Statewide ENS Framework
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 some clinical data, such as reason for visit 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 receive alerts for their patients from all EDs, hospitals, and post-acute facilities submitting ADTs 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 receive ADT alerts from all EDs, hospitals, and post-acute care facilities submitting ADTs 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 provides access to ADT alerts from all acute care hospitals in the Commonwealth when providers subscribe with a single Certified ENS Vendor. This framework, how it works, and the related participation requirements are explained below.
Statewide ENS Framework Overview Video
Review the animated video below to learn about the Statewide ENS Framework
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, ENS Vendor Portal, sFTP, and/or EHR.
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 interconnect their ENS systems to serve all care providers in Massachusetts. This means that care providers in the Commonwealth can subscribe to a single, interoperable certified ENS vendor to receive ADT alerts from all Massachusetts Acute Care Hospitals in addition to other contributing care facilities, to coordinate care after ADT events.
The Statewide ENS Framework includes regulations that require all Acute Care Hospitals in Massachusetts to submit ADTs 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 interconnect with the other Certified ENS Vendors,
- Requires Acute Care Hospitals to submit ADT alert notifications (Submitters) to one Certified ENS Vendor, 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.
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.
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 Certified ENS Vendors in the Statewide ENS Framework can assist hospitals in using ENS to comply with 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 an Acute Care Hospital 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.
Requirements and Eligibility
EOHHS imposed the following requirements and eligibility rules for the Statewide ENS Framework.
Submission Requirements:
- All Massachusetts Acute Care Hospitals are required to submit Admit, Discharge, and Transfer (ADT) data to one Certified ENS Vendor as of April 1, 2021. The vendors can also assist hospitals in meeting the CMS-9115-F ADT regulations to receive Medicare and Medicaid reimbursements.
Subscription Requirements and Eligibility: Subscription to the framework is an indirect process. To subscribe, care providers need to select, and subscribe to, one of the Certified ENS Vendors:
- MassHealth ACOs need to take into account that MassHealth ACOs are required to have event notification protocols that alert key providers and individuals involved in an Enrollee's care about admission, discharge, transfer and other important care events.
- MassHealth CPs need to subscribe to one Certified ENS Vendor, as per their agreement with EOHHS.
- All Massachusetts providers are eligible and encouraged to subscribe to a Certified ENS Vendor to receive ADT alerts. This includes all Massachusetts providers who are actively involved in treatment, payment, health care operations, and/or public health activities.
The Mass HIway encourages all Massachusetts providers to subscribe to a Certified ENS Vendor in the Statewide ENS Framework to receive ADT alerts, regardless of whether they are required to do so.
Certified ENS Vendors
Currently, there are two Certified ENS Vendors, Collective Medical (now part of PointClickCare) and Bamboo Health (formerly PatientPing + Appriss Health), 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.
As part of the certification, the Certified ENS Vendors had to demonstrate that they have business operations and a significant submitter base in Massachusetts. This ensures that subscribing providers get immediate access to a substantial submitter 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.
About PointClickCare
PointClickCare is a leading healthcare technology platform enabling meaningful care collaboration and real‐time patient insights. PointClickCare’s platform spans the care continuum, fostering proactive, holistic decision‐making, and improved outcomes for all. More than 2,800 hospitals, 27,000 long‐term and post‐acute care providers, 3,600 ambulatory clinics, 350 risk-bearing providers, 70 state and government agencies, and every major U.S. health plan use PointClickCare for care collaboration and value‐based care delivery for millions across North America.
Website: pointclickcare.com
Solution: pointclickcare.com/products/
Contact: Customer Support
Tel: 801-285-0770
Request a Demo: Please complete the interest form and select product “other”: https://pointclickcare.com/request-a-demo/
Advanced, Real-Time Alerts for Improved Patient Outcomes
Bamboo Health 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.
Bamboo Health also supports the CMS-9115-F ADT alert requirements.
Contact Bamboo Health for questions and/or to subscribe to submitting ADTs or receiving ENS alerts via their ENS solution:
Website: bamboohealth.com
Solution: bamboohealth.com/solutions/pings/
Network: bamboohealth.com/the-bamboo-health-network/
Contact: Bamboo Health Business Development
Tel: 857-382-5113
Email: growthopportunities@bamboohealth.com
ADT Alerts: Understanding the Massachusetts ENS Landscape and Making the Most of ADT Alerts – Webinar
Review the webinar below to learn more about the Massachusetts ADT Landscape, including the Statewide Event Notification Framework. Common challenges and best practices, including optimizing ADT alert feeds and follow-up workflows, are also discussed.
ADT Alerts: Understanding the Massachusetts ENS Landscape and Making the Most of ADT Alerts – June 2023-PDF
For questions or concerns related to the Statewide ENS Framework, you can contact the Mass HIway via the contact information provided below.