For more than two decades, admission, discharge, and transfer (ADT) alerts have served as the backbone of automated patient-activity notification in U.S. health care. Designed to give clinicians and care managers a real-time heads-up when patients interact with and move through the health care system, they remain a workhorse of care coordination, and inside the facilities a care team is directly connected to, they often perform exactly as intended.
However, the way patients receive care has changed faster than the infrastructure built to track it. Patients now regularly move across multiple hospitals, urgent care centers, post-acute facilities, specialty practices, and state lines. For example, 58 percent of hospital super-utilizers (patients with four or more admissions per year) visited more than one hospital in a one-year period, according to a study in BMC Health Services Research.
The events that negatively impact clinical outcomes, including readmissions, medication errors, and missed follow-ups, often occur in the gaps between systems. ADT feeds, however well implemented, have not been built to completely fill those gaps. As a result, care teams that depend on ADTs alone may lack a full view of what is happening to their patients.
The structural limits of ADT
Three notable blind spots define the ADT model.
First, ADT alerts only transmit to care team members inside facilities directly integrated with the sending facility. When an attributed patient visits an emergency department on the other side of the state, transfers to a skilled nursing facility outside the patient’s care network, or is admitted by a specialist with no direct interface, the event may be completely invisible to the remainder of a patient’s care team. Care teams can spend weeks unaware that an encounter ever happened. For example, a recent JAMA Network Open study found that only 19 percent of family physicians reported often automatically obtaining outside notes from independent practices in their EHR.
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Second, ADT messages capture the occurrence of clinical events but not the clinical context behind them. For example, an admission notification confirms that a patient showed up at an acute care facility, but it rarely conveys the history of the presenting illness, physical findings, test results, diagnoses, medication changes, or discharge plan. Clinicians receive a notification rather than a story, and the gap between the two often determines whether safe and timely follow-up occurs.
Third, most ADT alerts depend on custom, point-to-point connections that scale poorly. Each new facility relationship requires its own interface, and in fragmented care environments, particularly in rural geographies, that model has reached its practical ceiling. Many of the facilities a patient is most likely to visit will likely never be connected.
The result is familiar to anyone working in care coordination. Teams are often notified about the events that matter least and miss the ones that matter most. The consequence? Nearly one-in-six Medicare beneficiaries discharged from a hospital are readmitted within 30 days, and avoidable readmissions remain stubbornly tied to the visibility gaps between care settings.
A new layer of network-derived awareness
A new generation of clinical alerts is emerging that does not depend on facility-level integrations at all. Instead, alerts are derived from clinical document exchange that is already moving across national health information networks and frameworks. When a clinically meaningful event triggers a document exchange anywhere in the network, a patient’s care team can be notified, regardless of whether they have a direct relationship or connection with the facility that delivered the care.
This approach changes the geometry of what is visible. Outpatient encounters and specialty care can all surface through the same channel as emergency department visits, inpatient stays, and post-acute admissions. Alerts can arrive with clinical context attached, including encounter type, summary documents, and a path to retrieve the underlying records. Care teams move from confirming that something happened to understanding what it means and deciding what to do next.
The downstream effects are significant. Medication reconciliation can happen earlier and with better information, potentially triggering patient engagement regarding potential new drug interactions, coverage limitations, or monitoring requirements. High-risk patients, including those managing chronic diseases, recovering from surgery, or living with behavioral health conditions, can be monitored across the full continuum of their care rather than inside a single network. Care gaps and quality measures can be managed more accurately and proactively based on the impact of new diagnoses or procedures performed. Value-based contracts and population health programs gain a more honest picture of where attributed patients receive care, which is the foundation for closing equity and access gaps.
One important note: It is worth being clear about what this new communications layer does and does not do. While network-derived alerts would typically also reflect clinical activity included in ADT alerts, they do not replace ADT workflows, which remain valuable inside connected facilities, particularly for bed management and operational workflows. What network-derived alerts add is visibility beyond the narrow scope of acute care events, where the most consequential missed signals often live.
Looking ahead
The infrastructure to remain continuously aware of patients wherever they receive care is no longer aspirational. Document exchange across national frameworks is operational today. Federal frameworks such as TEFCA are widening participation, and Qualified Health Information Networks are turning cross-setting awareness into an everyday capability rather than a future state.
As more data sources connect to existing data exchange networks and frameworks and as alerting becomes smarter about what information is clinically meaningful, care teams can spend less time chasing partial signals and more time acting on complete ones. The shift from event-only notification to context-rich, cross-network awareness may be one of the most consequential improvements in care coordination in a generation, and it is finally within reach for the providers and patients who stand to benefit most.
Steven Lane is a physician executive.
