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.

ADT :arrow-right: FHIR

When sample patient John is admitted to Community Medical Center complaining of nausea, Zus receives an ADT message for visit number123456789 and creates an Encounter resource, along with resources for any Conditions, Practitioners, or Locations present. Any diagnoses received in an admit or discharge message will includeEncounter.diagnosis.use(values: "Admitting","Discharge"). Priority (i.e. primary, secondary diagnosis) is passed through from the sending facility via Encounter.diagnosis.rank

{
    "resourceType": "Encounter",
    "id": "cf53e4ef-611c-48d5-9a22-1031790e583a",
    "meta": {
      			"extension": [
                        {
                            "url": "https://zusapi.com/created-at",
                            "valueInstant": "2023-11-11T11:00:00.000+00:00"
                        }
                    ],
             "versionId": "1",
             "lastUpdated": "2023-11-11T11:00:00.000+00:00"
    				}
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "VN",
                        "display": "visit number"
                    }
                ],
                "text": "visit number"
            },
            "value": "123456789"
        }
    ],
    "status": "in-progress",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "I",
        "display": "Inpatient"
    },
    "serviceType": {
        "coding": [
            {
                "code": "285",
                "display": "General Medicine"
            }
        ],
        "text": "General Medicine"
    },
    "subject": {
      		"reference": "Patient/09c4d173-1af1-4668-a16f-401d94bb0eb5",
        	"type": "Patient",
        	"display": "John Doe"
    },  
    "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",
              	"display": "Patrick Adams"
            }
        }
    ],
    "period": {
        "start": "2022-11-11T15:45:00.000Z"
    },
    "reasonCode": [
        {
            "text": "Nausea"
        }
    ],
    
      
      
    "diagnosis": [
    {
        "condition": {
            "reference": "Condition/7616e37e-e284-4287-b32f-03dbd0f0792",
            "type": "Condition",
            "display": "Unspecified Abdominal Pain"
        },
        "use": {
            "coding": [
                {
                    "system": "https://terminology.hl7.org/5.2.0/CodeSystem-v2-0052.html",
                    "code": "A",
                    "display": "Admitting"
                }
            ]
        },
        "rank": 1
    }
],
    "location": [
        {
            "location": {
                "reference": "Location/2fb8fb58-93b6-4429-99e9-4cfaa370c22c",
                "type": "Location",
              	"display": "Community Medical Center"
            }
        }
    ]
}

As subsequent ADT messages arrive for visit 123456789Zus will update the existing Encounter resource to a new version, adding any new information and displaying the latest status:

ADT MessageEncounter.status
A04 (Patient Registration)in-progress
A01 (Admit)in-progress
A03 (Discharge)finished
A11 (Cancel Admit)cancelled
A13 (Cancel Discharge)in-progress

For example, when the patient is later discharged with a diagnosis of Celiac Disease, the Encounter resource is updated to include a stop time, discharge diagnosis, and a finished status:

{
    "resourceType": "Encounter",
    "id": "cf53e4ef-611c-48d5-9a22-1031790e583a",
    "meta": {
      			"extension": [
                        {
                            "url": "https://zusapi.com/created-at",
                            "valueInstant": "2023-11-11T11:00:00.000+00:00"
                        }
                    ],
             "versionId": "2",
             "lastUpdated": "2023-11-11T22:30:00.000+00:00"
    				}
    "identifier": [
        {
            "type": {
                "coding": [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code": "VN",
                        "display": "visit number"
                    }
                ],
                "text": "visit number"
            },
            "value": "123456789"
        }
    ],
    "status": "finished",
    "class": {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
        "code": "I",
        "display": "Inpatient"
    },
    "serviceType": {
        "coding": [
            {
                "code": "285",
                "display": "General Medicine"
            }
        ],
        "text": "General Medicine"
    },
    "subject": {
      		"reference": "Patient/09c4d173-1af1-4668-a16f-401d94bb0eb5",
        	"type": "Patient",
        	"display": "John Doe"
    },  
    "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",
              	"display": "Patrick Adams"
            }
        }
    ],
    "period": {
        "start": "2022-11-11T15:45:00.000Z"
    },
    "diagnosis": [
    {
        "condition": {
            "reference": "Condition/287c9d74-a7d3-9s82-90b6-h8732k73b07f",
            "type": "Condition",
            "display": "Celiac Disease"
        },
        "use": {
            "coding": [
                {
                    "system": "https://terminology.hl7.org/5.2.0/CodeSystem-v2-0052.html",
                    "code": "D",
                    "display": "Discharge"
                }
            ]
        },
        "rank": 1
    },
      {
        "condition": {
            "reference": "Condition/7616e37e-e284-4287-b32f-03dbd0f0792",
            "type": "Condition",
            "display": "Unspecified Abdominal Pain"
        },
        "use": {
            "coding": [
                {
                    "system": "https://terminology.hl7.org/5.2.0/CodeSystem-v2-0052.html",
                    "code": "A",
                    "display": "Admitting"
                }
            ]
        },
        "rank": 2
    }
],
    "location": [
        {
            "location": {
                "reference": "Location/2fb8fb58-93b6-4429-99e9-4cfaa370c22c",
                "type": "Location",
          			"display": "Community Medical Center"
            }
        }
    ]
}

Flags

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

  • high utilizer applies to any patient who has visited the ED three or more times within the past 60 days.
  • readmission risk identifies patients who may be at risk for a 30-Day All-Cause Hospital Readmission.
  • recent inpatient stay 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.
  • recent SNF stay applies to patients who currently are at the hospital and have been discharged from skilled services at a SNF within the prior 30 days.
"extension": [
    {
        "url": "http://bamboohealth.com/fhir/CodeSystem/healthFlag",
        "valueString": "high utilizer"
    }
]

Note: Flags are sourced from a third party ADT network, and not included from all data sources. The absence of a flag does not indicate that the criteria above do not apply to this patient