline the system so that only pertinent alerts are delivered to users.
“How do we make only the [ADT alerts] that are meaningful available,” he asked. “[Without filtering], you end up with this inundation of information that 70, 80, possibly even 95%, is not really usable because of the sheer volume.”
By doing so, healthcare providers can avoid drowning in a sea of information and focus on what truly matters in patient care.
“It’s just about finding that right balance between getting people the right information, but not overwhelming them with the wrong information,” Pugliese said.
Saeed pointed out that with numerous vendors and systems consolidating and disseminating these messages, achieving uniformity becomes essential.
“EHRs are just sitting here with our giant catcher's mitt trying to get anything that's thrown at us,” she said. “And that's why we feel that the ability to standardize is so important — so that all vendors, all different systems who are consolidating these messages and sending them out to us, are all in the same format.”
Standardization would enable smoother integration of ADT alerts into different healthcare systems, allowing for more efficient communication and collaboration among providers, Saeed said. “There has to be consistency and that's something that isn't fully there as yet,” she said.
The ‘Skinny’ on ADTs
Unfortunately though, ADT alerts are not always put into the context of the patient’s complete record and are often “skinny” in terms of detail provided.
“[When I receive an ADT alert, it’s like] ‘something happened somewhere’ – but they don’t necessarily tell you what,” Dr. Lane said. “I think ADTs should be able to trigger additional events to get the right data at the right time.”
The discharge summary can help fill in those gaps and provide insights into utilization patterns such as high emergency department use and readmission risk, says Saeed. “The ADT is the where and the when. But what’s really important to most providers is the what and the why,” she said.
“The ADT is very skinny, it really doesn't have a ton in it,” said Asnaani. “But once you put it alongside the ability to query for SDOH data, to query for clinical data, the discharge summary ... that tells me what happened to this patient in more detail.”
The key is augmenting these alerts with a comprehensive medical record. By combining ADT alerts with data from various sources, healthcare providers gain a more comprehensive understanding of a patient's condition and history, empowering them to make informed decisions – which has been Health Gorilla’s mission from the start.
Health Gorilla ADT Data includes detailed HL7 encounter data from a nationwide network of hospitals with event type, patient demographics, location, sending facility, admission type, diagnosis, procedure, and much more.
“One of the issues we have in healthcare is we spend more time looking at screens, less time actually having quality relationships between providers and patients – quality interactions,” Asnaani added. “So this can actually bring that element back in at exactly the right time that it's needed.”