As healthcare systems attempt to keep pace with the transformation of the digital age, lapses in data collection create additional challenges for patients and providers in California. Erica Galvez, CEO of Manifest MedEx—California’s largest nonprofit health information organization—highlighted the need for providers to access ADT (admission, discharge, and transfer) data regarding patients.
Galvez wove her way into the healthcare field through a 2005 research study that was focused on culturally competent care. From there, she dove further into patient safety and healthcare equity research, during a time when the use of electronic health records (EHRs) was fairly recent. For the last six years, Galvez has been at Manifest MedEx.
“We often call ADTs small but mighty,” Galvez said. “An ADT message is literally a message. It’s a small byte of information that automatically gets generated out of the back end of an EHR. Those messages get generated at certain triggers through a patient’s journey.”
ADTs are not entire medical records, but rather a snapshot relaying the time, date, and location of a patient’s admission, discharge, or transfer. Each time a new message, or ADT, is generated, the providers caring for that patient can learn more about their healthcare concerns in real time. The only catch is: for providers to receive ADTs, they must be connected to an electronic health information exchange (HIE) network that can relay notifications from a broad network of connected hospitals and other HIEs, or through other platforms and EHRs by contracting with individual hospitals. But, to make sure providers are getting ADTs from all hospitals in the area they serve, they must be connected to a larger network.
“Organizations or providers that participate in a network like Manifest MedEx, because of our scale—we have over 125 hospitals sending ADT messages into our network—they’re going to get pretty good coverage for their patient panels in terms of notifications,” Galvez said. “But not every hospital is connected to us in the state of California, and that means there will be gaps in the notifications that those providers get.”
Galvez is mindful of smaller and more rural networks that have finite resources, who oftentimes care for the most vulnerable patients, and acknowledges their difficulties accessing ADTs. Providers that are not connected to an HIE experience greater issues of digital equity, which Galvez believes state funding would address.
“I have yet to meet a provider who does not want to know when their patients are in the hospital,” Galvez said. “They want to know. They want to take good care of their patients, and without this kind of notification structure, they have zero visibility—unless they’re part of a large health system where they’re owned and operated by that health system, and they’re part of the technology that runs within the hospital. If they don’t have that, they don’t have visibility.”
Although each facility operates differently, providers, a care team, a care manager, nurses, or medical assistants go through ADT notifications daily, then follow-up with patients regarding recent discharges.
Galvez thinks ADTs have major benefits for all involved: patients, providers, and hospitals or healthcare facilities, and health plans. The alerts can assist with patients staying healthier for longer periods of time, creating a more patient-centered approach to care, and improving communication amongst numerous providers for a single patient.
“It’s good for the entire healthcare system in terms of cost of care also,” Galvez said. “It reduces the spend that might otherwise occur on an avoidable readmission or an avoidable emergency department visit for those patients.”
Galvez said ADTs are highly beneficial to older adults, who generally tend to have greater rates of chronic health conditions, in addition to the aging process having an impact on their overall health and wellbeing. She also thinks ADTs can be highly beneficial for individuals living with chronic health conditions.
“Folks who have a chronic condition to manage may end up in the emergency department for a whole host of reasons,” Galvez said. “Those are also folks who tend to have more than one care provider; they probably have a primary care provider, but then also a number of other specialists that they’re seeing, and you need that coordination and communication across those care team members to support that patient.”
ADTs can also be impactful when addressing vulnerable populations and social determinants of health, which are social drivers that affect the health and wellbeing of individuals. If an individual is admitted to an emergency department that requires other types of support, such as stable housing, ADT notifications can assist with getting the patient in touch with resources and support for that specific need.
“I think CalAIM has really recognized that hospital interactions can be indicative of a whole host of other social issues that need to be addressed in order for a person to live a healthy, long life,” Galvez said. “I also see these ADT notifications as a part of that structure that helps surround an individual who has particular social needs—it helps the care team identify those needs and act on them.”
CalAIM, which stands for California Advancing and Innovating Medi-Cal, is working to strengthen and transform Medi-Cal through creating a more equitable, coordinated, and person-centered approach.
Although Galvez sees the importance in ADT notifications, there is yet to become a seamlessly connected ADT network within California. Galvez mentioned that she’s been speaking with lawmakers about creating a digital health data safety net, creating a seamless ADT structure that builds upon existing infrastructure, and requiring hospitals to participate in ADT data collection sharing.
“We really think the state should be investing in that—that’s what’s going to propel a number of the programs that they’ve focused on for Californians, so that’s also a big topic of conversation for us,” Galvez said. “It’s something that benefits everybody. That’s part of why we think it should be funded by the state because the benefits really cover the entire population.”