Infrastructure for Alternate Level of Care (ALC) Identification

ALC identification requires explicitly documented clinical stability criteria defining when a patient no longer requires acute care—IV medication requirements, monitoring intensity thresholds, and functional status indicators for SNF vs. LTAC vs. home-with-services transitions. Discharge planning procedures and disposition categories are documented per baseline. When ALC criteria exist only as case manager judgment ('they just don't look acute anymore'), the AI cannot produce consistent daily ALC patient lists that withstand clinical scrutiny.

ALC identification depends on systematic capture of active treatment requirements (IV medications, continuous monitoring orders, daily therapy orders), social barrier status (placement pending, family decision pending), and LOS accumulation data. These must be captured through structured clinical documentation—not inferred from billing codes alone. Barriers to discharge that change daily must be logged as they evolve, not just at the initial assessment, so the ALC list reflects current patient status rather than admission-time assumptions.

Daily ALC identification requires consistent schema across inpatient records: active order categories (IV therapy, telemetry, wound care), clinical stability indicators, discharge barrier type codes, recommended transition disposition, and LOS days. The baseline confirms discharge disposition categories are defined and high-risk flag types are coded. With consistent schema, the AI can apply ALC criteria systematically across all inpatients and generate a ranked daily list by avoidable days and transition stabilisation capacity.

ALC identification must access EHR active orders, clinical documentation, and LOS data; UM software for disposition planning; and bed management for census pressure context. API access to the EHR and UM software is confirmed in the baseline. Daily ALC lists require the system to query current patient status each morning without manual data extraction. Bed demand pressure as an input requires access to the bed management system to contextualize which ALC patients most urgently need transition for throughput.

ALC clinical stability criteria update when utilization review criteria (InterQual, Milliman) release new versions and when institutional care pathways change. Payer-specific ALC thresholds change when contracts are renegotiated. The baseline confirms criteria updates occur when vendor versions release. Event-triggered updates to ALC definitions when new payer contracts specify different continued-stay criteria ensure the daily ALC list remains aligned with authorization requirements and avoids generating lists that recommend transitions payers won't authorize.

ALC identification requires integration between EHR (active orders and clinical status), UM software (disposition planning), bed management (census and demand), and care team communication systems (barrier escalation to social work). The baseline confirms EHR-UM integration and care manager worklist connectivity. API-based connections enable the daily ALC list to route automatically to the responsible case manager with barrier escalation triggers, rather than requiring manual list distribution and handoff through email or rounds.