The presenters on Day 1 described the characteristics, use cases, achievements, challenges, and recommendations of their provider directory implementations. Some of the most important presentation points from statewide implementations, nationwide exchange networks, and health plan initiatives are listed below.

Statewide Provider Directories

Four states – Oregon, Rhode Island, California, and Michigan – presented information on the provider directory implementations or plans in their states. In all four cases, the directories were statewide implementations related to or operated by statewide health information exchange initiatives.

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• Michigan has created a centralized provider directory with distributed management based on the Salesforce platform.

  • Michigan emphasizes support of valuable use cases as the core to achieving sustainability and high data quality. It has interfaced to NPPES through the pilot for NPPES Modernization, supports the HPD data model, has deployed an extension to the FHIR framework for RESTful APIs, and has incorporated support for provider-patient associations, care teams, and alerts.

  • See the section on Technical Standards for more on Michigan’s support for multiple provider directory standard APIs.

Health Plans

Blue Shield of California and CAQH presented information on provider directory created by and for health plans and insurers. The primary use case is to facilitate consumer access to lists of and information on providers that are within a specified health plan.

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• CAQH manages a vetted database of provider information as a product offered to health plans and insurers. Its primary purpose is to address and reduce the pain points for health plans in managing provider data. CAQH separates provider data into three tiers:
  1. Level 1 Core data is used in critical, daily business transactions. Failure can cause regulatory non-compliance, significant operational inefficiency and/or member abrasion.
  2. Level 2 Important data supports critical point-in-time business functions but not necessarily everyday use (e.g., contracting, credentialing).
  3. Level 3 Additional data is not used in health plan operations, but may have been collected historically for populating state-mandated credentialing forms.

Nationwide Exchange Networks

The Sequoia Project and DirectTrust presented on their provider directory initiatives. For both, the primary use case was the discovery of service information in support of health information exchange.

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• DirectTrust manages a directory service which aggregates submissions from its network members using a standardized CSV flat file format into a single file that is redistributed to participating members. The model is a “white pages” for Direct addresses issued by network participants to individual or organizational providers.
  • DirectTrust does not vet any of the submitted data for accuracy beyond conformance to the file format standard and completeness. Instead it relies on the fact that it is in the best interest of its network members to maintain and submit accurate information.
  • DirectTrust noted that no one wants to pay for provider directories.

See Appendix F, Provider Directory Workshop Materials, for more detail on the presented material and Workshop discussions, and Appendix G, Provider Directory Workshop Demonstration, for software materials for the demonstration presented on Day 1.

Summary

Presenters agreed that provider directories are critical to many stakeholders. However, not all stakeholders value the same use cases equally, and not all stakeholders define provider directories the same way. Different stakeholders provide different data to serve different constituents using different architectures and different business processes.

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Presenters also agreed that data quality is important, especially for critical data attributes. However, not all stakeholders and use cases consider the same data attributes critical. Despite these differences, there exists great opportunities to reduce effort and increase efficiency and quality by coordinating initiatives. Presenters described many models for managing data quality, from centralized data scrubbing processes, distributed processes for a centralized repository, and reliance on the processes of directory participants perhaps reinforced by policy. Health plans and insurers, in particular, have regulator mandates and reporting requirements concerning data quality.

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