ADT Networks

Zus partners with two of the major national ADT networks in the country, Collective Medical and Bamboo Health. Each of these networks are connected to Emergency Departments, Hospitals, and Urgent Care centers across the country. Notifications are sent when a patient is admitted, transferred, or discharged, enabling proactive intervention and transitional care management.

For each event, Zus will create or update an Encounter resource, along with corresponding resources for any diagnoses, practitioners, or facilities relevant to the event.

Encounter resources may contain an extension that will alert you to the following scenarios:

• The high utilizer flag applies to any patient who has visited the ED three or more times within the past 60 days.
• The readmission risk flag identifies patients who may be at risk for a 30-Day All-Cause Hospital Readmission.
• The recent inpatient stay flag builds on the readmission risk flag and applies to any current inpatient who also has had a prior inpatient hospital stay within the last 30 days.
• The recent SNF stay flag applies to patients who currently are at the hospital and have been discharged from skilled services at a SNF within the prior 30 days.

"meta": {
        "extension": [
            {
                "url": "http://bamboohealth.com/fhir/CodeSystem/healthFlag",
                "valueString": "high utilizer"
            },
          "extension": [
            {
                "url": "http://bamboohealth.com/fhir/CodeSystem/healthFlag",
                "valueString": "readmission risk"
            },
        ]

Note: Flags are sourced from a third party ADT network, and may or may not be present. The absence of a flag does not indicate that the criteria above do not apply to this patient

When sample patient John is admitted to Community Medical Center with nausea, the following Encounter resource is created in Zus:

{
    "resourceType": "Encounter",
    "id": "cf53e4ef-611c-48d5-9a22-1031790e583a",
    "meta": {
        "extension": [
            {
                "url": "http://bamboohealth.com/fhir/CodeSystem/healthFlag",
                "valueString": "high utilizer"
            }
        ],
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "VN",
                        "display": "visit number"
                    }
                ],
                "text": "visit number"
            },
            "value": "123456789"
        }
    ],
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "I",
        "display": "Inpatient"
    },
    "serviceType": {
        "coding": [
            {
                "code": "285",
                "display": "General Medicine"
            }
        ],
        "text": "General Medicine"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND",
                            "display": "attender"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/85fe2ec9-be0a-4329-ad13-6acfe0e27849",
                "type": "Practitioner"
            }
        }
    ],
    "period": {
        "start": "2022-11-11T15:45:00.000Z"
    },
    "diagnosis": [
        {
            "condition": {
                "reference": "Condition/7616e37e-e284-4287-b32f-03dbd0f07926",
                "type": "Condition"
            },
            "use": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
                        "code": "AD"
                    }
                ]
            }
        }
    ],
    "location": [
        {
            "location": {
                "reference": "Location/2fb8fb58-93b6-4429-99e9-4cfaa370c22c",
                "type": "Location"
            }
        },
        {
            "location": {
                "display": "Community Medical Center"
            }
        }
    ]
}

When he is later discharged with a diagnosis of Celiac Disease, the Encounter resource is update to include a stop time and discharge diagnosis:

{
    "resourceType": "Encounter",
    "id": "cf53e4ef-611c-48d5-9a22-1031790e583a",
    "meta": {
        "extension": [
            {
                "url": "http://bamboohealth.com/fhir/CodeSystem/healthFlag",
                "valueString": "high utilizer"
            }
        ],
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "VN",
                        "display": "visit number"
                    }
                ],
                "text": "visit number"
            },
            "value": "123456789"
        }
    ],
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "I",
        "display": "Inpatient"
    },
    "serviceType": {
        "coding": [
            {
                "code": "285",
                "display": "General Medicine"
            }
        ],
        "text": "General Medicine"
    },
    "participant": [
        {
            "type": [
                {
                    "coding": [
                        {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code": "ATND",
                            "display": "attender"
                        }
                    ]
                }
            ],
            "individual": {
                "reference": "Practitioner/85fe2ec9-be0a-4329-ad13-6acfe0e27849",
                "type": "Practitioner"
            }
        }
    ],
    "period": {
        "start": "2022-11-11T15:45:00.000Z",
        "end": "2022-11-11T18:10:00.000Z"
    },
    "diagnosis": [
        {
            "condition": {
                "reference": "Condition/7616e37e-e284-4287-b32f-03dbd0f07926",
                "type": "Condition"
            },
            "use": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
                        "code": "AD"
                    }
                ]
            }
        },
        {
            "condition": {
                "reference": "Condition/287c9d74-a7d3-9s82-90b6-h8732k73b07f",
                "type": "Condition"
            },
            "use": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role",
                        "code": "DD"
                    }
                ]
            }
        }
    ],
    "location": [
        {
            "location": {
                "reference": "Location/2fb8fb58-93b6-4429-99e9-4cfaa370c22c",
                "type": "Location"
            }
        },
        {
            "location": {
                "display": "Community Medical Center"
            }
        }
    ]
}