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.
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.
All four states emphasized data quality, but had different approaches to addressing the requirement, from scrubbing the data through centralized processes, to depending upon the quality processes of data contributors, sometimes supported or enforced by policy.
Participants in Oregon’s current provider directory export provider information in standardized comma-separated value (CSV) flat file format which is scrubbed, consolidated, and exchanged with other participants.
Oregon describes the method as an inelegant solution necessary until such time as there exists a widely-adopted standard for interoperable provider directories.
Oregon is in the process of developing a statewide directory to replace its current process. The purpose of the new directory will expand upon supporting transitions of care via Direct messaging to also create a directory that will address potential health plan penalties for inaccurate data. However, there remain questions concerning a technical standard, fee structure, and project scope.
The initiative is supported in part by recent legislation creating a Common Credentialing Program and allowing for fees associated with creating and maintain the provider directory.
The goal of a new Rhode Island directory is to provide patients, doctors, hospitals, health plans, and the State with timely and accurate information about the location and affiliations of providers, whether to select a local doctor, make a referral to a provider in the patient’s health plan, to send health information to support transitions of care, to attribute patients to doctors in a health network, or to understand the availability of doctors across the state.
Rhode Island plans to manage the provider directory much like its health information exchange, collecting and aggregating data across organizational boundaries to create a single, authoritative source of truth as a longitudinal record of provider information. Rhode Island will identify and acquire data feeds for the provider directory, create and maintain consistent reference data and master data definitions, analyze data for quality and reconcile issues, and publish relevant data to appropriate users.
Use of California’s provider directory is decreasing as a result of dwindling vendor support for HPD; the directory had six participants in 2015 but has only two today. It anticipates a transition to a new interoperability standard as soon as 2016, but to maintain the federated structure.
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.
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.
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.
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.
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.
Presenters described different architectures, from centralized directories managed centrally, centralized directories with distributed management, federated directories, and directories that aggregated information into a record.
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.