A Single Source of Truth for Provider Demographic and Professional Relationship Information
Inaccurate provider information has consequences – for patients, payers, and the providers themselves. Wrong telephone numbers and location information limits access to care. Inadvertently choosing an out-of-network provider can result in catastrophic healthcare bills. Health plans have been fined hundreds of thousands of dollars for publishing inaccurate directories. And inaccurate information propagated across multiple clinical and administrative systems at a hospital or Integrated Delivery Network can negatively impact efficiency and cash flow. A 2017-2018 CMS review of Medicare Advantage Organization provider directories found that nearly 49% of them contained inaccurate information.
InterSystems HealthShare Provider Directory is a master data management solution that automates the process of collecting, consolidating, and publishing accurate provider information. It enables you to more easily comply with regulations such as CMS 9115-F for patient data sharing, enhance customer service, and improve the efficiency of any business process that requires up-to-date and accurate provider information.
The Single Source of Truth
HealthShare Provider Directory compiles data from multiple sources, including NPPES national provider identification files. It uses a linkage engine and business rules to select the most accurate and up-to-date information, and creates master records for individual providers and provider organizations. The master record is the single source of truth storing common attributes for these entities and supports the many relationship structures that occur in healthcare.
The directory includes the organizational, location, and network relationships needed to navigate care delivery. Additional attributes include contact information, demographics, credentials, identifiers, specialty, education, Direct email addresses, generic application programming interfaces (APIs), and HL7 FHIR® (Fast Healthcare Interoperability Resources) APIs.
Individual providers can have relationships to organizations and locations. An organization can have relationships to other organizations, individual providers, and locations. Locations can have properties for address, location type, and references to individual providers and organizations.
Provider Directory tracks how an individual provider or organization participates in a network at practice locations. It also maintains network-to-health plan and contract administrator relationships.
Provider Directory ingests and processes data from multiple sources and uses its linkage engine to identify matches for individual provider records and provider organizations. During processing, Provider Directory normalizes the data, de-duplicates it, applies validation rules to screen for errors, and uses configurable business rules to consolidate matched data into a single master record for each entity. When matching results on the incoming records fall below a user-determined level of confidence, Provider Directory flags the records in a task list for human intervention.
The Task List contains linkage tasks for individual providers and provider organizations that require manual review or validation. Each task on the list displays the data source, source record name, and source IDs of linked records. The Task List is sortable by the work category, link reason, link weight, and task date, all of which are displayed in the user interface. Task List provides all the information needed to make informed decisions about linkages for individual providers and provider organizations.
The Master Browser is the central access point for managing all records in Provider Directory. Its authorized users can search for records, see overviews, and review the content of all record types, including individuals, organizations, locations, addresses, networks, health plans, and contract administrators. Authorized users may also manually edit or enter information into the directory for individual providers, provider organizations, locations, individual to organization and organization to organization relations. The Master Browser also supports relationship records such as individual-to-organization, organization-to-organization, and in-network, as well as network-to-health plan and contract administrator.
With so many healthcare business processes depending on accurate provider data, trust of the data in your provider directory is essential. HealthShare Provider Directory inspires such trust through Master Browser features that deliver unsurpassed transparency into the process of creating and updating master records. These features allow authorized users to:
- Filter information by date, time, and source
- See and adjust the rules used to determine the most accurate sources of information
- Track when record updates have occurred and the source of those updates
- View details about update sources
- Examine source records that contributed to a master and the rules that governed their use
Provider Directory is highly automated. But when human intervention is required, its user management capability supports work-list profiles to organize the flow of record validation by your staff. Provider Directory supports roles for an administrator, data stewards, and guest users:
- The guest user can only access the public application programming interfaces (APIs), and the Master Browser overview and Search features
- The data steward has access to the Master Browser, Edit, Entry, and Task List
- The administrator has access to the Master Browser, Edit, Entry, Task List, and User Management, as well as permissions to view the Provider Directory linkage definitions
The FHIR Repository in Provider Directory supports the Da Vinci PDEX Plan-Net standard for search and retrieval, based on FHIR R4. Provider Directory uses a push service to send new records and updates to the FHIR Repository.
Supported FHIR resources:
HealthShare Provider Directory publishes public REST APIs for searching and retrieving individual provider and provider organization records. Information supplied includes related organizations, locations, and networks.
Push Updates Service
Provider Directory can update trusted provider information in real time to drive referral management, revenue cycle management, or care coordination workflows. The system translates and pushes update events in various formats (such as HL7, JSON or XML messages) to downstream systems, including to the FHIR Repository. For example, the HealthShare User Clinician Registry receives these updates to ensure that it has accurate provider information to drive clinical notifications.
Provider Directory can be installed on premises or hosted in the cloud. The product currently is available for use by customers in the United States only.
More than a Service
Provider Directory is part of the HealthShare suite of connected health solutions and can be delivered as a managed service. Combine Provider Directory with HealthShare Unified Care Record, HealthShare Health Insight, HealthShare Patient Index, HealthShare Care Community, or HealthShare Personal Community to advance your digital transformation strategy.
Customer Support and Education
When you select HealthShare Provider Directory, you get more than technology. You also get our acclaimed customer support and extensive educational opportunities. Search for Provider Directory education resources at Learning.InterSystems.com.
Learn more about Provider Directory and all of the products within the suite of HealthShare connected health solutions at InterSystems.com/HealthShare.