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

Learning Objectives
1. Describe the myth or issue that impacts physicians and their care teams
2. Explain how hospitals should send patient event notifications
0.25 Credit CME

To earn full credit for this activity, you must review all accompanying resources, which have been curated to support your learning of the subject matter.


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

The Myth

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

Debunking the Myth

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

Case Study

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.

AMA Policy

H-225.946 Preserving Physician/Patient Relationships During Hospitalizations:


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The AMA Debunking Medical Practice Regulatory Myths series provides physicians and their care teams with regulatory clarification to streamline clinical workflow processes and improve patient outcomes. Learn more

Article Information

AMA CME Accreditation Information

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

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.

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.
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
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 0.25  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 0.25 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 0.25 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 0.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 0.25 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 0.25 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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