Must hospitals send ADT notifications to physicians’ EHR inbox?

This resource is part of the AMA's Debunking Regulatory Myths series, supporting AMA's practice transformation efforts to provide physicians and their care teams with resources to reduce guesswork and administrative burdens.

Medicare-participating hospitals are required to deliver electronic patient event notifications directly to a physician’s electronic health record (EHR) inbox.

Hospitals are not required to deliver electronic patient event notifications directly to a physician’s EHR inbox.¹ Rather, 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. ^1,2

Electronic patient event notifications are automated, electronic communications 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. These notifications alert the receiving clinician or entity that the patient has received care at another setting. Electronic medical records commonly use admission, discharge and transfer (ADT) messages as the basis for implementing and generating the necessary information for patient event notifications.¹

In accordance with CMS guidance, some organizations have created dashboards where ADT notifications are housed and can be accessed “on demand” by clinicians. The ADT notifications flow directly to these dashboards and do not appear in the individual clinicians’ inboxes, consistent with CMS guidance allowing development of communication processes whereby clinically significant events are prioritized so that receiving clinicians’ workflows are not disturbed.²

One example of an organization that created a dashboard to manage ADT notifications is Atrius Health in Massachusetts. Primary care physicians at Atrius used to receive automated alerts, notifications, and discharge summaries in their inbox through ADT feeds from an array of local and national health systems. Leaders found duplication of documentation and incomplete information in many of these messages.  One hospital admission could generate six or more unique inbox messages. The timing of notification was not synchronous with clinical care and finding clinically-pertinent information was onerous.

Atrius discontinued the ADT automatic routing to inboxes and instead pooled the notifications into a dashboard. The dashboard organizes emergency department and hospital ADT notifications by patient and provides the relevant information. When discharge summaries are available, they can be accessed via a link. Post-discharge calls and appointments are visible to the primary care physician as well. Physicians “pull” their dashboard on the main page of their EHR at their discretion.

H-225.946 Preserving Physician/Patient Relationships During Hospitalizations

• CMS Interoperability and Patient Access Fact Sheet. Accessed May 2, 2022.
• CMS Interoperability and Patient Access Rule- Admission, Discharge, and Transfer Notifications for Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs) Interpretive Guidance. Accessed May 2, 2022.
• Download this myth: Patient Event Notifications (PDF) 

1. Centers for Medicare & Medicaid Services, HHS. Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, and Health Care Providers. Vol 2020-05050.; 2020. Accessed July 26, 2022. https://www.federalregister.gov/documents/2020/05/01/2020-05050/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-interoperability-and.
2. Centers for Medicare & Medicaid Services (CMS). May 2020 Interoperability and Patient Access final rule FAQs. CMS.gov. Published 2022. Accessed December 12, 2022. https://www.cms.gov/about-cms/obrhi/faqs

Visit the overview page for information on additional myths.

Disclaimer: The AMA's Debunking Regulatory Myths (DRM) series is intended to convey general information only, based on guidance issued by applicable regulatory agencies, and not to provide legal advice or opinions. The contents within DRM should not be construed as, and should not be relied upon for, legal advice in any particular circumstance or fact situation. An attorney should be contacted for advice on specific legal issues. Additionally, all applicable laws and accreditation standards should be considered when applying information to your own practice.