Monday, October 1, 2012

Solving the Provider Directory Standards Gap


In 2012, the HIT Standards Committee evaluated the provider directory standards suggested for the Nationwide Health Information Network and concluded that none of the current implementation guides was sufficiently mature and adopted to mandate as a certification criteria for Meaningful Use Stage 2.

This means that vendors and HIEs will continue to pilot various approaches to provider directories until Stage 3.

In Massachusetts, we chose a simple web-friendly implementation that goes live across the Commonwealth in two weeks.

We created a SOAP 1.2-based API that enables any trusted partner to query the state-wide provider directory via HTTPS per this specification.

The provider search web service provides following parameters to search a provider.
First Name
Last Name
Middle Name
Specialty
Type
Gender
Street
City
State
Zip
Phone
Email
Language
Id

but requires one of the elements in the list below in order to perform a successful search.

First Name
Last Name
ZIP
Specialty
Id
Street
Phone

With a simple SOAP query response approach and a WSDL, we have everything we need - no complicated implementation guide or non-standard use of LDAP/DNS required.

If this works well in production, it could be a model for the country.

How will we load the provider directory?

Each organization will be registered via an identity proofing process that ensures we have a fabric of trusted entities which have signed participant agreements.

As part of the registration process, the organizations will pre-load their provider data into the state directory using this spreadsheet.

Ongoing updates (adds/deletes/changes) can be sent via the same template.

Once in production, I'm sure we will refine our approach, but creating a simple SOAP-based query/response and a template for loading/updating data in batch seems to solve the Provider Directory standards gap nicely.

4 comments:

TC1 said...

John - Great stuff! What are your thoughts about "mastering" the provider data? Initially, I would expect that you will potentially have the same provider coming into your registry from different sources. Are you planning on generating a single record of truth for each provider? If so, how are you looking to tackle conflicting data (i.e. different spellings, addresses, etc.) Also, if you're looking at generating a single provider record of truth, how are you planning on addressing on an ongoing basis adds, edits, and deletes from the various source participants? Tim

John Halamka said...

Our provider directory is organized by entity (hospital, office, nursing home etc.) and each entity is responsible for providing and maintaining a single master record per provider.

Lauri Scharf said...

If one entity's information differs from another's about the same patient, who wins? Who arbitrates?

Mark Frisse said...

Some of these issues were raised at an ONC meeting on December 16. 2009.
Brian Ahier Summarizes:

http://ahier.blogspot.com/2009/12/nhin-workgroup-mtg-materials-and.html

Arien Malec provided a one-year retrospective.

https://plus.google.com/106957993402864061713/posts/WSeM2vMppbG

So much has changed since then, but I would love to know who has best addressed the directory synchronization process.