Overview

A common ask for our customers is to know when a patient they are treating has been admitted or discharged from the ER or hospital. Most hospital systems support exchanging information via HL7 messages. One type of HL7 message is ADT, which stands for Admit, Discharge, Transfer. This is a real-time (or near-real-time) alert that can be made when a patient interacts with a hospital system or post-acute care facilities.

Customers want these alerts so they know if a patient has had an acute incident. Particularly in a risk-based business model (i.e. Value-Based Care), if a patient they are managing goes to the ER, that is likely a sign of both very high utilization (costs) but also that there are underlying issues that need more support to ensure the patient’s treatment is managed.

While almost all customers want ADTs, the major issue is that ADT integrations typically have to be created (via HL7v2 and a point-to-point VPN) with each hospital system. Particle offers a streamlined way to get ADT feeds without doing all the individual integration work.

Customers provide a cohort of attributed patients for whom the customer is managing and/or coordinating care. When one of these patients is admitted, transferred, discharged, or deceased at an Admitting Facility in the Particle community, the customer will receive a real-time notification about the patient's care encounter.

ADT Monitoring Workflow

1. Create a patient using the Patient API
2. Subscribe to receive ADT HL7 messages for the patient using the Subscriptions API
3. Create a callback endpoint (on your systems) and register it with Particle.
4. Receive an ADT notification on your registered callback endpoint.
5. Retrieve an ADT HL7 message using the HL7 API (Retrieving HL7 Message).

Note

Once a patient is subscribed, ADT monitoring will start from the 1st of the following month. For example, if a patient subscription is created on January 5th, monitoring will start on February 1st.

Creating Patients and Subscriptions

As explained in the workflow above, Patient ADT monitoring happens in two steps using the Particle Health Patient API and Subscriptions API. If you have already created a patient using the Patient API, you may use the Subscriptions API to create the subscription for monitoring the patient.

🚧

DO NOT use the Patient API to delete a patient if you want to stop receiving ADT notifications. Use the Unsubscribe Subscriptions API.

ADT Notifications

When a monitored patient has an ADT event at a facility in the Particle community, a notification will be sent to the registered callback endpoint. Refer to the Event Notification documentation on how to set up callback endpoints to receive ADT notifications. The notification message will contain a message id and the id of the patient for whom an ADT is available. The corresponding ADT HL7 message can be retrieved using Particle Health HL7 API.

{
  "specversion":"1.0",
  "id":"6a537bf6-ebc4-402e-ad27-92b3ce467dbc",
  "source":"api/notifications",
  "type":"com.particlehealth.api.v1.hl7v2",
  "datacontenttype":"application/json",
  "time":"2022-10-01T10:10:44.00Z",
  "data":{
    "patient_id":"bb97b572-17da-4e97-a306-c0daaf3328b1",
    "message_id":"2a416e07-0b8a-48dd-a327-7d6578550c04",
  }
}

Retrieving HL7 message

Example Request

curl -X POST -H “Authorization: $authToken” https://api.particlehealth.com/hl7v2/{message_id}

Response Model

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
  

Message Format

ADT HL7 messages are retrieved by calling the HL7 API with the message_id, which is included in the ADT Notification sent to the registered callback endpoint. The HL7 message is embedded inside a JSON structure which is encoded in Base64.

Here is a sample encoded HL7 API response:

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

Which corresponds to the following decoded message:

{"hl7Message":"MSH|^~\\&|Particle Health_ADT|1122^St. Mary Hospital^HOS|RECEIVING_APP|1234^Sample Health|20190306081949||ADT^A08|752f3eab-2d11-411a-b597-2b08325d1f20|P|2.5\rEVN|A08|20190305214300||EDIT_ENCOUNTER\rPID|1|35774410^^^PP^PP|a5782a06-95b5-47b3-be19-10ea60693f3c^^^sam^sam||Weasley^Fred^||19780401|M|||11400 Lansdowne St^^Boston^MA^02215|||||||439682389064|\rPD1||||1063484053^Haque^Mohammed^^^^\rPV1|1|E|||||1601234567^Rubeus^Hagrid^^^^|||||||Home|||||454123456789|||||||||||||||||||||||||20190305214300||||||31377573\rIN1|1|||Self Pay  J|||||||||||Self Pay|||||||||||||||||||||UNKNOWN\rZMD|51603c65-839b-48a0-9e9f-b3b7fa0c13d0\rZPP|PROGRAMS\rZPP|--------\rZPP|1. Sample Health\rZPP|2. ACME Health\rZPP|\rZPP|\rZPP|PRACTICES\rZPP|--------\rZPP|1. Practice Unknown\rZPP|\rZPP|\rZPP|CARE COORDINATORS\rZPP|-----------------\rZPP|Name.   : Transitions of Care Team\rZPP|Phone.  : 855-677-8787\rZPP|Email.  : \rZPP|Fax.    : 866-567-1010\rZPP|-------------------------------------\rZPP|Name.   : Utilization Management\rZPP|Phone.  : 877-333-6161\rZPP|Email.  : \rZPP|Fax.    : \rZPP|-------------------------------------\rZPP|\rZPP|\rZPP|ADMIT CARE INSTRUCTIONS\rZPP|-----------------------\rZPP|1. All other health plans call (212) 555-8697 and ask to speak with the Extensivist on call.\rZPP|2. Fidelis MMP call (877) 333-6161 for an authorization.\rZPP|\rZPP|\rZPP|DISCHARGE CARE INSTRUCTIONS\rZPP|---------------------------\rZPP|1. Call (855) 255-8282 to reach or get a message to a Transition Coordinator.\rZPP|\rZPP|\rZPP|OTHER CARE PROVIDERS\rZPP|--------------------\rZPP|Name.   : Luna Lovegood \rZPP|Phone.  : \rZPP|Email.  : \rZPP|Fax.    : \rZPP|Cohort Name    : Practice Unknown\rZPP|-------------------------------------\rZPP|\rZPP|\r"}

Receiving Test ADT Messages in Sandbox

1. Work with your Particle representative to enable ADTs in your Sandbox environment

2. Configure the callback URL that you would like us to send ADT notifications to.

   Note: Unlike in the production environment, we do not need to pre-register the callback URL for our customers in order for them to start receiving notifications. You are free to use any callback URL you would like.

3. Submit demographics for a patient using the Patients API.

   POST /api/v1/patients

4. Subscribe to the patient using the Subscriptions API.

   POST api/v1/subscriptions/adt/{patient_id}

5. Request an ADT notification using the HL7v2 API.

   POST /hl7v2/notification/test

   Request Body

   JSON

   {
       "patient_id": "test-patient-id",
       "event_type": "A01", // valid: A01, A02, A03, A04, A08
       "callback_url": "http://test-webhook-url", // URL of webhook from step 2
       "display_name": "Test ADT Notification 1" // display name for the webhook
   }
   

6. You will receive a notification at the webhook you specified. This notification will contain the Patient ID and a message ID.

7. Retrieve the sample ADT message using the HL7v2 API.

   GET /hl7v2/{message_id}

   Sample ADT messages are customized based on the patient and ADT event type specified.

Frequently Asked Questions

1. Is ADT coverage similar to Query API coverage?

Unlike the CCDA/FHIR Query APIs, ADTs are not restricted within a radius around a zip code. When a monitored patient has an encounter in any care facility within Particle's network, the corresponding ADT is available and can be retrieved after receiving a notification.

2. What is the format of the ADT message?

ADT messages are delivered as Base64-encoded JSON containing the raw HL7 V2 message. Messages are encoded in Base64 to ensure HL7 V2 standard encoding characters (| & ^ ~) are transmitted without corruption.

3. Do you support FHIR?

At this time ADT messages are not available in the FHIR format. However, Particle will consider offering this feature if there's sufficient demand.

4. What ADT event types are available?

The following ADT events are supported:

Note:

Update Patient (A08)

Applies to the preceding event. When patient information is updated, such as insurance, that update should link to the previous admission or discharge event.

Register Patient (A04)

Creates a presented event for ED presentations. This means for an A04 message with a patient class of emergency, the event will be mapped to CREATE_PRESENTED in the EVN.4. Additionally, Registration events do not precede an admit event unless the patient is returning to the ED.