Sending a Notification of a Patient’s Admission, Discharge and/or Transfer Status to Other Providers

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	HL7® 2.5.1 (or later) ADT message	Final	Production		No	Free	No
Implementation Specification	IHE Patient Administration Management (PAM) Integration Profile	Final	Feedback requested	Feedback Requested	No	Free	No
Implementation Specification	HL7 FHIR® DaVinci Unsolicited Notifications Implementation Guide	Balloted Draft	Pilot		No	Free	No
Implementation Specification	ANSI/DS 2020-03-100-2022 - Event Notifications via the Direct Standard™ Release Version 1.0	Final	Production		No	Free	No
Emerging Implementation Specification	Carequality Subscription Implementation Guide for Push Notifications	In Development	Pilot	Feedback Requested	No	Free	No

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
A variety of transport protocols are available for use for event notifications delivery. Trading partners will need to determine which transport tools best meet their interoperability needs, however, Direct (referenced further in Exchange/Services - "Push" Exchange), has been adopted by both EHRs and by intermediaries as a prominent option for transport. Even when HIE networks are in place, Direct is often used as a transport protocol to deliver notifications to EHRs in provider workflows. DirectTrust Standards Implementation Guide "Event Notifications via the Direct Standard(R)" provides a profile for the payload included in event notifications when Direct is the transport. The guide standardizes HL7 2.5.1 usage and maps metadata elements to support appropriate routing and workflow for receiving systems. Human readable text is also stipulated as a part of the specification to support uncomplicated edge systems. The Implementation Guide was published and ANSI approved May 11, 2022.	Secure Communication – Create a secure channel for client-to-server and server-to-server communication. Secure Message Router – Securely route and enforce policy on inbound and outbound messages without interruption of delivery. Authentication Enforcer – Centralized authentication processes. Authorization Enforcer – Specifies access control policies. Credential Tokenizer – Encapsulate credentials as a security token for reuse (e.g., – SAML, Kerberos). Assertion Builder – Define processing logic for identity, authorization and attribute statements. User Role – Identifies the role asserted by the individual initiating the transaction. Purpose of Use -Identifies the purpose for the transaction.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

A variety of transport protocols are available for use for event notifications delivery. Trading partners will need to determine which transport tools best meet their interoperability needs, however, Direct (referenced further in Exchange/Services - "Push" Exchange), has been adopted by both EHRs and by intermediaries as a prominent option for transport. Even when HIE networks are in place, Direct is often used as a transport protocol to deliver notifications to EHRs in provider workflows.
DirectTrust Standards Implementation Guide "Event Notifications via the Direct Standard(R)" provides a profile for the payload included in event notifications when Direct is the transport. The guide standardizes HL7 2.5.1 usage and maps metadata elements to support appropriate routing and workflow for receiving systems. Human readable text is also stipulated as a part of the specification to support uncomplicated edge systems. The Implementation Guide was published and ANSI approved May 11, 2022.

Secure Communication – Create a secure channel for client-to-server and server-to-server communication.
Secure Message Router – Securely route and enforce policy on inbound and outbound messages without interruption of delivery.
Authentication Enforcer – Centralized authentication processes.
Authorization Enforcer – Specifies access control policies.
Credential Tokenizer – Encapsulate credentials as a security token for reuse (e.g., – SAML, Kerberos).
Assertion Builder – Define processing logic for identity, authorization and attribute statements.
User Role – Identifies the role asserted by the individual initiating the transaction.
Purpose of Use -Identifies the purpose for the transaction.

Comment

Submitted by ScottStuewe on 2024-04-05

When Direct is used, The standard should be used

Please add this to "Dependencies, Limitations and Pre-conditions": "When Direct Secure Messaging is utilized for Event notifications to providers, senders should always utilize the full specification as stipulated in the latest version at this link. https://directtrust.org/standards/event-notifications-via-direct/versions. Many intermediaries are sending unformatted, text only notifications to Direct Addresses in the network. Most systems will not be able to process these messages without metadata. A great many EHR companies built receiving support for the specification routing notifications to unique workflows in their system. The specification also requires that the message body contain a text-only rendition of required elements that supports receivers that cannot process the metadata or the attachments. Intermediaries that send plain text event notifications via Direct need to know that most of these never reach the intended recipient. "

Submitted by ScottStuewe on 2023-04-07

Updates to Event Notifications Via the Direct Standard (R)

This entry should be updated to reflect current adoption and status of the standard.

Here is a link to the published Standard: https://directtrust.org/standards/event-notifications-via-direct

Direct Standard(r) is now a Registered Trademark.

Process Maturity Level should be "Final"

Adoption Level should be "Medium" - three "dots".

Update the Limitations in the following matter:

A variety of transport protocols are available for use for event notifications delivery. Trading partners will need to determine which transport tools best meet their interoperability needs, however, Direct (referenced further in Exchange/Services - "Push" Exchange), has been adopted by both EHRs and by intermediaries as a prominent option for transport. Even when HIE networks are in place, Direct is often used as a transport protocol to deliver notifications to EHRs in provider workflows.
DirectTrust Standards Implementation Guide "Event Notifications via the Direct Standard(R)" provides a profile for the payload included in event notifications when Direct is the transport. The guide standardizes HL7 2.5.1 usage and maps metadata elements to support appropriate routing and workflow for receiving systems. Human readable text is also stipulated as a part of the specification to support uncomplicated edge systems. The Implementation Guide was published and ANSI approved May 11, 2022.

Submitted by kwboone on 2017-11-20

Consider IHE Patient…

Consider IHE Patient Administration Management profile for this message: http://wiki.ihe.net/index.php/Patient_Administration_Management

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Sending a Notification of a Patient’s Admission, Discharge and/or Transfer Status to Other Providers

Comment

When Direct is used, The standard should be used

Updates to Event Notifications Via the Direct Standard (R)

Consider IHE Patient…

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