Because You Needed Another Regulatory Headache Right Now: Electronic Notifications of Admission, Transfer and Discharge Required in 2021

Hospitals (including critical access hospitals) will be required as of May 1, 2021, to provide "patient event notifications" electronically for all admissions, transfers, and discharges. If you are the proud owner of a record system that does not allow for such notifications, you are off the hook for now, but probably not for long. So, hospital leaders—it is time to start talking to your IT people (if they are still speaking to you after you get done talking to them about the price transparency requirements).

The requirement is part of a final rule published May 1, 2020 by the Centers for Medicare and Medicaid Services (CMS) regulating interoperability and patient access to health data. The final rule includes changes to Conditions of Participation (CoP) governing medical records. While some parts of the rule are effective sooner, this part of the rule (the notifications) are not in effect until May 1, 2021.

The required notifications are essentially automatic electronic messages to other providers whenever a patient is admitted as an inpatient or registered in the emergency department, or transferred or discharged. It is permissible to use a vendor/third party for the notifications. The required content is minimal—the patient's name, the treating practitioner's name, and the name of the sending hospital. The notifications go to other providers treating the patient such as the primary care provider, or an entity to which the patient is being transferred or discharged, or another community provider identified by the patient.

The final rule gives some examples of when the notifications are (or are not) necessary. For example, if an outpatient goes to the emergency department and is admitted from there to observation, a notification is required when the outpatient registers at the emergency department. If that same patient is later changed to inpatient status, a second notification is required. If that patient is then moved internally from a general medical floor to an intensive care unit, no notification is required.

If the recipient of the notifications does not want all those darn notifications clogging up his or her inbox, CMS gives hospitals the flexibility to tailor the notifications accordingly so long as the hospital could send all required notifications if necessary.

These notifications do not require separate patient authorization, as they are considered to be for treatment, care coordination, and quality assurance purposes. However, if the patient actually objects to the notification, as long as it is consistent with state law the hospital can accommodate the patient's wishes.

So, what should your hospital do to prepare? Here are some suggestions:

• Evaluate whether your current electronic health record has the capacity to send these electronic notifications of admission, transfer and discharge. If not, breathe a (possibly temporary) sigh of relief.
• Develop a policy that allows you to tailor the automatic notifications according to the parameters above, e.g., if the recipient only wants certain notifications, or the patient does not want you to send notifications.
• Figure out a system of training individuals in the health information department about the automatic notifications and prepare your IT department for the May 21 deadline. Conduct observations and interviews with medical records staff and leadership to determine if requirements for patient event notifications are being met. You may need to ply your IT folks with gifts or at least a stiff drink if they are already dealing with telehealth changes and price transparency preparation.

For more information on how these changes may affect your facility, contact your Quarles & Brady attorney or:

• Sarah E. Coyne: (608) 283-2435 / sarah.coyne@quarles.com
• Bailey Walden: (602) 229-5432 / bailey.walden@quarles.com