The purpose of an Event Notification Service (ENS) is to alert care providers about their patients’ Admissions, Discharges, and Transfers (ADT) to and from Emergency Departments (ED), hospitals, and post-acute care facilities. ADT alerts can include clinical data, such as reason for visit, test results, and diagnosis depending on the ENS services provided.
ENS is a specialized form of Health Information Exchange (HIE) that occurs after ADT events. It relies on an ENS system to automate the ADT alert distribution to efficiently and securely send patient information to care providers. ENS is offered by ENS vendors that have developed such an ENS system. When providers subscribe to an ENS vendor, they can exchange alerts with all providers subscribed to the same vendor.
To expand their service, ENS vendors can partner to interconnect their ENS systems into an ENS network in which each system shares all incoming alerts with the interconnected systems. Their subscribers can then exchange ADT alerts with all providers subscribed to any vendor in this interoperable ENS network.
The ENS concept was pioneered in 2013 to leverage available patient data from HL7 ADT messages (HL7 ADT = Health Level Seven, Admission, Discharge, Transfer). Since then, many vendors have developed ENS systems and networks to supply ENS to healthcare communities.
To enable the utilization of ENS across Massachusetts, EOHHS and the Mass HIway developed the Statewide ENS Framework to create an interoperable ENS network that serves all care providers in the Commonwealth. This framework, how it works, and the related participation requirements for the Massachusetts care providers are explained below.
How ENS Works
When a hospital, Emergency Department, or post-acute care facility participates in ENS, their admissions, discharges, and transfers of patients trigger ADT alerts to the ENS system. Upon receipt of an alert, the ENS system runs through a patient-provider matching algorithm that locates the subscribed providers with an existing care relationship with the same patient.
When patient-provider matches are found, the ENS system generates and sends alert notifications to all the subscribed providers who serve the same patient as illustrated below. The notifications include the clinical data provided with the ADT alert. The subscribed providers may be able to choose what, when, and how they want to receive the alert notifications, including:
- What they want to be notified about. For instance: admissions only, discharges only, both admissions and discharges.
- How often they receive the notifications. For example: real time per patient, or daily in a multi-patient summary list.
- How they technically receive the notifications. For instance: Direct Message, Secure Webmail, SFTP.
If the ENS system is part of an interoperable ENS network, it will also pass the alert on to all the interconnected ENS systems, which will then run their patient-provider matching algorithms to send notifications to their subscribed providers as well. This ADT alert sharing and distribution process is illustrated in the animation in the top-right corner of this page.
What is the Statewide ENS Framework?
The Statewide ENS Framework developed by EOHHS and the Mass HIway constitutes an interoperable ENS network consisting of Certified ENS Vendors who have interconnected their ENS systems to serve all care providers in Massachusetts.
The Certified ENS Vendors have been certified by the HIway to meet specific functional, data security, data sharing, and business criteria focused on ensuring statewide ENS access, delivery, reliability, and integrity. To learn more about the certification process, click here.
To participate in the Statewide ENS Framework, the Certified ENS Vendors have agreed to share all incoming ADT alerts with the other Certified ENS Vendors for distribution to their collective subscribers. This means that each care provider in the Commonwealth only needs to subscribe to a single Certified ENS Vendor to send and/or receive the alerts pertaining to their patients.
The Statewide ENS Framework includes regulations that require all Acute Care Hospitals in Massachusetts to subscribe to one Certified ENS Vendor. The framework thereby ensures that all Massachusetts care providers who subscribe to any of the Certified ENS Vendors can receive ADT alert notifications from all Acute Care Hospitals in the Commonwealth, as shown in the graphic below.
The Statewide ENS Framework shown in this graphic:
- Certifies, interconnects, and leverages the capabilities of Certified ENS Vendors with a presence in Massachusetts,
- Holds these Certified ENS Vendors accountable to a comprehensive set of ENS Framework obligations,
- Requires the Certified ENS Vendors to share all incoming ADT alerts with the other Certified ENS Vendors,
- Requires Acute Care Hospitals to subscribe to one Certified ENS Vendor to submit ADT alert notifications (Submitters), and
- Encourages all other care providers to subscribe to one Certified ENS Vendor to receive alert notifications (Recipients).
Purpose of the Statewide ENS Framework
Numerous hospitals, PCPs, payers, and other parties involved in coordinating patient care already use ENS for care coordination. The Statewide ENS Framework was developed to streamline, interconnect, and expand the utilization of ENS across Massachusetts, and was commissioned by EOHHS as part of the Massachusetts ENS Initiative. To read more about the initiative, click here.
Utilization of ENS via the Statewide ENS Framework will improve the continuity and quality of care, enable patient engagement, reduce hospital re-admissions, lower the cost of care, and offer other clinical and business advantages to Massachusetts care providers. To review a full list of ENS advantages that the framework enables, click here.
On June 30, 2020, CMS released the Interoperability and Patient Access Rule (CMS-9115-F), which requires hospitals to send ADT notifications to other care providers in order to maintain eligibility for Medicare and Medicaid reimbursements. The Statewide ENS Framework can be used by hospitals to meet the CMS requirement. To read more about the CMS rule, click here.
ADT Alert Flow across the Statewide ENS Framework
The Statewide ENS Framework operates the same way as other interoperable ENS networks. When an ADT alert comes in at a Certified ENS Vendor, the alert and related clinical data will be distributed by the interconnected ENS systems to the providers subscribed to any of the Certified ENS Vendors. The image below illustrates the data flow that occurs when a subscriber submits an ADT alert.
This illustration shows three Certified ENS Vendors. Currently there are only two Certified ENS Vendors.
Additional ENS vendors can apply to get certified to join the Statewide ENS Framework in the future.
Subscription Requirements and Eligibility
EOHHS imposed the following requirement and eligibility rules for providers to subscribe to the Statewide ENS Framework. Subscription to the framework is an indirect process. To subscribe, care providers need to select, and subscribe to, one of the Certified ENS Vendors:
- All Massachusetts Acute Care Hospitals are required to subscribe to one Certified ENS Vendor to submit Admit, Discharge, and Transfer (ADT) data by April 1, 2021. This can also enable organizations in meeting the CMS-9115-F ADT regulations to receive Medicare and Medicaid reimbursements.
- MassHealth ACOs need to take into account that ADT requirements for MassHealth ACOs state that they need to increase the use of real-time notification systems in accordance with their DSRIP plans.
- MassHealth CPs need to subscribe to one Certified ENS Vendor, as per their agreement with EOHHS that they must do so when the Statewide ENS Framework becomes available.
- All Massachusetts providers are eligible and encouraged to subscribe to a Certified ENS Vendor to receive ADT alerts. This includes, but is not limited to, Accountable Care Organizations, Clinically Integrated Networks, PCPs, and Specialty Care Providers.
The Mass HIway encourages all Massachusetts providers to subscribe to a Certified ENS Vendor in the Statewide ENS Framework to send and/or receive ADT alerts, regardless of whether they are required to do so.
Certified ENS Vendors
Currently, there are two Certified ENS Vendors, CollectiveMedical and PatientPing, from which care organizations and providers can choose. A brief introduction to each vendor and their ENS system is provided below. For a full overview, visit the vendors' websites.
Both vendors have been certified to meet the Statewide ENS Framework certification criteria. It is up to the care providers to select the solution most appropriate for their business and clinical processes. The Mass HIway neither endorses nor recommends one Certified ENS Vendor over another. For some providers it may be useful to subscribe to both ENS vendors, as their functionalities and the patient information that can be sent with the ADTs may vary per system.
As part of the certification, the Certified ENS Vendors had to demonstrate that they have business operations and a significant subscriber base in Massachusets. This ensures that subscribing providers get immediate access to a substantial subscriber list that may overlap with the care providers they partner with.
The Statewide ENS Framework will be governed, maintained, and updated to ensure continued ENS availability, capability, and quality. The Certified ENS Vendors have agreed to specific terms, conditions, and obligations, and they will need to have their solution recertified every 2 years. To learn more about ENS vendor certification, click here.
ADT-Based Care Collaboration Network
CollectiveMedical offers a cost-effective solution that ensures hospitals, psychiatric hospitals, and critical access hospitals are completely compliant, without the need for any additional intermediary service providers.
CollectiveMedical combines data from sources spanning the care continuum, including ADT, continuity of care documents (CCD), claims data, prescription drug histories (PDMP/PMP), imaging, and more, to give deep insights into patients’ activities.
CollectiveMedical also supports the CMS-9115-F ADT alert requirements.
Contact CollectiveMedical for questions and/or to subscribe to submitting ADTs or receiving ENS alerts via CollectiveMedical's ENS solution:
Contact: David Kimball
Advanced E-Notifications System
PatientPing delivers real-time notifications whenever your patients experience care events, whether they are at a hospital, ED or post-acute (SNF, LTACH, HHA, IRF, hospice).
Pings (alerts) allow you to scale how you manage your patient populations. Pings can be embedded within your existing workflow systems or used natively through our web and mobile user experience.
PatientPing also supports the CMS-9115-F ADT alert requirements.
Contact PatientPing for questions and/or to subscribe to submitting ADTs or receiving ENS alerts via PatientPing's ENS solution:
Contact: Elizabeth Weber
For questions or concerns related to the Statewide ENS Framework, you can also contact the Mass HIway via the contact information provided below.