Myth or fact? Hospitals must send event notifications to doctors

Tanya Albert Henry , Contributing News Writer

Physicians are familiar with the inbox influx: A host of messages from hospitals or other health care entities where their patients received care. Often the messages are redundant or have incomplete information. That all makes it hard to find the information physicians do need to best serve their patients.

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Many believe that Medicare-participating hospitals are required to deliver electronic patient event notifications directly to a physician’s EHR inbox.

But that’s just a myth, according to the latest research that the AMA has done through its “Debunking Regulatory Myths” series. This series aims to provide regulatory clarification to physicians and their care teams. It is part of the AMA’s practice-transformation efforts and provides physicians and their care teams with resources to reduce guesswork and administrative burdens so their focus can be on streamlining clinical workflow processes, improving patient outcomes and increasing satisfaction.

Instead, the Centers for Medicare & Medicaid Services (CMS) states that hospitals may develop internal processes to prioritize and tailor the delivery of event notifications in ways that align with clinician preferences and reduce redundancy.

Electronic patient event notifications let the clinician or entity receiving them know that a patient has received care in another setting. They are automated, electronic communications.

Physicians can receive them for their patients from the discharging clinician or entity to another clinician or entity in need of the notification for post-acute care coordination, treatment or quality improvement purposes. EHRs commonly use admission, discharge and transfer (ADT) messages as the basis for implementing and generating the necessary information for patient event notifications.

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Some organizations—without running afoul of CMS guidance—have created a workflow that allows ADT notifications to go directly into a “dashboard.” The messages can be stored there, and the system allows clinically significant events to be prioritized so that the receiving clinicians’ workflows are not disturbed.

Physicians and other health professionals can access the ADT notifications stored in the dashboard on demand. And, with the notifications not going directly to the individual physician, the inbox burden is reduced.

Atrius Health in Massachusetts, for example, successfully created a dashboard to manage ADT notifications for its primary care physicians. ADT feeds used to result in the organization’s primary care physicians receiving automated alerts, notifications and discharge summaries from a number of local and national health systems in their inbox. When Atrius leaders looked at how this system was impacting physicians, they found that the timing of notification was not synchronous with clinical care, clinically pertinent information was onerous, there were duplicates of the documentation and incomplete information in many of the messages. Their research also showed that one hospital admission could generate six or more unique inbox messages.

Atrius stopped automatically routing ADT to individual inboxes and now pools the notifications in a dashboard. The dashboard can organize emergency department and hospital ADT notification by patient and provides the relevant information. When discharge summaries are available, physicians can access them via a link.

Post-discharge calls are also visible to the primary care physicians. Physicians are also able to “pull” their dashboard on the main page of their EHR when they choose.

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Does that regulation really require extra work? Ask the AMA

Learn more with the “AMA Debunking Medical Practice Regulatory Myths Learning Series,” which is available on AMA Ed Hub™ and provides regulatory clarification to physicians and their care teams. For each topic completed, a physician can receive CME for a maximum of 0.25 AMA PRA Category 1 Credit™.

Physicians are encouraged to submit questions or ideas they have about potential regulatory myths.. The AMA’s experts will research the matter. If the concerns turns out to be a bona fide regulation that unnecessarily burdens physicians and their teams, the AMA’s advocacy arm can get involved to push for regulatory change.