ADT Network
Health Gorilla's ADT Data provides event-driven notifications from a nationwide network of hospitals. ADT notifications are sent anytime a patient is admitted to a care facility, transferred to a care facility, or discharged from a care facility.
To enable ADT notifications for your practice, a roster of patients must be submitted to the Health Gorilla SFTP. Health Gorilla will enroll the patients on the roster to our ADT network. If any patient on the roster is admitted, transferred or discharged to a care facility in our network, an ADT notification will be sent from the care organization, to your tenant in Health Gorilla. Received ADTs can be accessed the following ways:
- The Health Gorilla UI
- FHIR Subscriptions
- Accessing the original HL7 via a FHIR API
Setting up SFTP
A set of SFTP credentials will be created for you and provided during the onboarding and implementation process. You can also obtain your SFTP credentials from your account manager.
Enrolling Patients
The first step of using the Health Gorilla ADT network, is creating a roster file. Each roster file should represent the current list of patients for which you would like to receive ADTs. Each new roster file upload will supersede the previously uploaded roster. This will allow you to add and remove patients from your ADT roster when needed.
Creating a Patient Roster
To enroll your patients into the Health Gorilla ADT network, a roster of your patients must be uploaded via SFTP. The roster consists of a CSV file that contains the following headers and the attributes for each patient:
| Field | Definition | Status | Format |
|---|---|---|---|
| First_name | Patient's first name | Required | String |
| Last_name | Patient's last name | Required | String |
| Date_of_birth | Patient's date of birth | Required | Date MM/DD/YYYY |
| Gender | Patient's gender (Male/Female/Other/Unknown) | Required | String |
| Zip_code | Patient's zip code | Required | 99999-9999 (last 4 digits optional) |
| Subscriber_ID | Commercial Payer ID or MBI | Required | String |
| Internal_ID | Internal ID (MRN) of the patient - the ID that a customer is using for identification of a patient in their internal system | Required | String |
| Middle_initial | Patient's middle initial | Optional | String |
| MBI | Medicare Beneficiary ID | Optional | String |
| Street_address | Patient's street address. Strongly recommended for improved matching | Optional | String |
| City | Patient's city | Optional | String |
| State | Patient's state 2-letter abbreviation | Optional | String |
| Home_phone | Patient's home phone number | Optional | String |
| Mobile_phone | Patient's mobile phone number | Optional | String |
| Email_address | Patient's email address | Optional | String |
| SSN | Patient's social security number
| Optional | 999999999 9-digit numeric string, no dashes. |
| Subscriber_ID_prefix | If member’s Subscriber ID has a prefix, e.g “MM” | Optional | String |
| Subscriber_ID_suffix | If member’s Subscriber ID has a suffix, e.g. “01” | Optional | String |
| PCP_NPI | National Provider Identifier (NPI) of patient's primary care physician | Optional | String |
SubscriberID RequirementSubscriberID is always required. There are three possible scenarios.
- The patient has commercial insurance only - Place the commercial payer ID in the SubscriberID field
- The patient has medicare only - Place the MBI in the SubscriberID AND the MBI fields
- The patient has both medicare and commercial insurance - Place the commercial payer ID in the SubscriberID field and the MBI in the MBI field.
Uploading a Patient Roster
Once you have created your patient roster, you need to upload it to the Health Gorilla SFTP using the credentials provided to you during onboarding. Once the roster is uploaded to the SFTP, Health Gorilla will use the uploaded file to enroll your selected patients to the ADT network.
Roster ManagementEach roster uploaded will supersede any previously uploaded roster. It is recommended to upload updated rosters once a week.
Receiving Notifications
When an ADT is received for a patient on your roster, a notification can be sent via text message, email or a FHIR subscription service. The original HL7, representing the ADT, can also be retrieved using the Health Gorilla FHIR API.
Notification Types
Notifications are delivered by subscription to a notification type rather than to an individual HL7 v2 trigger event. Each type pairs a trigger event with a patient class, and a notification is sent only when both match.
| Notification Type | Trigger Event | Patient Class |
|---|---|---|
| Admission to the emergency department | A01 | Emergency |
| Discharge from the emergency department | A03 | Emergency |
| Transfer from the emergency department to inpatient | A02 | Inpatient |
| Admission to an inpatient facility | A06 | Inpatient |
| Discharge from an inpatient facility | A07 | Inpatient |
A message whose patient class is neither emergency nor inpatient produces no notification, even when its trigger event is one of the five, and outpatient is the case worth naming because it's the most common. An A01 carrying an inpatient patient class produces none either, because no type pairs those two: a source system that sends direct inpatient admissions as A01, with no A06 on the same encounter, produces no notification for that admission.
Inpatient admission is carried by A06, defined in HL7 v2 as "change an outpatient to an inpatient", and inpatient discharge by A07, "change an inpatient to an outpatient". Mapping a feed by trigger event alone, expecting A01 and A03 for inpatient admission and discharge, maps it wrongly.
Health Gorilla receives and processes every ADT message regardless of trigger event. Only notification delivery depends on the pairing.
Using the Health Gorilla UI
Once an ADT is in your tenant, it can be viewed by logging into the Health Gorilla interface using the login page or by logging your users in via our embedded iframe using SSO Embedded Iframe.
Individual users can configure their own ADT notification settings in the Settings section of the UI. Users can recieve notifications via email or SMS.
Using FHIR Subscription Notifications (webhooks)
Notifications of new ADT's in your tenant can be sent via FHIR subscriptions to a webhook provided to Health Gorilla. This notification will contain all of the information associated with each ADT, including a link to the original HL7. There a three steps involved with creating a FHIR subscription:
- Create your webhook url.
- Use your webhook URL and the Health Gorilla FHIR API's to create a FHIR subscription for ADT's.
- Create the code needed to consume the notifications sent to your webhook.
FHIR Notification Example
{
"resourceType": "Bundle",
"id": "2a64a366-4c4e-496e-8848-68eac8577e30",
"type": "message",
"entry": [
{
"fullUrl": "urn:uuid:128761641d1817df3377391a",
"resource": {
"resourceType": "MessageHeader",
"id": "128761641d1817df3377391a",
"meta": {
"profile": [
"https://healthgorilla.com/fhir/StructureDefinition/hg-message-header"
]
},
"contained": [
{
"resourceType": "Organization",
"id": "1",
"identifier": [
{
"value": "1467417865"
}
],
"name": "Hospital Jungle Junction"
}
],
"extension": [
{
"url": "http://hl7.org/fhir/3.0/StructureDefinition/extension-MessageHeader.timestamp",
"valueInstant": "2023-05-10T12:33:00+00:00"
},
{
"url": "https://www.healthgorilla.com/fhir/R4/StructureDefinition/adt-event-type",
"valueCode": "A02"
}
],
"eventCoding": {
"system": "http://hl7.org/fhir/message-events",
"code": "admin-notify",
"display": "admin-notify"
},
"sender": {
"reference": "#1"
},
"source": {
"name": "EVOLUTION",
"software": "EVOLUTION"
},
"focus": [
{
"reference": "Patient/128761643f1ccfdc5778f76b",
"display": "Joe Gorilla"
}
]
}
},
{
"fullUrl": "urn:uuid:patient",
"resource": {
"resourceType": "Patient",
"id": "patient",
"meta": {
"versionId": "1684113171551",
"lastUpdated": "2023-05-15T01:12:51.551+00:00",
"profile": [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
"http://fhir.org/guides/argonaut/StructureDefinition/argo-patient"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Joe Gorilla, 72y.o., Male, Rogerston, PA, United States</div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race",
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2106-3",
"display": "White"
}
},
{
"url": "text",
"valueString": "White"
}
]
}
],
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical record number"
}
],
"text": "Medical record number"
},
"system": "https://www.healthgorilla.com",
"value": "128761643f1ccfdc5778f76b"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical record number"
}
],
"text": "Medical record number"
},
"system": "https://www.healthgorilla.com",
"value": "863117"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PT",
"display": "Patient external identifier"
}
],
"text": "Patient external identifier"
},
"value": "70284123RTE"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "PT",
"display": "Patient external identifier"
}
],
"text": "Patient external identifier"
},
"value": "326123124"
}
],
"active": true,
"name": [
{
"use": "usual",
"text": "Joe Gorilla",
"family": "Gorilla",
"given": [
"Joe"
]
}
],
"gender": "male",
"birthDate": "1950-12-27",
"address": [
{
"use": "home",
"text": "543 Elle Rd, Rogerston, PA 00725",
"line": [
"543 Elle Rd"
],
"city": "Rogerston",
"state": "PA",
"postalCode": "00725",
"country": "USA"
}
],
"link": [
{
"other": {
"reference": "Patient/128761643f1ccfdc5778f76b",
"display": "Joe Gorilla"
},
"type": "refer"
}
]
}
},
{
"fullUrl": "urn:uuid:enc",
"resource": {
"resourceType": "Encounter",
"id": "enc",
"contained": [
{
"resourceType": "Practitioner",
"id": "1",
"identifier": [
{
"value": "1111111111"
}
],
"name": [
{
"text": "John Doe",
"family": "Doe",
"given": [
"John"
]
}
]
},
{
"resourceType": "Practitioner",
"id": "2",
"identifier": [
{
"value": "1111111111"
}
],
"name": [
{
"text": "John Doe",
"family": "Doe",
"given": [
"John"
]
}
]
},
{
"resourceType": "Practitioner",
"id": "3",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "NPI"
}
]
},
"value": "2222222222"
}
],
"name": [
{
"text": "Jane Doe",
"family": "Doe",
"given": [
"Jane"
]
}
]
},
{
"resourceType": "Location",
"id": "4",
"name": "01",
"physicalType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/location-physical-type",
"code": "bd",
"display": "Bed"
}
],
"text": "Bed"
},
"partOf": {
"reference": "#5"
}
},
{
"resourceType": "Location",
"id": "5",
"name": "365",
"physicalType": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/location-physical-type",
"code": "ro",
"display": "Room"
}
],
"text": "Room"
},
"partOf": {
"reference": "#6"
}
},
{
"resourceType": "Location",
"id": "6",
"name": "00030"
}
],
"identifier": [
{
"value": "372304270065"
}
],
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0004",
"code": "E",
"display": "Emergency"
},
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0007",
"code": "C",
"display": "Elective"
}
]
},
{
"coding": [
{
"code": "0"
}
]
}
],
"subject": {
"reference": "Patient/patient"
},
"participant": [
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "ADM",
"display": "Admitter"
}
]
}
],
"individual": {
"reference": "#1"
}
},
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "ATND",
"display": "Attender"
}
]
}
],
"individual": {
"reference": "#2"
}
},
{
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code": "REF",
"display": "Referrer"
}
]
}
],
"individual": {
"reference": "#3"
}
}
],
"period": {
"start": "2023-05-10T12:33:00+00:00"
},
"reasonCode": [
{
"coding": [
{
"code": "COA"
}
]
}
],
"hospitalization": {
"admitSource": {
"coding": [
{
"code": "1",
"display": "Physician referral"
},
{
"system": "http://terminology.hl7.org/CodeSystem/admit-source",
"code": "mp",
"display": "Medical Practitioner/physician referral"
}
]
}
},
"location": [
{
"location": {
"reference": "#4"
}
}
]
}
},
{
"fullUrl": "urn:uuid:Condition/d1",
"resource": {
"resourceType": "Condition",
"id": "d1",
"meta": {
"versionId": "1684113170677",
"lastUpdated": "2023-05-15T01:12:50.677+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Coarctation of aorta</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "HL70052",
"code": "F",
"display": "Final"
}
]
},
"code": {
"coding": [
{
"system": "I10",
"code": "Q25.1",
"display": "Coarctation of aorta"
}
]
},
"subject": {
"reference": "Patient/patient"
},
"recordedDate": "2023-05-01T10:18:00+00:00"
}
},
{
"fullUrl": "urn:uuid:Condition/d2",
"resource": {
"resourceType": "Condition",
"id": "d2",
"meta": {
"versionId": "1684113170680",
"lastUpdated": "2023-05-15T01:12:50.680+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Hypertensive heart disease without heart failure</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "HL70052",
"code": "A",
"display": "Admitting"
}
]
},
"code": {
"coding": [
{
"system": "I10",
"code": "I11.9",
"display": "Hypertensive heart disease without heart failure"
}
]
},
"subject": {
"reference": "Patient/patient"
},
"recordedDate": "2023-05-01T10:18:00+00:00"
}
},
{
"fullUrl": "urn:uuid:Condition/d3",
"resource": {
"resourceType": "Condition",
"id": "d3",
"meta": {
"versionId": "1684113170681",
"lastUpdated": "2023-05-15T01:12:50.681+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Pure hypercholesterolemia, unspecified</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "HL70052",
"code": "W",
"display": "Working"
}
]
},
"code": {
"coding": [
{
"system": "I10",
"code": "E78.00",
"display": "Pure hypercholesterolemia, unspecified"
}
]
},
"subject": {
"reference": "Patient/patient"
},
"recordedDate": "2023-05-01T10:19:00+00:00"
}
},
{
"fullUrl": "urn:uuid:Condition/d4",
"resource": {
"resourceType": "Condition",
"id": "d4",
"meta": {
"versionId": "1684113170682",
"lastUpdated": "2023-05-15T01:12:50.682+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Other specified postprocedural states</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "HL70052",
"code": "W",
"display": "Working"
}
]
},
"code": {
"coding": [
{
"system": "I10",
"code": "Z98.890",
"display": "Other specified postprocedural states"
}
]
},
"subject": {
"reference": "Patient/patient"
},
"recordedDate": "2023-05-01T10:20:00+00:00"
}
},
{
"fullUrl": "urn:uuid:Condition/d5",
"resource": {
"resourceType": "Condition",
"id": "d5",
"meta": {
"versionId": "1684113170683",
"lastUpdated": "2023-05-15T01:12:50.683+00:00"
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Personal history of other diseases of the circulatory system</div>"
},
"clinicalStatus": {
"coding": [
{
"system": "HL70052",
"code": "W",
"display": "Working"
}
]
},
"code": {
"coding": [
{
"system": "I10",
"code": "Z86.79",
"display": "Personal history of other diseases of the circulatory system"
}
]
},
"subject": {
"reference": "Patient/patient"
},
"recordedDate": "2023-05-01T10:20:00+00:00"
}
},
{
"fullUrl": "urn:uuid:AllergyIntolerance/allergy1",
"resource": {
"resourceType": "AllergyIntolerance",
"id": "allergy1",
"meta": {
"versionId": "1684113170704",
"lastUpdated": "2023-05-15T01:12:50.704+00:00"
},
"code": {
"coding": [
{
"system": "HL70100",
"code": "1605",
"display": "PENICILLIN"
}
]
},
"patient": {
"reference": "Patient"
},
"reaction": [
{
"manifestation": [
{
"coding": [
{
"display": "Hives and itching after taking penicillin."
}
]
}
]
}
]
}
},
{
"resource": {
"resourceType": "Parameters",
"id": "hl7",
"parameter": [
{
"name": "hl7",
"part": [
{
"name": "name",
"valueString": "message_hl7.txt"
},
{
"name": "url",
"valueUrl": "https://www.healthgorilla.com/fhir/Binary/1387616479b0872b4b836d6d"
},
{
"name": "contentType",
"valueString": "text/plain"
},
{
"name": "size",
"valuePositiveInt": 1160
},
{
"name": "checksum",
"valueString": "886E1B0A1992426A23B2D5386C9F2364"
}
]
}
]
}
}
]
}Retrieving the Original HL7
ADT messages are sent in HL7 format. The original HL7 can be retrieved from the FHIR subscription notification payload. Each notification payload contains a Parameters resource type in the FHIR Bundle. The original HL7 can be retrieved by using a GET request to the binary URL found within the Parameters bundle. A valid access token must be passed in the headers of the request to retrieve the HL7.
Example Parameters Resource from FHIR Subscription Notification
Parameters Resource from FHIR Subscription Notification {
"resource": {
"resourceType": "Parameters",
"id": "hl7",
"parameter": [
{
"name": "hl7",
"part": [
{
"name": "name",
"valueString": "message_hl7.txt"
},
{
"name": "url",
"valueUrl": "https://www.healthgorilla.com/fhir/Binary/1387616479b0872b123132"
},
{
"name": "contentType",
"valueString": "text/plain"
},
{
"name": "size",
"valuePositiveInt": 1160
},
{
"name": "checksum",
"valueString": "886E1B0A1992426A23B2D5386C9F2111"
}
]
}
]
}
}Updated 6 days ago