Admission, discharge, and transfer (ADT) feeds generate data about a patient’s healthcare encounter when they are admitted, discharged, and/or transferred from one care setting to another care setting or back home.
This information can be automatically sent to the patient’s primary care provider and other members of their care team, alerting them of the event in real time. In this blog post, we present a basic understanding of how ADT feeds work and the impact of ADT health data on care coordination, health outcomes, and quality measures.
What is an ADT Message?
ADT messages are a type of Health Level Seven (HL7) message used to document every step of a patient’s journey throughout the continuum of care. These messages contain details about the patient’s demographic information, type of healthcare encounter, insurance coverage, diagnosis, and more. Common messages you’re likely to see on ADT feeds include:
- ADT-A01: Patient admission
- ADT-A04: Patient registration
- ADT-A02: Patient transfer
- ADT-A03: Patient discharge
- ADT-A08: Patient information update
- ADT-A11: Cancel patient admit
The above message types are commonly referred to as trigger codes. These are triggered automatically in response to the healthcare encounter that’s happening in real time. For example, when a patient is admitted to the hospital, that event has a specific trigger code: ADT-A02.
How is ADT Health Data Communicated?
Within each ADT message, you’ll find patient demographics and visit information organized into segments. Each segment conveys a specific kind of ADT health data. Examples of important segments include:
- PID Segment: Patient identification information
- EVN Segment: Event type
- PV1&2 Segments: Visit information
- IN1&2 Segments: Primary and secondary insurance information
Segment titles are used to indicate what type of ADT health data is being communicated. So, the line of the message that contains information on the patient’s demographics would begin with “PID” followed by the actual data.
The way segments are composed on the ADT message depends on the type of ADT event as well as the HL7 version used. This information along with the trigger code, date, and information on the sending and receiving organizations is conveyed in the first line of an ADT message, or the message header (MSH) segment. This is how ADT messages communicate important health data.
Who Uses ADT Feeds?
Care teams and providers use ADT notifications to monitor and share information with other providers the patient has an active care relationship with like specialists, post-acute care providers, or health plan care coordinators. The organization that initiates the message is referred to as the Sending Organization, while the Receiving Organization is any that can receive and use the message.
Examples of healthcare organizations that qualify as a Sending and/or Receiving Organization include:
- Health clinics
- Psychiatric facilities
- Skilled nursing facilities
- Insurance providers
- Primary care providers
- Home health agencies
ADT messages are usually initiated by the hospital information system (HIS) and are used to keep ancillary systems in sync. The three types of ancillary care services — diagnostic, therapeutic, and custodial — provide support to the primary care physician, so it’s important that they’re all on the same page. When a patient’s record is updated, an ADT message is sent to all the care systems they’re apart of. These updates include information on the state of the patient as well as any insurance and contact information changes.
Healthcare organizations also use ADT notifications to help reduce overutilization. They do so by identifying patients who frequent the healthcare system and intervening accordingly so that avoidable ER visits and hospital readmissions do not occur.
What Are the Benefits of ADT Feeds?
The benefits of ADT feeds giving care providers the ability to share detailed, accurate ADT health data with one another may seem obvious. However, here are a few proven benefits from real-world use cases that show the impact ADT alerts can have on the quality of care patients receive and providers can offer.
Improved Care Coordination
Many providers are not informed when their patients are admitted or discharged from emergency rooms (ERs) or hospitals, especially when patients utilize care outside of their insurance coverage network. The instantaneous insight from ADT feeds enables providers to deliver timely care coordination, intervention, and outreach when a patient has a healthcare encounter.
In a real-world case study that demonstrates the power of ADT alerts, Palm Beach Accountable Care Organization (PBACO) in Florida leveraged encounter notifications to improve care coordination. The Florida-based accountable care organization (AC)O) utilized ADT data to drive an increase in follow-up visits and reduce expenses post-discharge. This proactive approach to care coordination resulted in a patient satisfaction score of 96.25%, and PBACO was ranked in the top four of all Florida accountable care organizations that year.
Reduced Hospital Readmissions
An estimated 27% of hospital readmissions are preventable. Knowing when, where, and why patients are hospitalized provides an opportunity to intervene and reduce hospital readmissions. ADT health data has had a tangible impact on reducing readmissions for many facilities, especially with alerts powered by Audacious Inquiry’s Encounter Notification Service® (ENS®).
For example, Primary Partners, an ACO in central Florida, saw a 40% decrease in hospital readmissions among their patients per quarter in their first year of receiving ADT alerts through the ENS service. This resulted in savings of nearly $284,000 in readmission costs.
Something that’s important to note here is that prior to connecting to ADT data feeds via Florida HIE Services, a statewide health information exchange, most providers from their network only knew a patient had gone to the hospital when the patient called the office and told them. This is a common challenge providers face that can be solved by ADT encounter alerts.
In an effort to address the high rate of readmissions, the Centers for Medicare and Medicaid (CMS) created the Transitional Care Management (TCM) reimbursement program. TCM services must be administered within a specific time frame to be eligible for reimbursement. Because providers who use ADT feeds receive information on an event as it’s happening, it’s easier for them to meet these time-sensitive requirements set by Medicare.
ADT messages also streamlines the communication between primary care providers and their patients. Because the provider receives an immediate notification when a patient was discharged from the ER, for example, they’re able to reach out to them and schedule a follow-up sooner rather than later.
Enhanced Public Health Reporting
During the COVID-19 pandemic, ADT health data was used to identify potential outbreaks of COVID-19 through an influx in hospital and ER admissions. ADT feeds send data elements—including presented symptoms and diagnosis—in real time, which can be crucial for syndromic surveillance efforts.
By receiving real-time ADT alerts via ENS, public health departments are able to receive additional clinical data for known and suspected COVID-19 patients. If they elect to receive real-time alerts on the health care utilization of these patients, they’re also able to better comprehend symptom progression and track patient encounters within the health care system.
The ability to access and capture real-time data makes ADT feeds a major asset to day-to-day care coordination, combating future public health crises, and, ultimately, furthering interoperability in healthcare.
As industry leaders, Audacious Inquiry offers easy-to-use solutions to help health organizations leverage ADT health data. To learn more about real-time health encounter alerts, download our guide on ADT data and its value to the various players throughout the continuum of care.
About the Author
Morgan Fitzgerald is a guest writer for Audacious Inquiry and a member of Silverback Strategies. As a content strategist, Morgan and the team at Silverback collaborate with Audacious Inquiry to create relevant and reliable content for the benefit of Audacious Inquiry’s healthcare audience. To learn more about Silverback Strategies, visit their website or LinkedIn.