Tuesday, March 20, 2012

Provider Directory Strategies

The Office of the National Coordinator asked me to present the Massachusetts Provider Directory approach to the Provider Directory Community of Practice (CoP) on March 21.

Here's the powerpoint that I'll present tomorrow.

It highlights the decisions we had to make (Entity v. Individual, Central v. Federated, web API verses LDAP, etc)

Issue: Should we include organizations, individuals or both in the provider directory?
Answer: The directory should have a schema that enables lookup of entities (e.g., Organizations, Departments, State Agencies, Payer Organizations, Patient Health Record services) AND an individual's affiliation with an entity trusted by the HIE.  You can lookup John Halamka to discover that I'm affiliated with BIDMC, then lookup BIDMC to determine how to exchange data with my organization.

Issue: Should the Provider Directory be centralized or federated?
Answer:  The Provider Directory should be centralized at the State level, given lack of proven scalable approaches to federated provider directories standards and architecture.  However, Public Key Infrastructure can be federated based on the Direct DNS specification for certificate exchange.

Issue: How should we expose Provider Directory services to the Internet?
Answer: A SOAP-based web services API will support query/response, add/change,  and delete operations over the Internet.  An LDAP approach will support directory access for applications behind the MassHealth firewall.

Issue: How should we populate the provider directory?
Answer:  Commercial databases often lack timely updates.   In Massachusetts, we have several existing data sources to leverage including those used by payers for quality reporting, those used by provider organizations, and those used by the regional extension center.

Issue: How will we integrate this service into EHRs?
Answer: We will work with EHR vendors via a centralized program management office to procure software components that integrate provider directory and HIE transport services into the workflow of the EHR itself.  We will not force clinicians with certified EHRs to use a disconnected portal outside of their the EHR.

I look forward to speaking with the Provider Directory Community of Practice (CoP) to hear about approaches in other states and share lessons learned.


Anonymous said...

Do you a central Registration Authority to credential and identify organizations and individuals?
How do you maintain organizations, individuals and relationships in the PD as they change over time?
Do you maintan a history of relationships? (i.e. BIDMC was Beth Israel Hospital before they merged with Deaconess Hospital)
Are your PD governance rules published?
Have you formed trust agreements with other states?
Would I have to setup agreements with each and every other PD in the nation in order to locate and interoperate with other organizations?
How do I trust your source of truth?

Anonymous said...

Are you thinking of using the PD to allow patients to identify which providers they will allow there data to be shared with?

Anonymous said...

Why isn't there a REST based approach for accessing the provider directories? As the NwHIN Power Team has stated the need for REST based specification to be developed it seems kind of odd leaving it out of this, especially when this is one of the simpler systems that will be in the NwHIN portfolio. This seems like a real misstep and given the low adoption rate of the NwHIN Exchange protocols a true lack of vision for the future of Health IT.