Must Medicare-Participating Hospitals Send Electronic Patient Event Notifications to Physicians' EHR Inboxes?

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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

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

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.