Why you should use a comprehensive platform to meet CMS’ new electronic notifications requirement

Why you should use a comprehensive platform to meet CMS’ new electronic notifications requirement

Healthcare technology

Although the usage of electronic health technology is high, the practice of using that information to empower patients, lower costs and deliver high-quality care remains to be fully realized. In deliberate step, the Centers for Medicare and Medicaid Services (CMS) implements seven new directives to move our industry forward – including a new requirement for hospitals to send real-time, electronic notifications to providers and groups. Non-compliance with the new regulation puts hospitals at risk of not receiving CMS payments. Using the right technology vendor will not only help you meet the mandate’s requirements but position you well for long-term care coordination, interoperability and data management needs.

The Requirement

CMS is using their regulatory power to assure compliance by modifying hospitals’ Conditions of Participation to add a new electronic notification in the medical services standard (hospitals (§482.24(d)(2), psychiatric hospitals (§482.61(f)) and critical access hospitals (§485.638(d)). These hospitals must send real-time electronic admission, discharge, and transfer (ADT) event notifications to a patient’s provider or group that is primarily responsible for care.

When: Upon registration in the emergency room, or admission/discharge from the emergency room or inpatient visit.

How: Real-time HL7 2.5.1 message including patient name, treating provider’s name and sending institution.

To: Care providers across the continuum, including primary care physicians, practice groups and other post-acute providers.

When it comes to sending electronic notifications, hospitals face three major challenges:

Real-time obstacles: The initial appeal of interoperability was to reduce the impact of providers not having timely care information – like an emergency room visit and inpatient stay. In a system still figuring out the last step of interoperability, information sharing outside the health system EHR-level, automating the data and making it compatible for providers can often provide a substantial challenge.

Maintaining the roster: Hospitals can use internal data, like from an EHR system, to accurately attribute the patient-provider relationship. Yet, what happens if the hospitals’ internal data set has gaps or inaccuracies?

Exchange complexities: Operating within state, federal and local data sharing regulations while maintaining a roster of patient-identified providers and being flexible to providers’ exchange capabilities and preferences can pose numerous obstacles. As an example: a patient that has an established primary care physician, yet the patient feels his/her neurologist is primarily responsible for care. The neurologist does not have ADT notification receiving capabilities and the patient is being discharged to a skilled nursing facility – routing notifications appropriately in a situation like this one can be troublesome.

Why Comprehensive Analytics?

History has taught us, no hospital or provider wants a conglomeration of different, disparate technologies to log in and out of, and manage. They want a single platform that is effective at helping them get stuff done. Platforms built to support enterprise-wide initiatives have the combination of interoperability capabilities and analytics all in one platform, to support and grow with your data and performance management needs.

This CMS mandate has an aggressive implementation timeline with an effective date of Spring 2021. In a time of pandemic criticality, organizations need the “easy” button today – a partner that will alleviate the burden of this mandate, yet also be a good long-term solution in advancing the use of electronic health data to drive health outcomes.

KPI Ninja has proven experience using a broad interoperability scheme for putting information in the hands of clinicians to empower better health care. With agnostic data acquisition capabilities and the ability to ingest data from Health Information Exchanges that typically have comprehensive provider directories, Medicaid 834 files and eligibility files from payers and Accountable Care Organizations (ACO)/Clinically Integrated Networks (CIN) are just a few examples of the many ways we can help you overcome roster management obstacles.

In addition, we have the functionality to send alerts that go beyond typical ADT messages,  including other standard alerts (labs, procedures), smart alerts (readmissions, high utilizers, disease management, COVID-19) and because we know each stakeholder is different, custom alerts, to providers across the care continuum in a variety of formats – this means if a logic can be created, we can implement it.

standard alerts (labs, procedures), smart alerts (readmissions, high utilizers, disease management, COVID-19) and because we know each stakeholder is different, custom alerts, to providers across the care continuum

There is tremendous value in having a partner with capabilities that extend beyond the current mandate. Analytics on top of electronic notifications can reveal opportunities that may have not been considered before. Use cases like:

  • Hospitals are highly dependent on their referral network. Analytics built on top of electronic notifications can help administrators have a better understanding of where patients come from and go to in order to refine their networks.
  • Providers that are accountable for a patient’s health would find value in understanding the percentage of time patients in their panel have a follow-up visit or pick up their medications in a timely manner.
  • Nearly every value-based program has performance metrics around reducing emergency room and hospital utilization rates. With providers and groups having more comprehensive information about their population, they can have better insight into performance trends and opportunities that may exist.

KPI Ninja effortlessly implements the powerful set of HL7 standards and others to help bind care settings. If performing efficient electronic notifications is your goal, KPI Ninja offers you the perfect platform to transmit your patient’s health data securely.  


Renee Towne

About the Author
Renee Towne
Director of Quality Programs at KPI Ninja, Inc.
Renee provides operational leadership of quality initiatives at KPI Ninja. Towne has a background in occupational therapy, education and experience in operational excellence across a variety of healthcare domains. Based on prior experience as a clinician that drove outcomes patient by patient, she is leaving a larger footprint by improving health care more comprehensively, population by population.


About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.

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