Among the thousands of patients Dr. Donald Rebhun has seen at his primary care practice in the San Fernando Valley, stories that stand out in his memory include cases where he was able to make a timely impact on patients because of a simple electronic alert sent by the hospital, letting him know his patient had been treated.
“I was alerted that my patient was in the hospital and received empiric antibiotics for an underlying infection,” Rebhun said. “The initial cultures came back negative, and the patient had an early release. Later, the cultures turned positive. Because I knew what was happening, I was able to follow up, and we probably kept that patient from becoming extremely ill and circumvented the need to go back into the hospital and be admitted for much stronger types of therapy and consequences.”
But this kind of follow-up doesn’t always happen. California does not have a centralized system for “admit, discharge and transfer” (ADT) notifications from hospitals to a patients’ primary care physician. Patients are often evaluated in emergency rooms or admitted to hospitals where their primary care provider is not on the medical staff. Thus, their primary doctor rarely receives prompt notification of the patient’s visit and doesn’t know to communicate with them to provide timely and appropriate follow-up.
“Really good medical care requires that patients follow up with their doctors after an emergency room visit or after a hospitalization,” Rebhun said. “I think most patients expect that once they receive this type of care, their physician is notified, but unfortunately, all too often, this is not the case.”
These ADT alerts are real-time, tiny pieces of data (just 2 to 10 kilobytes per notification) that are crucial to ensuring that a care team gets a proactive start to support people at a vulnerable time, without having to wait to be notified by a patient’s health plan, which may take several weeks. Timely support can include coordinating care details in the hospital and keeping a discharged patient at home recovering safely. Timely notifications from hospitals to primary care offices also help reduce waste in our health care system by enabling doctors to see the results of recent tests and radiology reports and avoid redundancy.
Recent federal requirements for sharing ADT notifications with providers tried to create systems to solve this. But hospitals can require doctors to use the hospital’s preferred technology or vendor, putting the administrative burden on the doctors’ office to try to figure out how to receive notifications from all the hospitals where their patients are seen. An individual physician might have to sign five or six contracts just to have access to information for their patients in their city, and still wouldn’t be informed if someone was hospitalized in the next town over.
What we need instead is a true health data safety net for ADT notifications across the entire state to help physicians provide better and more efficient care for their patients. Sacramento leaders have taken steps to get closer to this ideal by creating a new health data exchange framework. They are considering requiring hospitals to share ADT data with “qualified health information organizations” that can maintain patient panels from providers, physician groups, Accountable Care Organizations (groups of clinicians, hospitals and other providers that coordinate care), and health plans. This will ensure ADT notifications are consistently and securely distributed to the providers and plans permitted to receive them.
This system creates a beautiful opportunity to make it easy for hospitals to deliver ADT notification: The hospitals send their data feed to just one organization rather than fielding myriad requests for notifications in different formats or through different technology vendors. This makes it easy for providers and plans to get the notifications they need from all hospitals with just one contract through one vetted organization as their notification provider.
Real-time hospital notifications also have the potential to accelerate health equity. Enrollees in Medi-Cal, California’s Medicaid program serving low-income families, seniors, people with disabilities, children in foster care, and pregnant women, have higher emergency room visit rates compared to those with private coverage, according to Public Policy Institute of California research. Notifications to their primary care physicians and care coordination when they’re in the hospital can go a long way toward preventing unnecessary emergency department visits in the future, which in turn reduces overall health care costs and improves patient longevity and quality of life.
“I believe that having real-time hospital data allows me to provide the best care to each and every patient,” Dr. Rebhun said. “Increasingly, I have patients who are frail, elderly, higher risk and have chronic conditions, and in order to be able to optimize their health and keep them out of the ERs, hospitals and healthy, I need that data.”
Erica Galvez is CEO of Manifest MedEx (MX), California’s largest nonprofit health information organization.
William Barcellona serves as the Executive Vice President of Government Affairs for America’s Physician Groups, a national professional association of over 300 medical groups and independent practice associations across the United States.
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