Bill Barcellona, the executive vice president of government affairs at America’s Physician Groups (APG), highlighted the importance of ADT (admission, discharge, or transfer) notifications within the state of California in a recent interview with State of Reform.
ADTs are notifications that relay the time, date, and location of a patient’s admission, discharge, or transfer, and allows providers caring for patients to learn more about their healthcare concerns in real time.
Stay one step ahead. Join our email list for the latest news.Subscribe
Barcellona has been with APG since 2005. He is a trained lawyer, and obtained a Master’s degree in healthcare administration from the University of Southern California, where he also taught students for 11 years. A powerfully negative personal experience with the healthcare system led him down a career pathway in healthcare.
“My oldest daughter had some really serious health problems when she was two-and-a-half years old,” Barcellona told State of Reform. “She ended up losing a kidney. We had a horrible, horrible time with the healthcare system. It was a nightmare. My wife and I came away from that experience thinking there has got to be a better way to do things.”
APG represents physicians who receive and exchange ADTs. A top priority for Barcellona is helping these physicians further coordinate care and facilitate warm handoffs for patients.
“That’s where ADT has really come into play, is letting the treating physician know that their patients are ending up in the ERs and in the hospital, or that they’re coming out,” Barcellona said. “Believe it or not, that is a very difficult communication mechanism to accomplish. There are a lot of barriers in place.”
One of these barriers is patient privacy concerns. He said about two years ago, the federal government implemented an information blocking rule, which requires patient permission to share medical records with third parties. Barcellona said this raises privacy concerns for hospitals. He believes states and the federal government need to figure out easier ways for patients to consent to overall care and to share their health data with a series of providers across various conditions.
“What California’s considering in the digital exchange framework is creating additional rules that would make it simpler, so that when a patient has a treating physician, the hospital is automatically wired to send those notices to the treating physician,” Barcellona said. “That’s kind of where we’re at—that’s one of the big technical hurdles.”
He said another major hurdle is that the electronic pipelines to get ADT notifications from one provider to another need to be developed.
“Smaller providers need to have affordable, easy access to ADT notifications, and that’s where this notion of qualifying health information organizations (QHIOs) comes about,” Barcellona said.
Barcellona said APG believes QHIOs can be formed across the state of California to serve as an intermediary to route the notifications from larger facility-based providers to smaller, independent practice providers. Additional concerns arise for individuals who may not have a primary care provider.
“The digital exchange framework is envisioned—the way I understand it by the state—is that these other provider types, ‘non-medical providers’ if you will—are going to be included in this information exchange as well,” Barcellona said.
These provider types include providers who focus on social determinants of health, behavioral health, social services, and substance use.
When it comes to benefitting patients, Barcellona thinks an increase in ADT notifications will assist seniors the most.
“Seniors are the most acute demographic in healthcare. They’re the ones who need the most interaction when they’re being discharged,” Barcellona said.
He highlighted some of the challenges seniors face, such as getting prescribed medications mixed up and as a result, suffering from overdoses. Furthermore, older adults who live alone are prone to falling, breaking bones, and landing in hospitals.
“In many cases, it’s likely that they’re not going to be able to come back to that independent living right away, if at all,” Barcellona said.
According to Barcellona, it’s common to see a pattern of two to three falls within a single individual, and there becomes a point in time where they need to be transitioned into long-term care facilities. He also emphasized the importance of full-person care for seniors with these experiences, including counseling.
“They become clinically depressed,” Barcellona said. “This is a change in their life. They’re losing their independence. They not only need medication therapy management to make sure they don’t overdose, but they need these additional services.”
ADTs are critical to ensure all of the patient’s needs are covered, and so that providers have the opportunity to identify and connect with patients experiencing health concerns. For seniors, that means when falls and transitions in care centers occur, primary care providers will be in the know, and potentially connect the patient with appropriate services.
Barcellona said state legislators are learning about the process as time carries on.
“The governor has implemented the digital exchange framework—the legislature agreed to it. It was enacted two years ago under AB 133,” Barcellona said. “It’s being implemented now—this year. It’s a very ambitious process where in some ways, [we’re] trying to fly an airplane while we’re building it.”
Since the US healthcare system is one of the most complex in the world, Barcellona sees benefits in developing more granular rules around the digital exchange framework. He also acknowledged that hurdles arise along the way, and not every issue can be tackled or managed at once.
“It’s just not humanly possible given the complexity of our system,” Barcellona said.
According to Barcellona, California wants to develop this digital exchange framework over time and in a way that allows for good thought and consideration regarding hurdles when they arise. This legislative session, he said mechanisms will be set up for the governance and oversight of this exchange.