MAeHC’s Quality Data Center (QDC) serves as an ADT repository for its Event Notification Service (ENS) services, providing a cloud-hosted architecture. ADTs and ENS are considered high-value information assets that will greatly improve situational awareness of a patient's acute events. MAeHC’s collaboration and coordination approach with data providers and data subscribers allow for a centralized approach, avoiding multiple point-to-point interfaces.  To-date, the QDC receives an average of 148,799 ADT messages on a daily basis, though this number continues to grow as we connect additional sources. 

 

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ENS Services Include:

  • Secure and high-reliability publish-subscribe architecture
  • Outbound ADT messaging according to industry-based standards
  • Message normalization
  • A central mapping tool to normalize incoming ADT messages to a common set of fields and codes
  • Multi-tier patient-matching algorithm
  • Subscriber-specific modifications, allowing for efficient and accurate record matching and consumption into subscriber technologies and workflows
  • Subscriber-specific delivery rules - transport options (push/pull, transport modality), types of messages they wish to receive, frequency and periodicity of ADT delivery

Information Provided by ENS Services:

The ENS service is based on Admission, Discharge, Transfer (ADT) messages that are automatically created by hospital EHR systems when a patient has an encounter. These messages typically contain the following information:

  • Patient name and demographics (Name, DOB, MRN, age, gender, race, ethnicity)
  • Type of event (Registration, Discharge, etc.)
  • Visit type (Emergency Department, Inpatient, etc.)
  • Source (Hospital where encounter occured)
  • Patient PCP (varies)
  • Chief complaint (varies)

ENS Can Be Used For:

  • 72-hour post-discharge call back requirement
  • Pre-discharge planning for high-risk complex patients
  • ED and inpatient triggers in care management system
  • Safe transition to PCP post-discharge
  • Integrate ADTs in predictive analytics to enrich risk satisfaction (timelier than claims data)
  • Automated encounter and medical histories triggered upon admission

ENS Implementation:

  • A well-established implementation process
  • Detailed specs for both data providers and subscribers, outlining suggested preferred minimum data, message types, and content within the ADT, though the QDC can accept anything sent
  • ADTs are consumed in real-time by the QDC on a 24 hour/7/365-day frequency
  • Automated transaction reports (inbound and outbound by data provider and subscriber) are generated and reviewed daily for discrepancies
  • Monthly reports are distributed to submitters and subscribers providing details of their ADT data flows

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Frequently Asked Questions

What is an event notification? A notification is a message sent to an authorized subscriber informing them that one of their patients has had a new clinical event. Notification messages contain information on the patient (name, MRN), visit location, visit type, risk status (if available), and ACO enrollment (if available). 

Send Functionality “Data Providers”

How does encounter information get captured and sent?

  • Triggered by patient admission, transfer, discharge event with clinical entity
  • Can include a variety of visit types (e.g., ED admission, EKG lab admission, etc.)
  • Encounter information from clinical entities or from payers (e.g., Daily Admission/Discharge Reports)* where available
  • Supports any industry-standard transport & format, such as HL7 ADT, SFTP, flat file, etc.

What type of encounter information is sent? (Varies by source system)

  • Patient demographics (name, address, MRN, etc.)
  • PCP (if available)
  • Visit type (ED, inpatient, outpatient, x-ray, etc.)
  • Location (Hospital, Urgent Care, etc.)
  • Admit date/appointment date
  • Discharge date
  • Health insurer/plan**
  • Chief complaint (usually uncoded)**
  • Patient vitals**
  • Diagnosis (coded)**
  • Patient death indicator**

**Clinical and insurance data often not sent in notifications. Determined by clinical entity.


QDC Processing

Where does MAeHC store this information?

  • The MAeHC Quality Data Center is in Amazon Web Service (AWS)
  • The MAeHC data warehouse is an ONC-certified CQM EHR component for EP/EH CQM reporting and a CMS-certified QCDR

How does MAeHC process the information?

  • Encounter information is validated, parsed into structured data elements, and loaded into the database
  • Patient identity evaluated and either matched with Patient ID or new Patient ID created
  • New encounter added to Patient Encounter Repository

At time of Go Live, will sources send historical ADTs?

  • No, ADTs will be sent from time of go live and forward

Notify Functionality “Data Subscribers”

Who can receive event notifications?

  • Entities with an active relationship with a specific patient, determined from prior record history and institution-provided patient rosters such as payer- or ACO-provided attribution and MPI data downloads

How do subscribers receive event notifications?

  • Event notifications are available as secure messages delivered to a secure endpoint and through the MAeHC QDC ENS portal
  • MAeHC can also send event notifications using any industry-standard transport and format (HL7, SFTP, Direct, flat file, etc.)
  • Synchronous alerts to non-secure emails or texts are also available to inform subscribers of the availability of new event notifications

What can event notifications be used for?

  • Subscribers determine how to distribute, consume, and act upon event notifications within their own organizations
  • Typical use cases involve referral management, utilization management, care management, case management, and continuity-of-care follow-up

Is the ENS notifications downloadable?

  • Yes, notifications can be downloaded into Excel

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